MORE DARPA, LESS MAGA:

We need to continue making big bets on vaccines

The Covid-19 vaccine was undoubtedly the big success story of the pandemic. "It proved that a concerted public-private partnership is capable of producing at scale a highly effective vaccine in eight to ten months," Wachter says. This victory was a testament to the unprecedented commitment of federal resources, an expedited Food and Drug Administration approval process, previous research into mRNA vaccines and good fortune that the spike protein was an easy target.

But this success also offers an important lesson. "If you make a big bet, and you're successful with a program, you should keep making big bets," Topol says. By removing the risk for pharmaceutical companies, Operation Warp Speed got the U.S. first-generation vaccines, but the government didn't kick-start a second or third operation to make nasal vaccines or pan-coronavirus vaccines, which could have protected against new variants. This was reportedly because of a lack of political interest and funding. "It's stupid," Topol adds. "If this is the best we can do, it's not good enough."

Indeed, a big part of the promise of mRNA vaccines is that they can be endlessly tweaked, providing a foundation to tackle all sorts of infectious, autoimmune and neurodegenerative diseases. For future pandemics, the U.S. should take advantage of this iterative nature to develop a series of new vaccines and not put all its eggs in one basket with first-generation vaccines, Topol emphasizes. Furthermore, Congress should be thinking of vaccine development as an instrument of national security, opening up its enormous defense budget to pandemic preparedness. After all, big public-private partnerships will always be needed to continue pushing technological boundaries and protecting American's health.

We need to actively crowd out bad information

In 1984, HIV was discovered as the cause of AIDS, but almost 40 years later, scientists still haven't been able to develop an effective vaccine for the virus. For Covid-19, however, "we learned that the biggest problem with vaccines is that people don't take them," Wachter says. Despite high-quality scientific evidence that they are essentially riskless, "the misinformation machine is able to elevate any tiny risk, either perceived or real, to feel almost equivalent to the benefit," he adds.

Part of the challenge is that public health officials are not doing enough to compete for people's attention. "The network that makes a conspiracy theory go viral is very well worked out and very strategic and intentional," Wachter says, "whereas [public health] information networks tend to be like, 'Well, we're just putting out information. Why do we have to even think about spread?'"

For future pandemics, public health officials need to extensively engage their communities to drown out misinformation. "In Massachusetts, in the first 120 days of the pandemic, our governor had over 100 press events," Bharel says. "What we really wanted to do was make our information the trusted source of information, because we knew there was a lot else out there." Consequently, the department worked hard to put out information in different languages, create PSAs with physicians from local communities and creatively engage the public otherwise. In the Commonwealth Fund's Scorecard, Massachusetts came eighth in the U.S. in its response and management of the Covid-19 pandemic.

But Topol thinks holding press conferences and engaging the public isn't enough. "You have to take on the anti-science community, aggressively," he says, "because if you don't neutralize it, it just grows and gets more organized and sponsored and funded." But what would this takedown actually look like? Topol envisions a fact-checking team at the White House or U.S. Department Health and Human Services (HHS) that would be responsible for publicly calling out public health lies spread on major media networks. "These bad actors, whoever they are, need to be identified so that the public knows that these people are making stuff up or lying--and they're twisting and distorting things," Topol says.

Whether or not this fact-checking crew could actually work is an open question, but Topol is emphatic that public health cannot take a hands-off approach to misinformation going forward. "It's harmed millions of people, maybe cost hundreds of thousands of lives in this country already," he says. "And we just let it happen."

Tweet   @brothersjudd