What about scaling up production in more countries? Something like 60 countries have petitioned the World Trade Organization to temporarily relax relevant intellectual property rights—patents—in order to facilitate more production in other places. Is that a promising avenue, or would you oppose it?
I actually think it’s not promising at all, and I think it’s a distraction that people keep bringing it up. First of all, at Moderna we put out a statement back in October 2020 that we’re not going to enforce our patents. No one seems to be paying attention to that. But we said it’s not morally appropriate in the context of a pandemic to exclude other vaccines from being developed. It’s still on our website. So there is zero chance my patents are blocking anybody. This really has nothing to do with patents. This has to do with technical and engineering capability. There is no company in the world, Moderna or otherwise, that wouldn’t die to make one more dose of vaccine this week. But we’re already going 24/7. We have people who haven’t seen their kids in a year because we’ve got them working away, trying to figure out how to drive every marginal improvement and produce every possible dose—and at the highest quality, because you cannot cut corners. You can’t expand that kind of existing capability in fewer than 12 months, given how careful you need to be about hiring and training the teams. And you can’t build entirely new capability in fewer than two to three years—in the very best case.
How many doses have you created so far?
A couple hundred million. They’re in different stages of release. We will hit 300 million doses into the United States alone by July, and about a billion doses globally by the end of this year. It’s a huge exercise.
A year ago, when I interviewed University of Pennsylvania microbiologist Rick Bushman ’80, he called vaccine development “a multi-year approach.” What happened?
Well, we believed we could get a vaccine out in a year, and so we tried. It was an aggressive view, but we knew what our copy-and-paste technology could do. We were able to seamlessly go from a small-scale Phase I all the way into Phase III in about three months—and from there into tens of millions of doses in another three months. That had never been done before. In fact, if you look at the CDC data of a hundred million people who have been vaccinated, they’re seeing the same efficacy we saw in our phase three—well over 90 percent. That just doesn’t happen in vaccines! And the reason is that this is ultimately a different kind of medicine. But before we proved that—before this past year—people were probably right to be skeptical. Tony Fauci was a bit of an exception. He gave us credit early on for being different, back when he announced our collaboration to create the vaccine. Of course, now the rest of the world is rapidly becoming believers about mRNA. Next time there’s a pandemic I bet people will say, “Where are the mRNA companies? And how come they can’t get us a vaccine faster than six months?!”
Not every person is on board, though. Some estimates suggest that as many as 25 percent of Americans won’t get a shot. What thoughts do you have about vaccine hesitancy?
It’s the reality of our small-l liberal democratic societies that individuals get to make their own choices. I differentiate between the hesitant and the outright resistant.
People who say, “Look, I don’t want to be in the first wave”: I actually don’t think that’s anti-science. Those people increasingly become willing to take the vaccine as millions of others get vaccinated; at some point they say, “OK, fine. I’m in.”
As for the truly resistant, well, as a scientist and a physician I’m very data-driven, so I guess I just don’t understand it, because the arguments that work for me do not work for them. I think the data is unambiguous. But we haven’t figured out how to reach them with arguments that sway them.
Some of the problem is that we’ve got the wrong messengers. I recognize that “The biotech industry and government are here to save the day, trust us!” isn’t a message that will fly with everyone. The African American community, for instance, has every reason to distrust both pharma and the government—every reason. So we’ve got to find ways of reaching out through trusted voices, and we’ve got to adapt our arguments.
Looking forward, we can perhaps see the end of this virus’s impact. But given the prevalence of zoonotic diseases, climate-change habitat destruction and crowding of environments, new interfaces between people and animals, the increasing volume of global human travel, and so on, pandemics may become the new normal. Do you think, because of what we’ve learned this year, we’re going to be in a better place next time? Or will we just revert to unpreparedness?
It’s a really interesting question. I would like to believe that the world’s going to say, “Not again, no. An ounce of prevention would be so much easier.” That ounce of prevention would include doing better global surveillance, investing in distributed manufacturing of mRNA technologies all around the world and maintaining rapid-response capabilities. There’s no reason we can’t do it; it’s just that we’ve never bothered to build and maintain the infrastructure. But the problem with humans is that we get apathetic pretty quickly. I have friends who joke, “The next thing is the Roaring Twenties, right?” Because that’s what happened in 1918-1919. There was a world war and pandemic flu, and then you had 10 years of partying.
You seem like a non-alarmist person. At the same time, you’ve been immersed in an effort to stop a global plague. How scary is the world of pandemics? Is there anything that keeps you awake at night?
What scared me the most in COVID, and I remember it vividly, was when China started building a hospital. They were building it in like six days. I remember seeing all those cranes and thinking, “That kind of mobilization, by a country not prone to overreaction? Something is really wrong.” I looked at the curves and the R0, and the estimates at the time were three to four. And I think we all thought, “Oh, God. That’s exponential growth. You cannot stop it.” But it can be much worse. Take measles: its basic reproductive number approaches something like 20. If the world didn’t vaccinate for measles for decades and there was an outbreak, it would decimate us. It would make coronavirus look small. Measles, rubella, influenza, coronavirus: these are respiratory viruses. The pandemics that scare us are the respiratory viruses. Humans are terrible at social distance. It’s not what we’re meant to do. We breathe each other’s breath constantly. So what keeps me up at night is a respiratory virus with a reproductive number significantly above 2, or extreme apathy against an existing terrible virus like measles, that then creates opportunities for it to explode—and we lose control.
On a mundane level, I found during this pandemic that it was difficult to make informed risk-reward analyses. Do I let my kid go to the climbing gym? Is it OK to have a friend in my kitchen for an hour? Figuring out a family pandemic policy requires us to be statistical and analytical, whereas the human mind seems instinctively drawn to the anecdotal. Do you have any thoughts about this?
I love the heuristics work of Amos Tversky and Daniel Kahneman. Kahneman wrote a bestseller, Thinking, Fast and Slow. He won a Nobel Prize for his work. A basic idea is that the human mind is terrible in certain kinds of computations. I mean, just terrible. And it happens to be exactly the kind of computation you need when there’s a lot of uncertainty. We have too much confidence in our ability to predict an answer and we’re lazy in how we do it. Someone flips a coin and gets heads twice, and thinks, “Ah, it will always be heads.” Of course that’s not a correct response, but in real life, we do that kind of thing all the time.
Are you prone to these kinds of cognitive errors, even with your training?
In a public health challenge like we’re in now, I’m wrong all the time. But one thing I took from Kahneman’s work is the importance of trying to be good at asking the questions that let me figure out that I’m wrong. There’s hypothesis creation, and then there’s hypothesis validation. You’ve got to design an experiment to prove you’re right. And if the data say that you’re wrong, you’ve got to listen. That’s really what science is. Science is not a way to approach the known; it is a way to approach the unknown.
Have you been pretty good with this daily risk-reward analysis during COVID?
No better than anybody else. If you ask my wife, she’ll tell you I’m worse! She is a doctor, and I’ll be talking to her about why we can do our equivalent of sending the kid to the climbing gym. And she’s like, “That’s ridiculous. You have no basis for that. You have no way of proving that. You’re just saying what you want to happen.” And she’s right.
It’s heartening for this layman to know that you’ve had those same uncertainties playing out in your family.
Totally! My response is, “Yeah, but you don’t have a better answer. Nobody has a better answer.” And I think that’s the reality of what we lived this year. Uncertainty is paralyzing for all of us.
You mentioned that science is not about the known, but the unknown. Can you discuss this theme and how it has shaped your career and the turns it has taken, from Amherst neuroscience student, to physician, to consultant, to head of Moderna?
Amherst helped me get comfortable with topics that don’t have hard-and-fast answers. That was my liberal-arts experience—taking a class on the history of science, for instance, and engaging the question of whether there is a moral reality to science. Taking biology, and a political-science class on the American presidency, and literature, all at the same time: it teaches you to think across fields. I’ve always viewed my work as that of a translator, where I’m sitting at the interfaces between science and medicine and engineering and business. That comfort with translating between diverse fields is a product of studying science at a liberal arts college. It also fostered a view that science is a part of the advancement of humanity—and that, in and of itself, is an art.
Growing up, I’d always thought science was cool. But I misunderstood something: I thought science was about things that were known. Amherst fixed that. It helped me understand that science is actually about how you approach the unknown, how you ask questions and use the answers. If you are doing it right, you are always staring into the unknown. For me that brought a willingness to take on risk that I don’t think I would have had otherwise. It’s a willingness to say you don’t know, and that that’s OK, that exploring the stuff you don’t know is what life’s about. My senior thesis in neuroscience was the first real experience I had with that, and it had a lasting effect. It’s what led me to explore basic research in medical school, and to change careers when I realized that practicing medicine felt rote.
What felt rote to you?
I did a residency in ER medicine. I quickly realized it was the wrong career for me, because it became the same thing every day. There was all this human interaction, but I couldn’t enjoy it. I began to feel like I was delivering the mail. The mail’s always going to the same places, and while interesting things may happen after that, I wasn’t involved. I didn’t get to read the mail. And the next day, there’s just more mail! So I had this big crisis and left medicine. Caring for patients can be the most meaningful pursuit in the world, but it’s not for everyone. Over time I figured out that I needed something more focused on the scientific unknown. Nine years ago, when I decided to blow up my career a second time and move to biotech, I went looking for companies that were tackling the unknown, in a big and bold way, and where conventional wisdom said they had maybe a 5 percent chance of success. That’s when I found Moderna. Most people thought I was crazy. Maybe they were right, but the opportunity to stand at the precipice of a big unknown and say that my career will be wading into that and trying to make sense of it? I just couldn’t resist.
You’re a former physician who runs a company that is helping free humanity from a dreadful scourge. Have you been showered with vaccine gratitude? What does it feel like to be a global savior?
I don’t feel it’s over yet. There have been moments of elation, but I wake up every day and the first thing I’m reading about is the billions of people still exposed to the virus, or what’s happening in India, or the challenges we’re having keeping up. And I’m thinking about how our billion doses won’t be enough. That’s not to say that I’m not happier now than I was a year ago. I am. But I haven’t allowed any real joy in yet. Haven’t earned it yet.
I understand you and your family went on vacation last week.
Yes! We went to the beach—in the U.S.—and I hung out with my children. It was the first time we’ve gone anywhere. My wife’s a physician and a rule-follower, so we have been 100 percent CDC-compliant. There was a moment where my wife was asking whether we should go: “How are we going to wear a mask when we’re swimming?” And I looked at her and I said, “We’re not going to wear a mask when we’re swimming.”
You’re both vaccinated?
We’ve both been vaccinated. Yes.
So let me return to the question at the beginning: Pfizer or Moderna?
Ha-ha. Guess which? No cause for divorce here! But the one who keeps riding me is my teenage daughter. She’s told me she’s going to get Pfizer if she can get it first, because she wants her social life back. And that’s fine by me.
Postscript: Hoge’s daughter and son did get the Pfizer vaccine once they became eligible. “So,” said Hoge by email, “we’re half Pfizer and half Moderna in my own household.”
Rand Richards Cooper ’80 is contributing editor at Commonweal and a frequent contributor to Amherst. He interviewed four alumni for our Summer 2020 COVID-19 issue.