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Moncef Slaoui was approved by the Trump administration in May to lead a Manhattan Project-style effort to drastically reduce the time it takes to develop a coronavirus vaccine and produce hundreds of millions of doses for the American people.
The renowned immunologist and former head of the vaccine division of GlaxoSmithKline Plc is somewhat famous in the pharmaceutical world. He assumed the role of Chief Scientific Advisor to Operation Warp Speed under two conditions: “Total and interference-free empowerment.”
Slaoui, 61, sees the rapid development of multiple vaccines and the manufacture of millions of doses as an unprecedented success. However, a slow and confusing deployment has frustrated millions of Americans and led the Biden administration to promise to speed things up. Slaoui said he was concerned about not getting more gunshots.
“A vaccine is useless if it stays on a shelf,” he said.
Speaking to Bloomberg after resigning earlier this month as an adviser on the response to the US pandemic at the request of the Biden administration, Slaoui reflected on a fractured healthcare system that suggests he is responsible for the problems of dose administration.
His observations have been edited for clarity and readability:
Bloomberg: What do you think of the Biden administration’s vaccination target of 100 million doses in 100 days?
Moncef Slaoui: 100 million doses in 100 days is frankly below the plans we had. At that time we had 100 million people vaccinated. That means two doses. At least in terms of manufacturing and supply, there will be 200 million doses produced by the end of March or mid-April. So if the ambition is to use only half of it, that is the ambition. I hope that this goal is met and far exceeded.
Bloomberg: Why has the gap between distributed doses and administered doses been so large? Of the 39.8 doses administered in the US, only 19.8 million shots have been administered so far, according to Bloomberg’s Vaccine Tracker.
Slaoui: Having lived in Europe and now in the United States, it is clear that health systems are as different as the opposites. The issue in the United States is that the system is so fragmented, there are so many health care providers, so many health insurers, so many systems, so many jurisdictions, and people move much more among themselves than people moving in Europe. It’s really hard to send a consistent message to people and it’s hard to mobilize everyone at once into the healthcare system to do something.
Our way of doing it and, clearly, that turned out to be a problem, was to say, because we can’t align all these systems, we’re going to work on them and empower them. We were part of an administration whose worldview was based on less centralization.
Bloomberg: Why did the Trump administration’s approach to working across states not prove to be a success?
Slaoui: Frankly, what surprised me was that we went to health administration officials from many jurisdictions and states. We spent two to three hours with them in person and countless hours of calling. We have explained that we will have vaccines. There will be a limited number of doses. There will be a prioritization process and we will assign doses to each state based on population. And then each state and health system has to tell us where to send them.
Each week, a health care system in New York or California would say it sent 200 doses to that zip code, 300 to the other, and 500 or a thousand to that hospital, and so on. How is it possible that the healthcare system says so accurately that they want 200 here, 500 there, 700 here, and then, when we send them with 99.9% accuracy, it turns out they can’t even vaccinate people?
The assumption was that these places would be ready to be vaccinated and frankly we were not told we do not have the resources to do so. So this is still a puzzle for me.
Bloomberg: What could Operation Warp Speed have done differently to achieve its goal of distributing 20 million doses by the end of 2020?
Slaoui: I do not deny the fact that this has been, by far, inferior to our goal. That we missed him. When it comes to discovering vaccines, developing them and making them, we have gone faster than ever. But a vaccine is useless if kept on the shelf. Clearly it has to end up in people’s arms.
Maybe it would have helped to have a hundred stages where people could come and be immunized. Or use 200,000 Army troops to come and vaccinate people in tents. Maybe you do. The focus we have on our plan is that as soon as we get past phase 1, that restricted population, we would go to the pharmacies. There is a pharmacy less than ten miles from 90% of Americans. As we reach these populations, which is happening now, the vaccination rate will increase. Right now, we are reaching one million people a day and will continue to increase according to the previous plan.
Bloomberg: In a previous interview with Bloomberg, you said that Pfizer Inc. had appealed to the US government gain priority access to raw materials so that it can administer 100 million doses in the second quarter of this year. The US government unleashed the Defense production law to this end? And what would this mean for the relationship between the US government and Pfizer?
Slaoui: Pfizer is getting everything they asked for. We used an 18 times different DPA to speed up manufacturing. With the DPA there is the opportunity to have priority access to any material you need. The consequence of this is that the government has much clearer visibility than Pfizer does with these materials. There is an obligation to use those products purchased through a DPA for vaccine manufacturing for the United States, and this really creates a lot more transparency around Pfizer plants than before.
Bloomberg: Anthony Fauci said he felt it “A little” released now that he no longer worked for the Trump administration. How do you reflect on your time working at the White House?
Slaoui: The day I was interviewed to take on the role, I proposed two conditions: full empowerment and no interference. I remember saying, “I don’t know the bureaucracy, I don’t know how this world works and I won’t learn how it works. I will just focus on the goal and continue with it. And they said, “Perfect, that’s what we want.”
When the president said, “Do you think you can have that data before election day?” I have always said, Mr President, that there is no way of knowing. Whoever tells you it’s possible doesn’t know what he’s talking about. And whoever tells you it’s not possible doesn’t know what he’s talking about. If there was interference, he would raise his hand and resign.
I know Tony very well, respect him, and I empathize with him. I would say to the system, please let science dictate what needs to be done.