Vaccinating The World: Harnessing The 7 Horses of Innovation
How many products do we know that have had to be conceptualised, created, tested, approved by regulators, produced in billions by equipment configurations that don't currently exist, and globally distributed AND consumed all within the space of 2 calendar years?
We’ve entered 2021 with a strange combination of despair and hope. On the one hand, across many parts of the world, we’re back in lockdown, and winter is here. Stuck indoors, and let down by the false dawn that 2021 would somehow be magically different. On the other hand, there’s are silver linings - the vaccine race is on. We’ve moved past the point of proof into the challenge of global production and delivery. Most of you probably have travel that you have booked and delayed. Fingers crossed, sometime in 2021, many of you will go back to ’normal’ lives. But for that to happen, we will have any number of incredible innovations to thank. After all how many products do we know that have had to be conceptualised, created, tested, approved by regulators, produced in billions by equipment configurations that don't currently exist, and globally distributed AND consumed all within the space of 2 calendar years? Here’s a snapshot of where we are in this great human endeavour.
Scaling innovation is hard. It needs a number of critical areas to go right. And here are 7 areas of innovation that often have to be harnessed for getting us there.
- Pre-work/ readiness
- The hard work behind the scenes to get solutions to work
- A new way of looking at the problem
- Managing the moving pieces for real-life solution
- Getting the policy aspects right under constraints
- User experience - winning hearts and minds
- Managing a changing environment
(1) Staying ready for a crisis - Disease X
One of the most important milestones in fighting the virus went somewhat unheralded. Early in the game, almost a year ago, on the 11th of Jan, 2020, the Chinese scientists published the full genetic code of the virus. Thanks to the previous decades of work on genomics, which made this possible, it made the virus entirely decipherable to the world. It was the starting gun for a number of teams, including the Oxford/ Astra Zeneca partnership, which would proceed to get a vaccination into the market in a year - or in the world of vaccine development, at lightning speed. Of course, having the previous experience of dealing with SARS also helped. And importantly, the groundwork had already been done by creating a plan for 'Disease X' - which was a 'plan' to deal with the threat of an unknown disease.
(2) Doing the hard yards - dealing in genetic sequences.
Many teams have worked on the vaccine in parallel, including Pfizer/Biontech. Beyond the initial idea, there have been months of punishing work schedules for those involved. But at the heart of most of the approaches is the ability to construct sequences of genetic material. The use of these sequences, or mRNAs, comes from all the background work done in genomics. This is why we can take just the bit of the virus that has the 'spike' which attaches itself to the cell and train the body's immune system to recognise and fight that spike. Either directly, or via different 'adenovirus' from monkeys. Either way, the body learns to fight the spike. Further work may need to be done to ensure we can both treat and sterilize against the virus, to both save the individual and stop the spread. Remember that the ChAdOx1 (Chimpanzee Adenovirus Oxford 1) is a 'postman' it can be used to deliver any payload of treatment, aimed at specific diseases. The Chimpanzee virus has been used before for other vaccines but this time, the genetic modification and extraction of just a strand of the RNA is unique.
(3) Taking a different initial perspective - harness the human body
Arguably, one of the most compelling stories in the vaccine development journey is that of Moderna - a 10-year-old startup. Here, the co-Founder and investor Noubar Afeyan talks about what it means to be pioneering, and how exploration, hypotheses, and testing lead to truly path-breaking products, which can go from “outrageous to obvious” in a decade. One of the more insightful comments here is that for 8 out of those 10 years, you’re having to continuously convince people to keep believing in the idea. But even more powerful is the Moderna premise - harnessing the human body to create its own medicine. After all, one of the most powerful tools for innovation is creating a new lens or perspective - often asking the question in a different way - which automatically leads you into a different set of answers. And yes, it's another immigrant entrepreneurial success story.
(4) From lab to limb: an 8 billion piece jigsaw puzzle
Raw materials not the problem, but getting everything lined up, producing the vaccines in the requisite quantities - and we’re talking in billions of units here, is obviously a herculean task. The bottleneck could for example be in producing the equipment to manufacture the lipid nano-particles which are used to deliver the vaccine. So while raw materials could be available, the production facilities themselves may be inadequate.
Many governments have already placed their orders, and by the middle of December, some 7.5 billion vaccine doses had been booked by governments (covering half that number of people). But half of these are booked by rich countries which account for only 15% of the population. So this needs global cooperations such as Covax to step in to help ensure that all countries have access. It looks like a significant number of people may end up waiting beyond the end of this year one way or another. And the Oxford AstraZeneca vaccine may be the best option for middle and low-income countries.
Once ready to ship vaccines will need well-monitored cold chains, and delivered across the world based on government contracts, local needs, and global logistics systems will be pushed to their limits. The US has already missed its own targets. And although some government decisions seem to be based on expediency rather than research, such as Argentina’s use of the Sputnik V - this may create additional challenges for the logistics of delivery.
And when they get to the cities and towns, their delivery and administration will have to be tightly monitored for effective implementation at the grassroots level. India is using its smart city ‘control centres’ for effectively monitoring this process.
But whatever the losses, the great big win here at the end of this program should be the presence of a global production and distribution chain that can arguably be reused for any emergency - including disaster relief, or environmental needs.
(5) Creative policy - should governments innovate?
So what do you do when you're in the middle of a second wave, a new strain of the disease is spreading faster, and the phrase 'winter of our discontent' never seems more apt, and the supply of vaccines at population scale isn't guaranteed? Well, you try a few variations of your plan. Which includes increasing the time between vaccine doses or even mixing vaccines. Neither of which has been tested or is recommended. Now, this may look like a bad idea but this is the story with any innovation. It could be a really bad idea but also, it could be a great move in retrospect. As with any new idea, only time will tell, but perhaps the UK government would be advised to ensure there is a clear approach to experimentation and calibration of this approach.
(6) Winning the battle for hearts and minds - build a strong coalition
Imagine the frustration you would feel if you've worked with very little rest or sleep for a year to create a vaccine, and thousands of people have managed to get it manufactured and distributed, and when it reaches the citizens, there are people who refuse to take it. Or after you've spent a year away from your parents, you still can't be sure about their safety because there are some people who will not be vaccinated. To be anti-vaccine in this environment is to be anti-science and anti-humanity. Yet these counter viewpoints exist and are well supported.
It's not new - there has been opposition to a lot of life saving ideas, including for example seatbelts and crash helmets. I can appreciate it when lack of education causes misinformation to spread, but it turns out a potent combination of vested interests, and political motives, can prey on people's doubts and questions to create powerful false-narratives even amongst the so-called 'educated'. So in places such as Europe and the US, there also needs to be a clear strategy for winning hearts and minds. It turns out that countering vaccine myths is not very effective as a strategy, but rather getting a strong coalition starting with healthcare professionals, but including religious leaders and opinion makers who all provide the same advice may be a much better approach.
(7) The shifting landscape: the virus as a great innovator
Meanwhile, the virus itself is not sitting still, from an evolutionary standpoint. If you understand anything about the story of how we got to this point in evolution, you know what a magnificent innovator mother nature is. And so, the Covid19 virus has already generated 2 main mutations, both of which follow a natural law of sacrificing severity for faster spread. So the variations in both mutations are largely in the way in which the virus attaches itself onto the cell via the spike. So at the end of the day, this is like playing chess against an innovative grandmaster. A strong position must not be interpreted as a victory and any complacency is likely to be punished.
Hopefully by the end of 2021, these seven horses will have been tamed. But even if one or two of them get away, we might rue the consequences!
This is extracted from our Innovation Exchange newsletter #127. To get the weekly newsletter in your inbox, click here to subscribe.