Podcast: COVID Vaccine in Record Time - What Now? Moderna Co-Founder Noubar Afeyan

TRANSCRIPT: COVID Vaccine in Record Time - What Now? Moderna Co-Founder Noubar Afeyan

Noubar Afeyan:

There's a lot we don't know about the virus. We don't know what its ultimate mutations will be. We don't know how much mortality it can cause. There's a lot we're learning about the virus and we will also learn about the vaccine.

Ian Bremmer:

Hello and welcome to the GZERO World podcast. Here you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer, and today we are talking about the race for vaccines that will put an end to the biggest global crisis of our lifetimes. We are just days away from the first doses, once the FDA approves emergency use of the top candidates, ones from Moderna and Pfizer. Several others are in late stage trials around the world. My guest today is Moderna co-founder Noubar Afeyan. We'll talk about the cutting edge technology that created a vaccine in world record time, and the many challenges that still lie ahead. Let's get to it.

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Ian Bremmer:

Noubar Afeyan, he is co-founder and chairman of Moderna. So good to be with you, Noubar.

Noubar Afeyan:

Great to be here, Ian.

Ian Bremmer:

So you're the man of the year right now, I mean when did you realize that what you've been working on is truly game changing?

Noubar Afeyan:

Well about three weeks ago, we received the first look at the interim results from our phase three trial, 30,000 subjects involved. And that glimpse already indicated that we had a very strong, statistically significant signal of efficacy at 94.5% and that then about a week ago last week, we cracked open the whole final analysis of the results. And what we saw across 196 cases is a 94% efficacy. And importantly, we saw in serious Covid cases a split of 30 to zero. All 30 cases were in the placebo group, which represents a hundred percent protection. That bodes well for a broader population.

Obviously this is a relatively small study compared to what we expect to vaccinate, but that all sinks in pretty quickly. And the 10 months of work we've done to get to this point following 10 years of science and technology development, but the last 10 months now all of a sudden has shifted our emphasis and focus to how are we going to get this vaccine distributed and how do we ensure that it's safely administered and we track the folks who receive it. So there isn't much time to look back, but certainly it's a super gratifying and sense of relief to know that the science and the technology that Moderna pioneered, some 10 years ago, seems to be having a pretty significant impact.

Ian Bremmer:

Give us one quick minute on how this works, the mRNA vaccine. What is it that makes this unprecedented in human beings?

Noubar Afeyan:

So the central tenet in biology of life is that DNA is a molecule that stores information. Messenger RNA, mRNA, is the piece that copies that information over to making proteins, which are the important parts that govern the functioning of different cells. So Messenger RNA is what we use to deliver the information to the body of the subject, and inside the body we have specially formulated this, such that the mRNA can get into certain cells that in turn, translate the mRNA into proteins, just like the cells know how to do. But the protein we've coded for is a protein that is on the surface of this coronavirus.

So what we're trying to do is to educate the immune system to see the protein before it's seen the virus and be ready with the arsenal of immune cells and antibodies to attack that protein. Now when a virus shows up to somebody who's had their immune system activated in that way, the immune system knows exactly what it's looking for and neutralizes the virus. That's why we see this kind of efficacy. The messenger RNA is like a cassette which you can replace. Depending on what code you put in, you make a different protein and therefore you can go after a different virus. That's the basic technology.

Ian Bremmer:

So in other words, the results themselves are likely stronger because of a technology which is essentially teaching the body to create its own response mechanism.

Noubar Afeyan:

Yes. In fact, all vaccines teach the body, but the question is do you have a clean way of doing that? Because if you come in instead with the virus itself that you have somehow attenuated or some other virus that you want to get into the body, get into cells and then make this information available. Or proteins, which is what a lot of vaccines are made up of. All of those are other ways to deliver the information, but what we find is that the Messenger RNA is the cleanest, most compact way to do this. And it looks as though it's very modular in the sense that we can take advantage of all the learnings of what particles work, how to formulate it, and then we just swap the code and we make a new protein. And we've seen that across many, many different vaccine applications.

And that's why when this virus showed up, within two days it was targeted by the technology and within 42 days we were testing it in humans. And frankly, but for the fact that this is the first time it's being done at this large scale, we would've gone faster. Because we would've had even more confidence with after this pandemic on a second pandemic or a mutant of this particular virus. I believe we'll be able to be more confident of the components because we really are using an information molecule and we're getting the benefit of all the technologies that we've developed as humans that take advantage of information to do a much better job. That's not the case for other vaccines in general.

Ian Bremmer:

Now there's a very, very big difference between the research that's required to get this vaccine discovered, if you will, and producing it for a billion people or more around the planet. That's a very different kind of organization. I mean, you're not Pfizer, that's been making big drugs for over a century. I mean Twitter's older than Moderna. So how do you do that?

Noubar Afeyan:

Well, you catch us midstream and I'll tell you how we've done it so far. I learned a long time ago in the startup world that when you get to the moment of scaling, the objective is not success, but it is failing to fail that defines success. So you continue to find ways in which you might fail and you try to anticipate and avoid it. And if you fail to fail long enough, that ends up being a scaled success model. And that's how we feel we're going about it. So first I should say that the company has been an unusual company. If you look at the biotech field, Moderna stands out in the sense and stood out before the pandemic in that it happened to be the first, what the valley crowd calls, unicorn company. It had access to hundreds of millions of dollars early in its existence, through partnerships and through fundraisers.

And then we actually ended up attracting many, many partnerships. And so from a scale standpoint, we've had the resources to scale, organizationally, in all ways but manufacturing, which is what this is, manufacturing and of course commercialization, which this is testing. But it's not the case, thank God, that we were a research based single product company as most biotech companies are, and suddenly our single product became a pandemic vaccine. So long way of saying the leadership team, first and foremost, comprises many industry leaders that we've attracted. Juan Andres for example, headed up manufacturing at Novartis, heads up manufacturing at Moderna for several years. Got sent when it came time to get this scaled up by tens of thousands of folds. David Moline joined us in the summer, formerly CFO of Amgen, formerly CFO at 3M. And we have across the board a number of very experienced, the CEO Stéphane Bancel, ran a global leading diagnostics company. Before that was at Lilly.

So partnerships, people, resources, more resources. We went out to our shareholders early this year and secured an additional billion dollars largely to support this program. And that was before. And in addition to what the US government committed and certainly US government came in and committed to cover all of the costs of the clinical development and then subsequently placed orders. So all of those things gave us the resources, we had the personnel to plan and execute and the rest is ahead of us. There's a long, long way to go, but sometimes, as you've seen in other industries, it helps a little not to know what you can't do.

It helps a little to have to make it up as you go because there's a lot of things people think can't be done, that if you aren't in a large company you might actually decide therefore not to do. And in a pandemic, I think Moderna certainly, going from the initial sequence of this virus to having a designed mRNA being tested in 2 days and then tested in humans in 42 days, I don't think a large company, by any measure, would dare do that because they think it's completely impossible. And not until we did it that a lot of other people join the fray and realize, "Oh my god, this can be done. We better have our own way of doing it too."

Ian Bremmer:

We have people putting timelines out now for when it'll be normal for people again, when their step will be in line. We have president-elect Biden talking about a 100 days that we have to all wear masks, which you hear that and a lot of people in the American public are going to think on day 101, "As long as we wear those masks, we'll be okay." If we've got two companies and only two companies that are putting out large numbers right now of what we hope are going to be these vaccines for everybody, but it's never been done before and a lot of things have to go right. Shouldn't we be a lot more cautious in terms of the timeline we're looking at in 2021?

Noubar Afeyan:

I agree with you that the notion that in a 100 days we'll be done with this if that's what people understand, and I suspect that's not what is meant. But certainly that level of sacrifice being made in order to beat back the viral spread, in addition to through a vaccine being deployed, because I view Ian that approach being a more artificial way to create immunity rather than the biological way. But I think that is an important step. But I agree with you that we're not within three months of taking a deep breath and saying, "Okay, we're moving on." This is going to be an issue around us for many more months than that, but that does not mean that we will be embattled the way we are. We will be as scared as we are, as worried that every slight gathering is going to cause yet another gigantic spread.

I do think that the combination of discipline, distancing, masks all the things we've been hearing about but now adhere to coupled with an increasing and smart deployment of the vaccine to the right set of people, so that we protect the vulnerable and those we need to support the vulnerable. I think all of that will conspire together to get us to a better place, but I don't see that through at least the middle of next year. And it's not a forecast about the vaccine, it's a forecast about adoption and interdependency of all these different steps. And yet again, we don't know what uptake there will be. So I think we're going to live with a pandemic for much of 2021, but I don't think it's a binary thing. We have a pandemic and everything's awful or the pandemic's gone, therefore everything is great again. I think there's going to be a continuum.

Ian Bremmer:

And treatment has gotten much better and mortality rates are going down and I mean all of those things are factors, but since I'm talking to the guy that has a lot to do with the vaccine, I guess I want to ask you on that piece. How much uncertainty do you think it's safe to be thinking about right now? In other words, if we're looking at when we think that most Americans can actually get vaccinated, and I understand there are uptake issues, but in terms of production and distribution, is the level of uncertainty around that a three-month period, a six-month period, is it potentially a one-year period? What do you think we're thinking about?

Noubar Afeyan:

Based on everything that we've seen so far, I think that there's a reasonable expectation that come the second quarter of next year, so spring of next year, there will be adequate supplies to vaccinate, certainly in excess of a hundred million people. And that does not rely on any kind of additional major new vaccines. If there's some new vaccines that come along, that's even better. But I would say that there is a path to that. There are things that could keep us back from that, but right now I don't think that that is a major stretch. The Operation Warp Speed people have been talking about vaccinating a hundred million people and I think that'll make a pretty big dent, especially if it's not a homogeneous network.

In other words, how things are being spread. It's not like every single person is equally spreading and equally vulnerable. There's network heterogeneity, and that is being taken into account. So I think even a hundred million is going to be more than just random hundred million people. So I actually feel that there is a pretty encouraging path through the middle of next year to be able to get things out there. But there are risks along the way and that's what we need to keep in mind as you're saying.

Ian Bremmer:

Let me talk a little bit about the interaction, the interdependence between the producers and the US government. Maybe start with Operation Warp Speed itself. Pfizer of course didn't take money for the research, you guys did about a billion dollars. Give me a little bit of what was the thinking behind your decision, especially since you had lots of funding sources already to be a part of and receive that money from the US taxpayer?

Noubar Afeyan:

Well, the Operation Warp Speed, let me just say at a high level, was in my view an important part of what allowed the current situation to exist. And so the government did not just offer Moderna the support, it offered everybody the support. And everybody but Pfizer, for their own reasons being the large company that they are, took that support because in addition to the support, what that also involved is being part of a consortium that harmonized clinical trials, protocols, tests, a lot of open communication about the results as we were doing phase one, phase two. Phase three is a separate matter, but there was a lot of sharing and that whole thing was enabled by Operation Warp Speed. So yes we certainly as the least resourced company felt that this was the appropriate thing to do because we were taking the money, not only thinking of this year, but also thinking ahead of being in a position to prepare to produce up to a billion doses next year.

You should realize that the timelines are such that unless we placed orders back in June, July for hundreds of millions of doses, we would not be in a position in 2021 to deliver. So the money went to more than R&D. That's a bit of a misconception, because there was clinical lots and then being ready to manufacture for a global community. So that was a very important intervention and I think that the coordination also helped. We happened to be the first to go through the NIH coordinated OWS sponsored set of clinical trials, but I think it's going to help the other companies who come behind us, AstraZeneca, J&J, Novavax. These are all companies that are essentially running similar trials and are going to be able to use the learnings.

So that's how I think about it. I think it was a very positive, not just for the money part and the coordination, but also supplies. I mean we've worked with Operation Warp Speed and apprentice people for a long time now, and they've been great partners. And it's interesting because walking into it, we had no way of knowing what to expect, but it certainly has increased even more of my confidence that the military establishment in this country is in fact a major enabler.

Ian Bremmer:

So I mean, given that the Trump administration has, and with legitimate reason, taken a lot of criticism for the politicization of various parts of response to this pandemic, but as far as Operation Warp Speed is going, you're saying this was led by science, this was led by the United States government. This has been a success.

Noubar Afeyan:

Without any caveats. Without any caveats. I mean, the only thing one could find fault with maybe is the name because it's a little bit scary and most people don't even know what warp speed is unless they've watched Star Trek. So I actually sometimes jokingly tell people, just call it OWS so that it's just from letters.

Ian Bremmer:

Starting literally within days, we're going to see Americans and others around the world starting to receive these vaccines. Not only is the technology new, but also requiring cold chain support, the infrastructure is clearly going to be challenging. The United States is a federal government, but states are in charge of a lot of the rollout. You're only responsible for one piece of this, you've got a manufacturer. Once it's out, then the distribution is being done by the government. Well, how easy mean, usually you say working with the US government, generally speaking, is more complicated than with a lot of other folks. As you think about this rollout, what are the things that are going to be critical to watch?

Noubar Afeyan:

Well, look. The way I think about it is that I'm not sure what our alternative was because the reality is that this country has never done this before, nobody has at this scale. There is no institution that could do it as an alternative, either. And so we're quite comfortable that the distribution process that's been put in place is the best chance we have. Now what are we looking for? In the case of Moderna's vaccine, we have many years of investment already made in ensuring a storage set of conditions that are quite attractive. That was not, the original technology that exists for people to use would require extremely cold temperatures. But because we have been developing many other vaccines, we've already worked on improvements to both the lipid particles that we use to deliver this and the processing of them that allows us to keep the materials at minus 20 degrees centigrade, which freezers can handle.

And then above all, a few weeks ago we also announced that we can keep vaccines up to a month in refrigerated conditions and for 12 hours on a tabletop at room temperature. What that means is that you can easily think about where the vaccine goes centrally, where it goes to the periphery, and how long any given lot can be available for that day's worth of vaccinations. And so training becomes important, surveillance becomes important, making sure that the right tests are done before vaccines administered, et cetera. All of that is going to become important. And look, to some extent, the flu vaccine, albeit at a much lower penetrance, has given the various distribution points, including pharmacies and doctor's offices, some precedent. In our case, the vaccine will not actually operate any differently from a handling standpoint. There are other vaccines that are being developed that are going to need to be handled at the site of distribution.

So they'll have to be diluted and put into the proper form. So some of those things might, when you scale it to a billion injections, introduce errors, which would worry me a little more than complexity. Because those errors, if you're thinking about a vaccine, you want to make sure that the data that you're making your decision on is relevant when the vaccine enters your body. And it's only going to be the case if the dose is intact and it's been properly prepared for administration, otherwise it's an apple and orange comparison. So these are the things I think people are worrying about and tracking and we'll support them, but you're right. This is a bit out of our hands at this point.

Ian Bremmer:

What are the things that we don't know yet? I mean, when we're rolling out to billions of people vaccines that didn't exist even months ago, what are the things that we don't yet know? For example, how long it lasts and what kind of transmission, long-term side effects, what are the range of things that we'd be much more comfortable in a year and five years time that we're going to learn?

Noubar Afeyan:

A good question. Look, we don't know as much as we didn't know about the virus and we still don't. In other words, when your threat is unknown and new, it's hard to imagine that you can know more about your deterrent or your counter punch than you do about the threat. And there's a lot we don't know about the virus. We don't know what its ultimate mutations will be. We don't know exactly how much mortality it can cause because it's hard to get that number given how we're trying to limit it's spread based on techniques of masks, et cetera. So there's a lot we're learning about the virus and we will also learn about the vaccine. So as you pointed out, how long will the antibody response offer protection against a new infection? Will a new infection be severe after a vaccine ever? Or will it always be a muted response so that even if somebody gets infected, they do not get severe Covid?

So there's going to be some things we're going to learn, how long it lasts, but many of the other things I mentioned. And I think that the good news is, so much is being focused now on this experiment, this global experiment. I've described this to people, there's been the recent statements made that the mask is perhaps the best vaccine. I view the vaccine as the best mask. It's a molecular mask, and once we have it on board once, then presumably it'll protect us. We don't know for how long, but we're creating in a global collective immune system that has the information needed to counteract the virus wherever it attacks. It's an interesting, unprecedented situation, but I do think it's going to point the way to how we counteract future such threats.

Ian Bremmer:

You say in some ways it's like a better mask, which I understand at the collective sense. But at the individual level, someone's vaccinated. Do you expect that person then feels like, "Okay, I don't need to socially distance anymore. I don't need to wear a mask anymore. I've been vaccinated so I can now reemerge in life as we used to know it." To what extent is that not true?

Noubar Afeyan:

That is not knowably true. In other words, I cannot say it's not true. I can say that there's uncertainty to that behavior. And so I think what's going to happen is people are going to continue to be cautious because the people around them are going to be potential threats, and we're going to have to collect data to figure out. Because there'll be some people who behaviorally will choose to act in a way that's perhaps makes them more vulnerable. And we're going to see if those people are getting more infected versus the people who don't. So there'll be constant studies run, because when you're vaccinating a hundred million people, guess what? You can find 5,000 person sub experiments all you want, every day, every week. So we're going to be looking for that. It is indeed the case that some of this may happen, but I'll also point out to you, Ian, that people have not yet quite realized that when you do a clinical trial, the same factors exist in the sense that now you have it in reverse.

Everybody in the trial thinks that they don't have the vaccine, because they may not. They have a 50% chance of not having the vaccine and everybody actually tries probably to make sure that they're not overexposed. So now the question will be, will we see even more protection if people are being more exposed? I just don't know how it's going to play out. But the key is let's be cautious, as you said earlier, let's gather the data and we'll make adjustments and decisions as we go. At some point, the prevalence of the virus will come down to a level where, taking into account your likelihood of being exposed and the protection you have on board, I think people will begin to be more comfortable that they can take less extreme measures. It's going to be a continuum.

Ian Bremmer:

The other piece of this of course is what percentage of the population feels comfortable with all of this? The numbers went down a lot under the Trump administration. They've gone up a little bit after the Pfizer and the Moderna announcements. Hopefully that will continue. I just saw that three former presidents have said that they're willing to get the vaccine publicly, and indeed even President Obama said that he would do it on television. Do you know if that's going to be a Moderna vaccine or not at this point?

Noubar Afeyan:

I don't know. I don't know. I hope so, but I don't know. And I think that my attitude is, I think at some point we're all vying to have protection from whatever source we can get. And so it's going to be interesting to see. From a timing standpoint, I expect these vaccines to basically come on the market within a week of each other, plus or minus. And there's a particular set of guidelines that's been laid out of who gets the vaccine. As we've discussed earlier, the storage conditions are such that my guess is one set of vaccine will go one direction, another will go to places which may can handle this, and that may affect who gets which vaccine first.

Ian Bremmer:

Sure. I mean, in the developing world, no freezing and only one shot is a hell of a lot easier and the Chinese are going to be exporting everywhere, no question. But in terms of, I mean, maybe just to close a little bit on the disinformation, a little bit on the anti-vaccine sentiment, where do you think that is most worrisome?

Noubar Afeyan:

Well, in any debate, if one side has to offer facts and the other side can offer doubts and they're considered of equal value, then the ones who offer doubts will always have an advantage because it doesn't take much to raise doubts. It takes a lot to create facts. I would argue that the best decisions are made when both sides of the argument are based on fact. And there is no fact based argument that says that vaccines are in some way problematic if properly tested, if properly administered and properly followed up. So I think that, broadly speaking, I'm obviously well aware that there's a very strongly held view by some in the anti-vax community. But then in the current information distribution systems we have with social media, et cetera, I would say the concern is that folks who aren't actually given facts confuse what are doubts and what are facts as though they're the same thing.

And so I think that's going to take some time. It's going to take leadership. It's going to take leadership from the healthcare community. There's a lot of, by the way, doctors and nurses who are against vaccines. And I think they sometimes don't realize the degree to which what they say and what they do is going to be held to a much higher standard because they're supposed to know. And if there is data that informs their decision, then they should make that available broadly, including for Covid.

So I think there's going to be a societal experiment here, not of the vaccine, but of our willingness to make a risk reward evaluation of saying, "Are we better off risking the virus and the effect it has?" And I'll say parenthetically, and I think one of the things that is grossly underreported and underappreciated, is just how devastating and uncertain the health effects of this virus is to people who survive. Not to the people, this mild versus severe case. Everybody's busy trying to name these things, but the reality is most people who are infected with this virus are actually having longer term effects, some more severe than others. So if you have to ask, it's not as though-

Ian Bremmer:

When you say most people, you mean most symptomatic people, or do you mean most people, period?

Noubar Afeyan:

I don't think we know anything about whether asymptomatic people are or are not having physical effects because nobody's looked into it. So if we want to be in the doubt business, let's also doubt what's happening to people who are getting infected. But think about what an infection is. An infection is no different than getting the vaccine. The vaccine's delivering mRNA to make a protein to protect you. The virus is delivering mRNA, by the way, it's quite ironic that this is an RNA-based virus. It's delivering in another way, RNA, that is largely there to propagate itself and to infect various organs in your body. So I don't think, Ian, that the medical community can say as we sit here today that the effect of the virus, not the vaccine, is something we don't have to worry about if you're asymptomatic. I just don't think we know.

That's not to say people should be worried unnecessarily, but it's to say that it's the same thing. You're either being affected by a virus or you're being affected by a vaccine that's trying to cause your immune system to help it. So I do believe that people are not I think necessarily understanding just how unknown this virus's effect is on our health. And I, for one, think that there's no amount of protection. We should not seek to avoid getting infected. That's what I've said for 10, 11 months. I've lost people in my family to this virus, and to people who've survived it and have significant issues as we speak. So I see it firsthand, and I don't think we should take this lightly. And I think this, by the way, this is going to be a huge burden on our economies in the future from a healthcare standpoint. Unfortunately.

Ian Bremmer:

You guys are fairly busy right now, but I would assume that that technology would also apply to all sorts of other viruses that we vaccinate against. What do you think are the things that we'll be attacking first beyond coronavirus with mRNA and what's the impact likely to be?

Noubar Afeyan:

We have an active program in Zika virus that's shown some very strong results. We have a very active program in CMV, Cytomegalovirus, which is the single largest cause of birth deformities in babies born from mothers who get infected during pregnancy. No solution, no vaccine for that, first time ever we've shown very impressive data, and several other vaccines. And of course, importantly adjacent to the general notion of a respiratory virus is influenza. I mean, we have made due with a 50, 60% efficacious vaccine for influenza for a long time. We've told ourselves, "Oh, it's seasonal. It changes. We need eggs, we need this and that." But the reality is that it's possible, we think, that influenza can be attacked with maybe not one mRNA, but several mRNAs that cover a range of variants of the presented proteins in that particular strain.

So a lot of things to come, but already a whole lot that are way down the path and entering in one case soon, phase three trials. So I think the technology, if anything, we accelerated this pandemic, accelerated the learnings and the data, the proof points, but the underlying science is already well on its way to make many new vaccines.

Ian Bremmer:

Noubar Afeyan, great to be with you. Thanks for joining us.

Noubar Afeyan:

Thank you.

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