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Moncef Slaoui was exploited by the Trump administration in May to lead a Manhattan project effort to drastically reduce the time required to develop a coronavirus vaccine for hundreds of millions of doses for the American people.
The renowned immunologist and former head of the vaccine division of GlaxoSmithKline Plc is a little famous in the pharmaceutical world. He assumed the role of chief scientific adviser for Operation Warp Speed under two conditions: “Full empowerment and no interference.”
Slaoui, 61, sees the rapid development of multiple vaccines and the production of millions of doses as an unprecedented success. However, a slow and confusing implementation has frustrated millions of Americans and prompted the Biden government to promise to speed things up. Slaoui said he was concerned about the failure to get more shots in the arms.
A vaccine is useless if it stays on a shelf, ‘he said.
In a conversation with Bloomberg after resigning earlier this month as an adviser to the U.S. pandemic response at the request of the Biden government, Slaoui reflected on a broken healthcare system that he said was responsible for the problems with administering doses.
His comments have been edited for clarity and readability:
Bloomberg: What do you make of the vaccination goal of the Biden administration of 100 million doses in 100 days?
Moncef Slaoui: 100 million doses in 100 days is honestly less than the plans we had. By that time, we had vaccinated 100 million people. That means two doses. At least in terms of production and supply, absolutely 200 million doses will be produced by the end of March or mid-April. So, if the ambition is to use only half of it, then that’s the ambition. I hope the goal is achieved and far surpassed.
Bloomberg: Why was the gap between distributed vaccine doses and doses so large? Of the 39.8 doses delivered in the US, only 19.8 million shots have been delivered so far, according to Bloomberg’s Vaccine Tracker.
Slaoui: Having lived in Europe and now in the United States, the health care systems clearly differ as much as the opposite. The problem in the US is that the system is so fragmented, that there are so many healthcare providers, so many health insurers, so many systems, so many jurisdictions, and that people move so much more between them than people move around in Europe. It’s really hard to convey a coherent message to people, and it’s hard to mobilize everyone in the healthcare system at the same time to do something.
The way we went about it, and it seems to be clearly a problem, was to say because we can not align all these systems, let’s work through them, empower them. We were part of a government whose view of the world was based on less centralization.
Bloomberg: Why was the Trump administration’s approach to working through the states not successful?
Slaoui: What has honestly remained a surprise to me is that we have gone to health administration officials in many jurisdictions and states. We spent two to three hours in person with them and had countless hours of calls. We explained, we’re going to have vaccines. There are a limited number of doses. There will be a priority process, and we are going to allocate doses to each state based on the population. And then every state and health system has to tell us where to send it.
A health system in New York or California would say every week: 200 doses to this zip code, 300 to the other one, and 500 or a thousand to this hospital, and so on. How is it possible that the health care system would say with so much precision that they want 200 here, 500 there, 700 here, and if we then send it with an accuracy of 99.9%, it turns out that they can not even immunize people not?
The assumption was that these places would be ready to immunize, and honestly, we are not told, we do not have the means to do so. So it remains a mystery to me.
Bloomberg: What else could Operation Warp Speed do to achieve its goal of distributing 20 million doses by the end of 2020?
Slaoui: I do not deny the fact that it was far less than our goal. That we missed it. In terms of vaccine discovery, development and manufacturing, we have gone faster than ever before. But a vaccine is useless if it stays on the shelf. Clearly, it has to end up in the arms of people.
Maybe it helped to have a hundred stadiums where people could come and be vaccinated. Or use 200,000 military personnel to immunize people in tents. Maybe that’s the way you do it. The approach we have in our plan is that once we have passed phase 1a, the limited population, we go to the pharmacies. There is a pharmacy within 90 km of the Americans. As we get to the populations, what is happening now is going to increase the rate of vaccination. At present, we reach a million people a day, and this will continue to rise based on the previous plan.
Bloomberg: In a previous interview with Bloomberg, you said that Pfizer Inc. turned to the US government to get priority access to raw materials so that it can deliver 100 million doses by the second quarter of this year. Does the US government have the Defense Production Act for that? And what would that mean for the relationship between the US government and Pfizer?
Slaoui: Pfizer gets everything they asked for. We used a DPA 18 different times to speed up production. With the DPA comes the opportunity to have preferential access to the materials you need. As a result, the government is much more visible about what Pfizer is doing with the material. There is an obligation to use the products obtained through a DPA for the manufacture of vaccines in the USA. It really creates more transparency in Pfizer’s plants than there was before.
Bloomberg: Anthony Fauci said he felt “Something” free now that he no longer worked for the Trump administration. How do you reflect on your time working for the White House?
Slaoui: On the day I was interviewed to accept the role, I set two conditions: full empowerment and no interference. I remember saying, ‘I do not know the bureaucracy, I do not know how this world works and I am not going to learn how it works. I’m just going to focus on the goal and work with it. “And they said, ‘Perfect, that’s what we want.’
When the president would say, “Do you think you can have this information before election day?” I have always said, Mr President, there is no way to know. Whoever tells you that this is possible does not know what they are talking about. And whoever tells you that this is not possible does not know what they are talking about. If there was interference, I would raise my hand and resign.
I know Tony very well, I respect him and I have empathy with him. I would say to the system: let science only prescribe what needs to be done.