When Stephen Hoge ’98 joined Moderna Therapeutics in 2012, the company was a minor player in the biotech scene—a 2-year-old startup with two dozen employees and a novel approach to making vaccines and medicines. That approach, which harnesses messenger RNA to help the body create therapeutic proteins at the cellular level, was the company’s sole focus; indeed Moderna’s name derives from the molecule’s acronym. Industry observers viewed mRNA technology as promising but unproven; as of January 2020, the company had never brought a product to market.

That same month, the first cases of COVID-19 were reported in the United States, and soon thereafter, the U.S. government indicated its willingness to fund large-scale vaccine development. Moderna leapt at the chance. Hoge, as president and head of research and development, steered the company through a dual opportunity: to demonstrate the efficacy of its mRNA approach while leading the battle against a global scourge.

One vaccine and hundreds of millions of doses later, Moderna is now a household name, its value zooming to more than $50 billion, promising a vast enlargement of its R & D footprint. As Amherst’s Assistant Professor of Biology Sally Kim noted, introducing Hoge as a guest speaker to STEM students, “Moderna’s rise has been nothing short of extraordinary.”

Hoge spoke with me via Zoom from his home in suburban Boston, where he lives with his physician wife and their three children. An avid conversationalist, articulate and self-deprecating, he conveys an infectious excitement about science, and likes to quote motivational speaker Les Brown’s admonition that “if the dream is big enough, the odds don’t matter.”

After majoring in neuroscience at Amherst, Hoge went to medical school at UC San Francisco, served as an emergency medicine physician in New York City (“a very brief and inglorious career,” he says), then worked at McKinsey & Co., the management-consulting firm, before taking the reins at Moderna.

He described his company’s dizzyingly transformative year as we discussed a wide range of topics, from vaccine hesitancy to pandemic preparedness, from the enormous potential of mRNA to the benefits of a liberal arts education for scientists.

Our conversation has been edited and condensed for length and clarity.

A man wearing a white shirt standing in a laboratory
"We describe the process as making software as opposed to making hardware. If we want to make a change, we can simply copy and paste some new information into it. We can go in, delete a paragraph and insert a new paragraph."

A year ago no one had heard of Moderna. Now the six-word phrase “Did you get Pfizer or Moderna?” has been spoken by hundreds of millions. What has this year been like for your company?

Let me give you a bit of context on us. We’d spent the last 10 years inventing a new way of doing vaccines, based on messenger RNA. Everybody knows what that is now, but at the time nobody knew, and the question I’d get most often was, “Why do we need this? Aren’t there lots of technologies that are already effective for vaccines?” Our view was that those are very cumbersome, analog technologies, and that the next wave of vaccines would be based on our mRNA approach. It’s a little-known fact, but by January 2020 we had actually shown nine vaccines that work. We’d been working in cancer and in cardiac disease, but we also had nine antiviral vaccines—all of which had shown protective immune responses. It’s just that nobody cared.

What viruses was Moderna addressing before the coronavirus?

We had two programs in influenza. We had one against CMV—cytomegalovirus—the leading infectious cause of birth defects in the U.S. And we had a bunch for other respiratory diseases. For us it had felt like this long trudge uphill against dogma. But by 2020 we’d gone nine for nine with our vaccines, and we didn’t think it was a fluke. In January 2020, people at the company started saying, “Hey, should we do a vaccine against this influenza-like illness that’s emerging in China?” It was a good public health thing to do. And it would allow us to demonstrate something we’ve always believed about our technology—that we’d be able to move fast. So we got to work.

By mid-February, cases and deaths were cropping up in Europe and the U.S. I still don’t think we were all convinced internally that this was going to be a global pandemic. But there’s always that moment when it changes. For me it was when the kids’ school shut down. I live in Brookline, Mass., and the government sent the kids home on March 13. From that day on there was a building sense of foreboding. New York started falling apart. There was the devastation in Italy. At that point we as a company said, “Look, we’ve been working for 10 years, and either we are going to make a big dent in this thing or not, but it’s now or never.” So we decided to put all of our money in. At the time we were one of several companies that jumped in: Johnson & Johnson, AstraZeneca, GSK, Sanofi, Merck.

How many had mRNA as the sole focus of their work?

We were the only one. Pfizer came in a month later, and they basically copied our approach. I don’t mean that in a pejorative way. They just had never done it before. Nobody had done an mRNA vaccine prior to January 2020 other than Moderna. From our point of view it was good to have multiple companies working on this. We looked at what we could do and said, “If we go all-in and we succeed, we can maybe help a billion people.” And there were 8 billion people needing to be helped.

Your CEO, Stéphane Bancel, is ebullient in his view of Moderna’s potential. But as the drastic scope of COVID was unfolding, how confident were you that your company’s approach was going to work?

Personally, I was optimistic, because after 10 years of preclinical and clinical data—including those nine vaccines—we believed we knew what we were doing. Of course, you have to be restrained in talking publicly. There’s a chance you fail. You could get the dose wrong. There’s a chance the vaccine is not very well tolerated, or that there’s a safety signal. There’s always a chance that the virus mutates in some way that you can’t get ahead of. But I believed those were all low-probability events, and that we were going to be able to go first and fast. There is always uncertainty, but we had spent a decade building for this moment. So I guess I believed in it as strongly as I can as a scientist.

Was there a moment, like in the NASA space program, when it became crystal clear that it had in fact worked, and everyone in the control room erupted in cheers?

I’ll describe two moments. The first was a Friday in mid-May 2020. I was at home on the couch and getting the first data from our Phase I trial from the NIH. It’s a huge amount of raw data, and I’m flipping between pages, trying to see what happened: Did this vaccine create an immune response, and does it look like a relevant immune response? I remember reading, digging in, trying to understand what the data says, with a building sense of excitement, and finally understanding clearly that we’d nailed it—that we were able, after two doses, to generate immunity that was well above the levels that people who’d been infected had acquired. I was like, “My God. It’s a home run. Everybody got above that level.” We all celebrated remotely. Phone calls, texts, virtual high fives. It’s 9 at night and I’m literally hiding from my wife in the living room, because I’m supposed to be putting the kids to bed.

The second moment came six months later. In May we had shown that the vaccine can generate an immune response. But then you go into these huge Phase III studies, and you expose yourself to totally unknown risks. Emotionally I was back in “it’s a coin flip” territory. So we vaccinate 30,000 people. And then we need to sit and wait for cases of COVID-19 to happen. You’re literally waiting for people to get sick, and you have no idea if they got the vaccine or the placebo. There’s an independent NIH-sponsored data and safety monitoring board that gets to see the data in real time, but we have to wait. It feels a bit like picking a pope. The cardinals go into the room every week. They look at the data, and we look for a white puff of smoke. It doesn’t come. We wait another week. You’re like, “OK, the white puff of smoke is not coming in October. Maybe in November?”

The first week goes by. The second week goes by. Finally, on a Friday in mid-November, we learn that the monitoring board has enough cases to make their determination and will meet on Sunday. Saturday is the longest day of my life, and I can’t sleep Saturday night. The meeting is Sunday morning. If the white puff of smoke happens it’s going to be at noon on Sunday. If not, then we came up short, and it’s back to the drawing board.

As head of R & D for the company, it’s myself, along with Tony Fauci, who will be the first to hear. I had been in a virtual waiting room since about 8 a.m., ridiculously early. All of a sudden, just after noon, we get called in. It’s a Zoom meeting, Hollywood Squares format. There’s 10 people, plus Dr. Fauci and myself. You’re trying to read anything: body language, any sign at all! But they’re stone-faced. Then one of the statisticians starts reviewing the data. And maybe two minutes in, they get to the result: there’s a huge number of COVID cases on the placebo, and a very small number on the vaccine. The vaccine efficacy is 94 or 95 percent.

If you had asked me going in—or Tony, or anybody—what an excellent result would have been, I’d have said that anything above 80 percent is a home-run vaccine. And this was way above that.

What was your reaction?

I tried to be stoic. But I had this huge ear-to-ear grin on my face. I even let out a little shout, like, “Yes!” Tony was looking down, but I think I could see he was also smiling, trying not to break. Meanwhile, they complete the readout and ask us for comments or questions. Of course I defer to Dr. Fauci. And all he says is, “That’s astounding.” For me it was this overwhelming feeling of relief. People had poured their heart and soul into this for months. They had missed birthdays and countless other important things. And the whole time, there was this fear that the thing was just going to fail at the end, for some unknown reason. Now, instead, it was this huge home run.

Can you backtrack and explain what makes the mRNA approach such a breakthrough?

Sure. The historical way people have made vaccines has been to grow the virus, or a piece of the virus—literally grow it in huge stainless-steel vats—then give it to you as a way for your immune system to learn what the virus looks like and develop a response. There’s a lot that can go wrong as you make that virus or piece of the virus, because you’re growing it in culture. It’s all happening in huge stainless-steel bioreactors. Imagine something that looks like small-scale petroleum refining. The process is really, really analog.

What we hypothesized with mRNA is that you don’t need all that. What the body actually needs is just instructions—a blueprint, if you will, of what the virus looks like. And to achieve that, you can use the body’s own instruction molecule. Messenger RNA is how every cell in the body knows what needs to be made; it’s the central molecule in the central dogma of molecular biology. What we do is write down information on a piece of mRNA about what the virus looks like and give that to the body. The body then takes over. It makes a piece of that virus on its own—no stainless steel required—and uses that piece to learn how to protect against the virus.

Basically we can provide the body with instructions about what the virus looks like without actually having to make the virus at all. And so our technology, our manufacturing, doesn’t involve big petroleum tanks to make individual proteins, because the molecule is always the same; only the information we encode is different. We describe the process as making software as opposed to making hardware. If we want to make a change, we can simply copy and paste some new information into it. It’s like a word processor. We can go in, delete a paragraph and insert a new paragraph. Voilà—you have a COVID vaccine.

The approach would seem to hold tremendous promise for other diseases. What’s the dream horizon for mRNA in terms of applicability? And what about possible side effects? Some have expressed concern about the toxicity of the lipid nanoparticle wrappers that introduce the mRNA.

On the second question, I may be torturing the metaphor, but the software we make goes away really quickly. If you look at mRNA or even the lipid components, we have designed them to be metabolized away, like food for your body. There’s no long-lasting presence. We’ve studied that in humans for over five years, we think it’s not an issue, and now the CDC and others have thus far said as much.

About application, we have always believed that if our approach worked with one virus, there was no logical reason it wouldn’t with others. We think that’s ultimately why we went nine-for-nine with vaccines prior to COVID. The same should hold for treating diseases like cancer or cardiac disease. If we can make it work once, there’s no reason we can’t do that a second, a third, a fifth, a hundredth time. From the start, the big idea at the core of Moderna wasn’t to do one medicine or one vaccine. It was to invent a new way of making vaccines—a better way, a transformational way. And the same for medicines: a way of making them that lets you democratize and
personalize medicine in the way that only information technology really can do. We make individual drugs for individual people in cancer right now. That’s not something you can do with a petroleum-tank-sized bioreactor. But we can do it with mRNA.

We set out to change how medicines get made—and to change the way people think about medicine. Before COVID, everything we believed was just that, a belief. For 10 years, whenever I’d go into a boardroom in a big pharma company, the message was, “That doesn’t fit any of our models, but thank you very much.” They’d pat you on the head and shoo you out the door. Now almost every one of these companies, and the popular press, are all saying, “This is the future of how we do vaccines.” It’s jarring for those of us who lived this for a decade. Now, suddenly, it’s the new thing, and it’s going to be the big thing.

Looking three, five, 10 years out, what do you have your eyes on?

The work we can do in infectious disease is huge. Take respiratory disease: In this country respiratory viruses kill 100,000 people a year. That’s pre-COVID—flu and a bunch of other viruses. We’d basically shrugged it off, because we didn’t have a good solution. Well, we have a great solution now. If we could reduce that mortality by 95 percent, think of the number of lives saved. But I think the next big thing for Moderna will be in the non-vaccine space. We have active clinical trials in cardiac disease, cancer and metabolic diseases, and very soon we will have them in autoimmune diseases. Over the next three years I expect to see data emerge from those. If any of them work, I expect it to be the same zero-to-10 moment we experienced with the coronavirus vaccine. We’re just waiting for that first proof.

We used to talk about the company as a 20-year journey—five to 10 years of grueling scientific failure, eventually some breakthroughs, and then 10 years of trying to perfect those into medicines. Then COVID happened, and the view went from “This will never work” to “Everybody is doing it.” While it’s nice at some level to have that outside validation, it doesn’t really alter the challenge. We still have 10 years of work to do to deliver the bigger dream. It’s not hype if we deliver, but it is hype if we don’t.

In some ways it was easy to be the underdog outsider. Now I guess we’re the favorite.

At least you have more funding.

Yes. Although that puts more pressure on us. Now if we fail it’s because either the science didn’t work or we failed as leaders. We can’t blame lack of money anymore.

Given the political partisanship of our country, a fair-minded citizen might be forgiven for being unable to say how well or poorly the Trump administration responded to this crisis. What’s your evaluation?

During the pandemic the political stuff felt like arguing over the weather. It comes and goes, swirling around, but ultimately it was a distraction. Of course things got politicized. We were in a presidential election year, after all. I can’t speak to the overall public health response. But I think the bottom line is, the country—private sector and public sector together—did really well in the vaccine race. It was the Democratic Congress that approved the CARES Act and allocated tens of billions of dollars to accelerate a vaccine response last spring, and the Trump Administration that implemented it. I guess I always viewed that as a nonpartisan allocation of our country’s resources. I think that the United States, its people and its government—both Congress and the executive branch—deserve a ton of credit for financing the creation of six different vaccines, three of which succeeded, and essentially provided the world’s solution to the pandemic in less than a year.

The other thing I’d say is that, yes, political administrations have big impacts, but it’s actually the career civil servants who make things happen, at places like the FDA, the Department of Health and Human Services, the CDC and NIH. And the Department of Defense. The military was tasked with figuring out how to get the vaccine manufactured at scale. HHS, CDC, NIH and FDA were tasked with, “Make sure it’s safe. Make sure you run the right studies.” So we deployed the innovation of the private sector and said, “Here’s money. Now go innovate the hell out of this problem.” Then we brought in the expert government agencies to sit on top of that innovation, so we could be confident in the vaccines and in our ability to scale them up if they work. It was a marrying of private sector and public sector, of innovation and oversight, that made this work. The career folks in government were as much a part of this success as the companies. That’s often lost in the talk about the politics.

At the time of this interview, in April, about one in four people in the world’s wealthy countries have been fully vaccinated, while in poorer countries it’s about 1 in 500. The New York Times has called this “unconscionable,” and Vanity Fair, reporting on governmental agreements with vaccine makers that prevent surplus doses from being sent abroad, calls the U.S. a “vaccine hoarder.” Was the global discrepancy between vaccination rates inevitable?

I think perhaps it was. This country has done a terrific job domestically, mobilizing manufacturing and vaccinating a large percentage of the population. There’s no other country of this size that approaches us. As for the international inequities: well, we need the government’s permission to export. But that won’t happen until they feel confident they’ve protected their population. Look at the massive political upheaval in Europe right now.

I think the U.S. didn’t do anything inherently wrong. Their $10 billion financed the manufacturing of these vaccines, and so the government was in a position to decide to protect its population first, and it did. To be completely clear, every other government had the same chance last year but chose to let the U.S. bear the early financial risk.

You used the phrase “vaccine hoarder.” While I don’t think the U.S. is doing anything inherently wrong, I do think there is a point at which we have a moral obligation to get vaccines to the place where they can have the biggest impact. Until recently that place probably was the U.S. But maybe now it’s time to say, “Look, before we protect the last half or the last quarter of our population, we need to play a global role and make the vaccine available.” How do you get more vaccine to Africa or Europe or elsewhere? You export it. You make a lot and you export it.

What has to happen in order for your company to do that?

We need the permission of the U.S. government. Then the industrial and biotechnology might of the U.S. can go solve a lot of the world’s problems. [The week after our interview, Moderna announced an agreement to supply up to 500 million doses to the World Health Organization’s vaccine effort, COVAX, including an initial 34 million in the last quarter of 2021.]

A man in a white shirt standing outside looking at his smartphone
"Amherst helped me understand that science is 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."

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.