President Joe Biden continues to make good on his campaign pledge to accelerate progress on climate change, rapidly working down the list of what he can accomplish on his own in his early days in office.
On Wednesday, January 27, he will sign a second set of executive orders and memorandums on climate change that direct federal agencies to purchase US-made, zero-emissions vehicles and carbon-free electricity, halt nearly all new oil and gas leases on public lands, and eliminate fossil fuel subsidies.
Biden also placed climate change at the center of national security planning, requiring federal agencies to evaluate how increasingly severe heatwaves, fires, flooding and famines could inflame global conflicts. The actions will also begin the process of creating new climate emissions reductions targets for the US under the Paris climate agreement.
The latest directives follow Biden’s climate actions on his first day in office, which included kickstarting the process of rejoining the Paris agreement and establishing new regulations on methane emissions, vehicle fuel economy standards and much more.
A big market boost
The orders will provide a major boost to the domestic market for renewables like wind, solar and geothermal plants as well as electric or hydrogen vehicles. It will direct billions of federals dollars to these industries while creating regulatory certainty that will make it easier to finance new projects and factories, says Josh Freed, who leads the climate and energy program at Third Way, a center-left think tank in Washington, DC.
Agencies, however, will likely only replace vehicles as they reach the end of their useful lives, so the full turnover will surely take years.
It’s not yet clear how the order to buy clean electricity will work or what it achieve at this stage, including whether it will require agencies to obtain a certain percentage or all of their electricity through low-carbon sources like wind, solar and nuclear power. It’s also not immediately apparent how government agencies will reach those goals given limited control over the mix of sources generating electricity on local grids.
Without incorporating detailed assessments of shifting climate conditions, the US won’t recognize the potential for regional conflicts that can stem from things like prolonged droughts; can’t properly prepare and equip its overseas troops and bases; and won’t grasp how power dynamics are likely to shift among nations and non-state actors, she says. For instance, famines could increase recruitment among terrorist groups and warming conditions could boost the economic output and regional influence of countries like Russia.
Elevating environmental justice
The new executive orders included numerous additional directives and announcements. Among them:
Biden will host a climate summit with other world leaders on April 22, Earth Day. It’s a clear bid to reset the nation’s international climate diplomacy efforts.
Biden also directed agencies to take steps to address the outsized impact of environmental and climate threats on disadvantaged communities, and to ensure they receive 40% of the benefits from any related federal investments.
The president also directed the Secretary of Agriculture to begin exploring ways of encouraging farming practices that can reduce emissions and store more carbon in soil; and called for the creation of a Civilian Climate Corps Initiative to put Americans to work planting trees and otherwise restoring public lands and waters.
A new memorandum elevates the role of science and expertise in federal policy making, directing agencies to “make evidence-based decisions guided by the best available science and data.”
Biden also set up or reestablished numerous climate and science advisory groups, including the White House Environmental Justice Advisory Interagency Council and a National Climate Task Force that will pull leaders from 21 agencies and departments.
The limits of executive orders
At this stage, Biden is effectively checking off the things he can accomplish on climate change through executive orders, rather than pushing new laws through Congress.
But there are limits on how much he can achieve through this approach. Executive orders are effectively instructions on how federal agencies should operate, but they can’t reverse existing laws or create new powers for the presidency. Presidents also generally can’t spend money that Congress hasn’t already authorized, although they can direct how it’s spent, as Biden seems to be doing with clean electricity and vehicles.
The precise boundaries of what can and can’t be achieved through executive orders is a subject of heated debate and frequent court challenges. The other downside is they can also be unilaterally overturned from one administration to the next, as Trump did with many of President Barack Obama’s orders and Biden is now doing with Trump’s.
Accelerating the shift to zero-emissions technologies enough to prevent 2˚C of warming, the stated goal of the Paris agreement, will clearly require legislation. The real climate test for Biden’s climate agenda will be whether he can get that done with only slim Democratic control of the Senate.
After just a week in office, the Biden administration is already under immense public pressure to fix America’s mangled vaccine rollout.
Operation Warp Speed injected enormous sums into developing vaccines but left most of the planning—and cost—of administering them to states, which are now having to cope with the fallout. The reliance on chronically underfunded health departments has exposed a threadbare digital ecosystem in which manual data entry, unscalable though it is, is often the fastest way to fix things that break.
Biden’s newly released pandemic strategy is organized around a central goal: to oversee administration of 100 million vaccines in 100 days. To do it, he’ll have to fix the mess.
Some critics have called his plan too ambitious; others have said it’s not ambitious enough. It’s guaranteed to be an uphill battle. But before we get to the solutions, we need to understand how the system operates at the moment—and which aspects of it should be ditched, replaced, or retained.
From manufacturer to patient
At the federal level, two core systems sit between the vaccine factories and the clinics that will administer the shots: Tiberius, the Department of Health and Human Services’ vaccine allocation planning system, and VTrckS, the Centers for Disease Control and Prevention’s vaccine ordering portal.
Tiberius takes data from dozens of mismatched sources and turns it into usable information to help state and federal agencies plan distribution. VTrckS is where states actually order and distribute shots.
The two are eons apart technologically. Whereas Palantir built Tiberius last summer using the latest available technology, VTrckS is a legacy system that has passed through multiple vendors over its 10-year existence. The two are largely tied together by people downloading files from one and uploading them to the other.
Dozens of other private, local, state, and federal systems are involved in allocating, distributing, tracking, and administering vaccines. Here’s a step-by-step explanation of the process.
Step one: Manufacturers produce the vaccine
HHS receives regular production updates from Pfizer and Moderna. The manufacturers communicate estimated volumes in advance to help HHS plan before confirming real production numbers, which are piped into Tiberius.
Both vaccines are made of messenger RNA, a biotechnology that’s never been produced at scale before, and they need to be kept extremely cold until just before they go into a needle: Moderna’s must be kept at -25 to -15 °C, while Pfizer’s requires even lower temperatures of -80 to -60 °C. In the fall, it became clear that manufacturers had overestimated how quickly they could distribute doses, according to Deacon Maddox, Operation Warp Speed’s chief of plans, operations, and analytics and a former MIT fellow.
“Manufacturing, especially of a nascent biological product, is very difficult to predict,” he says. “You can try, and of course everybody wants to you try, because everybody wants to know exactly how much they’re going to get. But it’s impossible.”
This led to some of the first stumbles in the rollout. While training the states on how to use Tiberius, Operation Warp Speed entered those inflated estimates into a “sandbox” version of the software so states could model different distribution strategies for planning purposes. When those numbers didn’t pan out in reality, there was confusion and anger.
“At the end of December, people were saying, ‘We were told we were going to get this and they cut it back.’ That was all because we put notional numbers into the exercise side, and folks assumed that was what they were going to get,” says Maddox. “Allocation numbers are highly charged. People get very emotional.”
Step two: The federal government sets vaccine allocations
Every week, HHS officials look at production estimates and inventory numbers and decide on the “big number”—how many doses of each vaccine will go out to states and territories in total. Lately, they’ve been sticking to roughly 4.3 million per week, which they’ve found “allows us to get through lows in manufacturing, and save through highs,” Maddox says.
That number goes into Tiberius, which divvies up vaccines on the basis of Census data. Both HHS and media reports have sometimes described this step as using an algorithm in Tiberius. This should not be confused with any kind of machine learning. It’s just simple math based on the allocation policy, Maddox says.
Thus far, the policy has been to distribute vaccines according to each jurisdiction’s adult (18+) population. Maddox says the logic in Tiberius could easily be updated should Biden decide to do it on another basis, such as elderly (65+) population.
Once Operation Warp Speed analysts confirm the official allocation numbers, Tiberius pushes the figures to jurisdictions within their version of the software. An HHS employee then downloads the same numbers in a file and sends them to the CDC, where a technician manually uploads it to set order limits in VTrckS. (You can think of VTrckS as something like an online store: when health departments go to order vaccines, they can only add so many to their cart.)
Even that hasn’t been an exact science. Shortly before the inauguration, in a phone call with Connecticut governor Ned Lamont, outgoing HHS secretary Alex Azar promised to send the state 50,000 extra doses as a reward for administering vaccines efficiently. The doses arrived the next week.
The deal was representative of “the rather loose nature of the vaccine distribution process from the federal level,” Lamont’s press secretary, Max Reiss, told us in an email.
Step three: States and territories distribute the vaccine locally
State and territory officials learn how many vaccines they’ve been allotted through their own version of Tiberius, where they can model different distribution strategies.
Tiberius lets officials put data overlays on a map of their jurisdiction to help them plan, including Census data on where elderly people and health-care workers are clustered; the CDC’s so-called social vulnerability index of different zip codes, which estimates disaster preparedness on the basis of factors like poverty and transportation access; and data on hospitalizations and other case metrics from Palantir’s covid surveillance system, HHS Protect. They can also enter and view their own data to see where vaccination clinics and ultra-cold freezers are located, how many doses different sites have requested, and where vaccines have already gone.
Once states decide how many doses of each vaccine they want to send to each site, they download a file with addresses and dose numbers. They upload it into VTrckS, which transmits it to the CDC, which sends it to manufacturers.
Last week, Palantir rolled out a new “marketplace exchange” feature, effectively giving states the option to barter vaccines. Since the feds divvy up both Moderna and Pfizer vaccines without regard to how many ultra-cold freezers states have, rural states may need to trade their Pfizer allotment for another state’s Moderna shots, Maddox says.
When thinking about the utility of the system, it’s worth noting that many health departments have a shallow bench of tech-savvy employees who can easily navigate data-heavy systems.
“It’s a rare person who knows technology and the health side,” says Craig Newman, who researches health system interoperability at the Altarum Institute. “Now you throw in large-scale epidemiology…it’s really hard to see the entire thing from A to Z.”
Step four: Manufacturers ship the vaccines
Somehow, shipping millions of vaccines to 64 different jurisdictions at -70 °C is the easy part.
The CDC sends states’ orders to Pfizer and to Moderna’s distribution partner McKesson. Pfizer ships orders directly to sites by FedEx and UPS; Moderna’s vaccines go first to McKesson hubs, which then hand them off to FedEx and UPS for shipping.
Tracking information is sent to Tiberius for every shipment so HHS can keep tabs on how deliveries are going.
Step five: Local pharmacies and clinics administer the vaccine
At this point, things really start to break down.
With little federal guidance or money, jurisdictions are struggling with even the most basic requirements of mass immunization, including scheduling and keeping track of who’s been vaccinated.
Getting people into the clinic may intuitively seem easy, but it’s been a nightmare almost everywhere. Many hospital-based clinics are using their own systems; county and state clinics are using any number of public and private options, including Salesforce and Eventbrite. Online systems have become a huge stumbling block, especially for elderly people. Whenever jurisdictions set up hot lines for the technologically unsavvy, their call centers are immediately overwhelmed.
Even within states, different vaccination sites are all piecing together their own hodgepodge solutions. To record who’s getting vaccines, many states have retrofitted existing systems for tracking children’s immunizations. Agencies managing those systems were already stretched thin trying to piece together messy data sources.
It may not even be clear who’s in charge of allocating doses. Maddox described incidents when state officials contacted HHS to say their caps were too low in VTrckS, only to realize that someone else within their office had transferred doses to a federal program that distributes vaccines to long-term care homes, without telling other decision makers.
“Operation Warp Speed was an incredible effort to bring the vaccine to market quickly,” and get it to all 50 states, says Hana Schank, the director of strategy for public interest technology at the think tank New America. “All of that was done beautifully.” But, she says, the program paid little attention to how the vaccines would actually get to people.
Many doctors, frustrated by the rollout, agree with that sentiment.
“How much money was put into the science of making the vaccine? How much money is being put into the distribution?” says Courtney Rowe, a pediatrician in Connecticut who’s been volunteering at her hospital’s vaccination clinic. “It doesn’t matter that you made it if you can’t distribute it.”
Theoretically, when patients do manage to get a shot, clinicians are supposed to log information about the appointment and send it to their jurisdiction’s immunization registry. Those registries are aggregated in a different federal system called the CDC Clearinghouse, which is supposed to de-identify the records and forward the data to yet another federal system, called the IZ Data Lake, according to Maddox. This software then feeds it back into Tiberius.
States and feds both use those numbers to track what proportion of vaccines received are actually being administered.
There are a couple of reasons not to trust that data. One is that states, and even individual vaccination sites, have widely varying rules around reporting vaccination data to the jurisdiction’s registry. Clinic workers in multiple states have found the new requirements so onerous they’ve started writing all the vaccination records on paper and entering them into the computer by hand when they have free time.
“There’s just a lot of manual stuff, so then you get a delay in the data,” said Brendan Babb, the chief innovation officer of Anchorage, Alaska, during a January 25 press call with New America. “As much as that can be glued together, it’ll free time up for people and you’ll get more real-time data of where vaccines are at.”
Where do we go from here?
While much criticism has been directed to federal tech systems during the rollout, it seems they are in fact largely working. Maddox says without Tiberius, things could get far worse. “We would have to fall back on very old-fashioned ways,” he says. “We would need a lot more people, and we would need access to systems that would take us some time to recover from, and it would not be integrated.”
Experts say the bigger challenge, however, was Trump’s decision to leave vaccine administration to the states. This put significant strain on local governments, which are often understaffed, have limited technical capabilities, and must deal with outdated tech systems.
During the New America press call, several speakers emphasized that the federal government needs to take greater initiative to do things like supply states with better technology options.
Latanya Sweeney, a professor of government and technology at Harvard University, said Biden could set up a federal tech team to create better appointment scheduling software and provide it to states as an easily accessible alternative. This would not only help states save resources but offer a better user experience for those trying to book appointments, especially elderly people and non-native English speakers.
“There are rumors that the United States Digital Service might take this on … so there is hope,” says Schank. “National coordination will be a game-changer.”
Some steps are being taken in the right direction. December’s stimulus package included $9 billion to help state vaccine campaigns. HHS also recently announced $20 million will go to modernizing immunization registries, though it’s a fraction of the $500 million state public health officials estimate they will need to update aging, often non-interoperable systems. (Many systems can’t talk to each other, and often rely on employees to compensate for incompatible medical record systems. Some still accept records by fax.)
Biden’s covid plan says the administration will work with the CDC and states to “bolster” state IT systems and improve data transparency for vaccination efforts across the board, though they have yet to release a budget.
The most recent federal stimulus bill allocated over $100 billion to help jurisdictions’ vaccination campaigns, and Biden’s plan includes an additional $350 billion. And while the vaccine has always been free for jurisdictions, the rest of the bill has been on states and vaccination sites. Biden’s plan argues the federal government should pay for it all.
All of this presents an opportunity to fix a fundamental part of our safety net, one that’s been ignored for decades, according to Newman of the Altarum Institute.
“It’s really important that public health has stable resources,” he says. “They can make long term plans and not worry–nine months from now, is this going to drop off everyone’s radar? Is the funding going to evaporate?”
The bottom line, says Schank, is that Operation Warp Speed met its own goal. Now that part is over, she says, “so somebody has to pick that up.”
The current covid-19 pandemic has shined the spotlight on longstanding health inequities for people of color. According to the Centers for Disease Control and Prevention, compared to the general United States population, African Americans are 1.4 times more likely to contract the coronavirus, and 2.8 times more likely to die from covid-19. Similarly, Native Americans and Hispanics/Latinos are nearly twice as likely to be infected by coronavirus, and 2.5 to 2.8 times more likely to die from it.
Underlying these statistics are significant structural, social, and spatial issues. But why is this? And how do we begin to quantify and address the nested problems of public health inequality?
Understanding the geography of health inequity
One tool that can help us understand the higher coronavirus infection and death rate among people of color is mapping produced by a geographic information system (GIS). GIS correlates geography to key issues by layering relevant, sometimes seemingly disparate data to achieve clarity on complex situations.
For instance, one of the first things GIS users and epidemiologists mapped in the pandemic was the locations of vulnerable populations. Each layer of data took into account various contributing factors to such vulnerability. These include potential exposure through essential jobs; disease susceptibility for seniors and people with certain health conditions; the risk of transmission for public transit commuters and those in group living situations; and socioeconomic disadvantages through poverty, inadequate education, and lack of health insurance. The dynamic analyses that GIS enabled immediately guided actions by first responders and gave epidemiologists an evidenced-based way to assess vulnerability against hospital accessibility and capacity.
As awareness of the disproportionate number of deaths in communities of color grew, the same tool was applied to understand the causes behind this inequity, which, in turn, can aid in defining and developing potential solutions.
It’s been long understood that people living in inner cities face conditions that have clear correlations to overall health. These include income and education disparity, a low percentage of home ownership, increased exposure to neighborhood pollution, and reduced access to wellness care and reasonably priced fresh food. Another important dataset relevant to the covid crisis is the disproportionate percentage of people of color in service jobs that put them into daily close contact with the virus.
“GIS can help identify where outcome disparities exist, perform analysis to understand root causes, and focus mitigation efforts on places where systemic racism concentrates causal factors,” says Este Geraghty, chief medical officer and health solutions director at GIS vendor Esri. By analyzing all relevant data on a GIS-based smart map, Geraghty says leaders are poised to uncover localized insights that drive potential solutions. This means, “we can provide stopgaps until we have fully equitable systems, ensuring that one day everyone will have the same opportunity to reach their full health potential.”
Geraghty adds, “If you can’t understand all of the contributing factors in context, you might not anticipate potential problems or solutions.”
GIS for effective covid-19 vaccine distribution
Another pandemic-related problem tied closely to geography is how to get covid vaccines to the public in an equitable, safe, and effective manner. GIS provides the tools to analyze prioritized needs, plan distribution networks, guide deliveries, see the real-time status of inoculation missions, and monitor overall progress.
Geraghty developed a covid vaccine distribution approach using GIS. She explains that the first step is to map those facilities currently suitable for distributing the vaccine to the public. Since some vaccines need ultra-cold storage, facilities will have to be differentiated according to that and other storage capabilities. As part of the facility dataset, Geraghty says, GIS can also be used to calculate how many vaccines each facility’s staff can potentially administer in a day. In addition to hospitals, other facility types will need to be considered based on their ability to deliver the vaccine to underserved and remote populations. Facilities might include university health clinics, independent and retail pharmacies, and potentially even work sites willing and able to inoculate employees, among others.
The next step involves mapping the population—not only their locations and numbers, but also according to the categories recommended by the CDC guidance and state-based plans for the phased rollout of the vaccine.
By correlating these two layers of data on the map (facilities and population), it becomes clear which communities aren’t within a reasonable travel time to a vaccination location, based on multiple modes of travel (for example, driving, walking, public transit).
Geraghty explains, “That geographic perspective will help find any gaps. Who is left out? Where are the populations that aren’t within the range of identified facilities?” This is where GIS can improve decision-making by finding options to fill gaps and make sure that everyone has access to the vaccine.
In areas where GIS analysis identifies “gaps” on the map, such as communities or rural areas that aren’t being reached, Geraghty envisions pop-up clinics in places like school gyms, or drive-throughs in large parking lots, or, in some circumstances, personal outreach. For example, Geraghty explains, “People experiencing homelessness may be less likely to show up at a clinic to get a vaccine, so you may have to reach out to them.”
Public communication about vaccination progress offers another opportunity for mapping and spatial thinking. For example, an updated map could give a clear picture of how many people have been vaccinated in different parts of a state or county. The same map could help people figure out when it’s their turn to be vaccinated and where they can go to receive their vaccine. Maps could even help community residents compare wait times among different facilities to guide their choices and offer the best possible experiences.
Geraghty says that organizing covid vaccine distribution in this way can represent hope for people. “If we take this logical and strategic perspective, we can be more efficient in vaccine delivery and enjoy our normal activities much sooner.”
Vulnerable populations, geographic insights
Long before the world was forced to struggle with covid, the connection between geography and solving public health and social issues was very clear. Using GIS to address homelessness is one example.
In Los Angeles County, GIS has been used to map the homeless population by location, and also document and analyze the risk factors that create homelessness in each community. GIS analysis revealed that a predominant risk factor for homelessness in the northern, and especially northwestern part of the county, was veterans with post-traumatic stress disorder (PTSD). Conversely, in the northeast area, the predominant risk factor creating new homelessness was women and children escaping domestic violence.
In Snohomish County, Washington, health-care workers hit the streets to gather the data needed to facilitate such risk-factor mapping. They used GIS to perform the biannual survey and census of homeless people, gathering details on the conditions and needs of 400 people in short order. They collected standard information like the age of people in camps and whether any were veterans and reported whether they saw needles used for drugs.
Once location-specific differences like these are identified, appropriate resources can be deployed on a community-by-community basis, such as targeted social and health services to help specifically with domestic violence, PTSD, addiction, joblessness, or other identified root causes. “Using a geographic perspective, you can allocate resources, which are always limited, in ways that do the most good,” Geraghty says.
Lessons from the pandemic
Addressing disparities related to living conditions, locations, and genetics has always been a factor of disease spread and mortality, but it has never been tracked, measured, and analyzed on such a scale. However, confronting the covid crisis has been an ongoing case of catch-up, trying to find and correlate critical data to save lives, and Geraghty doesn’t want to see that level of frenetic activity repeated.
“Building strong public health preparedness systems means having foundational data ready,” she explains. “For instance, where, relative to the population, are the hospitals, the shelters, blood banks, and key infrastructure? Who are the community players and partners, and what services can they provide, and where?” In March, at the start of the pandemic, there was no comprehensive map of how many beds each hospital had, what percentage were intensive care beds, the number of ventilators available, and how much personal protection equipment was easily obtainable, and from where. “For anything that is health-related infrastructure,” explains Geraghty, “you should have a baseline map and data that you keep updated, as well as population demographic data.”
The crisis has also brought to light other issues; for example, better and more data sharing is needed, as well as clearer governance for which data are acceptable to share, so nothing will delay essential communications among institutions in the next crisis. And improved system interoperability ensuring key systems can work together to keep data fresh and reaction times quick should be a priority. The covid-19 pandemic has been a tragedy in terms of the human toll. But if we can learn from it, perhaps we can make corrections so that all communities and future generations can look forward to better, longer, and healthier lives.
This content was produced by Insights, the custom content arm of MIT Technology Review. It was not written by MIT Technology Review’s editorial staff.
The pharmaceutical and chemicals industries are no strangers to digital technology, with decades of experimentation using data and statistical techniques to improve productivity and innovation. But the results were historically disappointing relative to the promise.
Over the past two or three years, the pace of digital transformation is increasing thanks to the improved performance, power, and adaptability of tools, and investments in cloud computing, data architecture, and visualization technologies. There are also an increasing number of use cases for machine learning and, in future, quantum computing, which will accelerate the development of molecules and formulations.
The broad digital transformation taking place in R&D is allowing researchers to automate time-consuming manual processes and opening new research horizons in thorny problems that have failed to elicit breakthroughs. This new report, based on interviews with R&D executives at companies including Novartis, Roche, Merck, Syngenta, and BASF, explores the use cases, best practices, and roadmaps for digitalizing science.
Exploring patterns in complex datasets
Rich, accessible, and shareable data are the fuel on which today’s breakthrough analytics and computing tools rely. To ensure that datasets are usable for scientific purposes, leading companies are focusing on FAIR data principles (findable, accessible, interoperable, and reusable), developing robust metadata and governance protocols, and using advanced analytics and data visualization tools.
Digital transformation is opening up R&D horizons in areas such as genomics that could lead to breakthroughs in precision medicine. It is also creating opportunities for decentralized clinical trials, unleashing future innovations in digi-ceuticals and healthcare wearables.
Reaching the right study faster
Experiments and clinical trials carry a huge cost for both industries, both financially and in terms of human and scientific resources. Advanced simulation, modelling, AI-based analytics, and quantum computing are helping identify the strongest candidate for new therapies, materials, or products, allowing only the most promising to proceed to the costly experimental phase.
R&D leaders foster bottom-up innovation by giving research teams freedom to experiment with new technologies and techniques. They also drive top-down strategic initiatives for sharing ideas, harmonizing systems, and channeling digital transformation budgets. As in any industry, AI and automation are changing ways of working in scientific research. Rather than being seen as a threat to research careers, leading organizations in pharma and chemicals are demonstrating that digital provides new opportunities for collaboration and the breaking down of silos. They celebrate wins, encourage feedback, and nurture open discussions about culture shifts in the workplace.
The global vaccine rollout is full of glitches, shortages, and problems, but not every country faces the same challenges. Evening out those inequalities to make sure poorer countries are included in the vaccination race isn’t just the ethical thing to do: it’s good for rich countries, too. A new study from the National Bureau of Economic Research shows that the entire global economy depends on poorer countries’ getting residents vaccinated: advanced economies will still bear 49% of the costs of the pandemic, even if they get their own populations entirely inoculated.
With a new leader in the White House, we’re seeing signs that the US will do its part. The Biden administration says it will join Covax, a global vaccination effort led by the World Health Organization that aims to get the first batches of vaccines to poorer countries in February. To learn more about global vaccine inequality, we spoke with Anita Ho, associate professor in bioethics and health services research at University of British Columbia and the University of California, San Francisco.
This interview has been condensed and edited for clarity.
Q: What’s the upshot of the US joining Covax? Do you expect that to be any sort of game-changer for global vaccine inequity?
A: Even from a symbolic perspective it’s really important to have the US rejoining the WHO efforts and Covax. It’s also important for financial reasons, because Covax needs money to get supplies. It’s not just vaccines … we need money for personnel, we need money for protective equipment. We need money for glass, for syringes, for needles—everything. So the US being there can provide leadership and provide more financial security as well.
Q: So it really goes beyond just needing the doses. What are some of the biggest disparities in global vaccine distribution right now? It sounds like supplies might play into that.
A: It’s not just, “Are we willing to donate the vaccines?” It’s, “Do we have the infrastructure to even store and transport the vaccines?” The main ones approved in the US, for example—the Pfizer and Moderna vaccines—really require very cold refrigeration. That is not even very feasible in some areas of the world that have limited electricity supply.
One of the greatest contributors to the disparity is when wealthier nations pre-order vaccines from manufacturers. They’re buying up most of the supply—the potential supply, even. So even when companies are ramping up the supply, they’re not going to be able to go to these poorer countries unless Covax can buy them.
Q: You’ve spoken before about vaccine disparities even within high-income countries. Why do those happen? What should we be watching out for?
A: Think about how people get notifications that it’s their turn to get vaccinated. In the US, for example, the ones who’d get those notifications would have smartphones, have email addresses, would already have a primary care provider. If you are undocumented, if you are homeless, you may not have access to that information and you wouldn’t even know.
The Pfizer, Moderna, and AstraZeneca vaccines all require two doses with variable time between them. This means we need careful tracking of individuals twice: to get their first dose, and then to get them to return at the right time frame to get their second dose. For people in remote areas, or places that don’t have convenient access to pharmacies—often poorer neighborhoods—it’s difficult for them to travel twice. And for people who may be homeless or without cell phones, it would be challenging to reach them twice in a designated time frame. So one way to promote vaccination equity is to have reserve vaccines that would only need one dose for these populations. Johnson & Johnson is developing a one-dose vaccine right now.
There may also be another disparity. There are many people who, even if you offer them the vaccine, will not take it. And that’s partly because of the distrust. There is a much higher level of distrust among Latino and Black Americans, partly because of historical mistreatment.
Q: How are you seeing mistrust affect global vaccination disparities more globally?
A: When we think about mistrust on a global scale, that may be partly because of how the pharmaceutical industry prices things and how they have patents. Some countries may be thinking, “These companies from the US or Europe are really trying to sell us their expensive vaccines. But we can’t really afford them for our population in the first place because they are patented, and we are not allowed to just make a generic version of it.” They may be thinking, “These companies are just trying to take advantage of us.” And there certainly have been examples of lower-income countries that have been exploited by the pharmaceutical industry.
In Indonesia, for example, this happened with H5N1. Whenever there’s an outbreak, if you’re a WHO member, you send samples to a WHO lab and they try to find out about this particular virus or disease. Based on genetic material sent from Indonesia, scientists developed therapeutics for H5N1 and tried to sell them back to Indonesia. Then Indonesia thought, “Okay, these were our samples. Should there not have been collaboration? You’re using them to sell drugs back to us.”
Q: Does the US have a moral obligation to send people to other countries to help with vaccinations?
A: One of the problems is that we’re not able to train enough people in the local places. For Covax or other kinds of international collaboration, it’s not about sending people so much as it’s about how do we help them build up their own infrastructure? Even financial resources for training courses or other kinds of ways to beef up their own human resources. Because you can imagine we’d go, and then we’d leave, and they’re not any better in terms of infrastructure.
Q: How would it affect higher-income countries if other, lower-income countries don’t receive their vaccines until later? Recent research says, for example, that if poor countries don’t get vaccines, it will disrupt the economy for everyone.
A: While it’s still likely that at the human level, people in the most vulnerable countries will suffer more, inequitable vaccine allocation definitely will disrupt the supply chain for all, including—perhaps even especially—the wealthiest nations that have come to depend on cheap sources of labor. If supplying nations have lots of people being sick, or they have to shut down, [there are] no workers to process or transport the raw materials, or to manufacture and deliver the products. People in these countries also can’t travel or spend money, which can greatly affect international hotel chains, airlines, and hospitality industries as well.
This would apply within a high-income country too. If undocumented workers, farm workers, homeless people, and others in low-wage jobs can’t get vaccinated, they can’t work to keep the supply chain going. So restaurants, entertainment industries, etc. would suffer. If they can’t pay the rent or mortgage or have extra money, that also affects the rest of the economy.
Every morning, as Nandita Mohan sifts through her emails, her college pals are in her ear—recounting their day, reminiscing, reflecting on what it’s like to have graduated in the throes of a pandemic.
Mohan, a 23-year-old software programmer in the Bay Area, isn’t on the phone, nor is she listening to an especially personal podcast; she’s using Cappuccino, an app that takes voice recordings from a closed group of friends or family and delivers them as downloadable audio.
“Just hearing all of us makes me value our friendship, and hearing their voices is a game-changer,” she says.
Audio messaging has been available for years; voice memos on WhatsApp are especially big in India, and WeChat audio messages are popular in China. And during the pandemic, these features have become an easy way for people to stay in touchwhile bypassing Zoom fatigue. But now a new wave of hip apps are baking the immediacy and rawness of audio into the core experience, making voice the way people connect again. From phone calls to messaging and back to audio—the way we use our phones may be coming full circle.
The best-known audio-focused network is Clubhouse, the buzzy, invite-only app that debuted last spring to glowing reviews for its talk-show-like twist on the chat rooms of the early internet. Using it is akin to dropping in on an (online) party conversation.
But Clubhouse’s promise was shattered by its lack of moderation and the unfettered chatter of misogynistic venture capitalists. New York Times reporter Taylor Lorenz, once a fan of the app, was subject to harassment in Clubhouse sessions for calling out one VC’s behavior.
“I don’t plan on opening the app again,” Lorenz told Wired. “I don’t want to support any network that doesn’t take user safety seriously.” Her experience wasn’t a one-off, and since then darker, racist elements have appeared. It seems the behavior that mars every other social platform also lurks beneath Clubhouse’s exclusive, cool veneer.
Gaming chat app Discord, meanwhile, has exploded in popularity. The service uses voice-over-IP software to translate spoken chat into text (an idea that came from video gamers who found typing while playing impossible). In June, to tap into people’s need for connection during the pandemic, Discord announced a new slogan—“Your place to talk”—and began trying to make the service appear less gamer-centric. The marketing push seems to have worked: by October, Discord estimated 6.7 million users—up from 1.4 million in February, just before the pandemic hit.
In both Discord and Clubhouse, the in-group culture—nerdy gamers in Discord’s case, overconfident venture capitalists for Clubhouse—have led to instances of groupthink that can be off-putting at best and bigoted at worst. Yet there’s undeniably an appeal. Isn’t it cool to talk and literally be heard? After all, that’s the foundational promise of social media: democratization of voice.
Speak and you shall be heard
The intimacy of voice makes audio social media that much more appealing in the age of social distancing and isolation. Jimi Tele, the CEO of Chekmate, a “text-free” dating app that connects users through voice and video, says he wanted to launch an app that would be “catfish-proof,” referring to the practice of deceiving others online with fake profiles.
“We wanted to break away from the anonymity and gamification that texting allows and instead create a community rooted in authenticity, where users are encouraged to be themselves without judgment,” Tele says. The app’s users start voice memos that average five seconds and then get progressively longer. And while Chekmate has a video option, Tele says the app’s several thousand users overwhelmingly favor using just their voices. “They are perceived as less intimidating [than video messages],” he says.
This immediacy and authenticity is the reason Gilles Poupardin created Cappuccino. He wondered why there wasn’t already a product that gathered voice memos together into a single downloadable file. “Everyone has a group chat with friends,” he says. “But what if you could hear your friends? That’s really powerful.”
Mohan agrees. She says that her group of friends switched to Cappuccino from a Facebook messenger chat group and then tried Zoom calls early in the pandemic. But the discussions would inevitably turn into a highlight reel of big events. “There was no time for details,” she laments. The daily Cappuccino “beans,” as the stitched-together recordings are called, let Mohan’s friend circle keep up to date in a very intimate way. “My one friend is moving to a new apartment in a new city, and she was just talking about how she goes to get coffee in her kitchen,” she says. “That’s something I would never know in a Zoom call, because it’s so small.”
Even legacy social media firms are getting in on the act. In the summer of 2020 Twitter launched voice tweets, allowing users to embed their voice right onto their timeline. Andin December,it launched a feature called Spaces in beta for live, host-moderated audio conversations between two or more people.
“We were interested in whether audio could add an additional layer of connection to the public conversation,” says Rémy Bourgoin, a senior software engineer on Twitter’s voice tweets and Spaces team.
Bourgoin says that the vision is for Spaces to be “as intimate and comfortable as attending a well-hosted dinner party.” He adds, “You don’t need to know everyone there to have a good time, but you should feel comfortable sitting at the table.”
You may have snorted in disbelief reading that Twitter wants to create a space that is “comfortable” and “intimate.” After all, Twitter doesn’t exactly have a stellar track record in creating an online environment that is welcoming and protects vulnerable users from abuse.
Bourgoin says the group is moving slowly on purpose before releasing Spaces beyond beta and a small group of users, even going so far as to include captioning—a rare accessibility feature in audio networks. “Right now, Spaces can be reported by anyone who is in the space,” Bourgoin says. “Reports will be reviewed by our team, who will evaluate for violations of the Twitter rules.”
Ah, moderation. Content moderation in audio is far more difficult than it is in text. Searchable text and automoderators have been used with some success, but human moderators seem to be the most effective way to block people who don’t abide by community rules—which puts human beings at risk. For platforms where people can jump in at any time and chat, the very democratization that makes audio attractive creates a nightmare in moderation. “That’s definitely a huge challenge with any user-generated platform,” says Austin Petersmith, who launched Capiche.fm in beta last year. The site grew out of a software community that is a bit like a call-in radio show: hosts call each other to start the show, and invite listeners to chime in while they’re “on-air.”
As users of Clubhouse have learned, voice-only spaces can quickly get ugly, just like anywhere else on the internet. People who already suffer from abuse online—those who are marginalized, female or nonbinary, nonwhite, and/or younger—are unlikely to want to make the leap to a place where they can be abused in a different, harder-to-police format.
There’s also reason to believe these newer, less regulated platforms will be attractive to disaffected, far-right conspiracy-minded extremists and QAnon believers, who are now creating their own podcast networks.
Still, audio social networks seem to offer something that traditional social media cannot. One of the format’s main benefits is the way it gives users the immediate connection of a voice or video call, but on their own terms. Phone calls—and Zoom calls, for that matter—require some planning. But audio social media content can be created and digested at your own convenience in a way that news alerts, notifications, and doomscrolling don’t allow. As Mohan, who listens to her friends every morning, says of Cappuccino: “It engages me and forces me to listen more carefully as each person is talking. I even take notes of things I want to respond to and say.”
For Mohan, playing the recordings from her circle of five friends has become a beloved ritual, allowing her to catch up with them at her own pace. “Every day, in the middle of my work day, I’ll record my Cappuccino,” she says, referring to the recording she makes on the app. “It feels really personal. I’m hearing all their voices and I feel on top of what they [her friends] are doing in their day to day.”
Editor’s note: A previous version of this story equated voice tweets with Twitter Spaces and said they launched at the same time. We regret the error.
Online misinformation and political polarization have hampered the efforts of public health officials to stop the spread of covid-19. Are there better ways to counter the falsehoods and get more reliable information out there?
The MIT Media Lab’s HealthPulse project recently tried to answer that question. It ran a trial in Atlanta, a city with a large population of African-Americans, who for historical reasons have a high level of mistrust in health authorities. The HealthPulse team used a mix of technological tools to analyze what people were saying on radio and in social media, crafted messaging that could counter common falsehoods and misperceptions, and then asked community leaders and other influential people to spread those messages.
So how well did it work? And could similar methods help create more informed and less divisive public discussion on other subjects? In a live panel on January 28 at 2 p.m. US Eastern time, as part of the World Economic Forum’s Davos Agenda Week, we’ll talk to the HealthPulse team and other experts about the lessons from the trial. The session will be livestreamed here, and a recording will be available afterwards.
Deb Roy, director of MIT’s Center for Constructive Communication and director of HealthPulse
Rear Admiral (ret.) Susan J. Blumenthal, public health director of HealthPulse and former US assistant surgeon general
Joan Donovan, director of research, Shorenstein Center at Harvard University
Ceasar McDowell, professor of the practice of community development, MIT Department of Urban Studies and Planning
On January 10, Charlie O’Donnell, a startup investor who runs Brooklyn Bridge Ventures, published a blog post that he hoped would inspire self-reflection among his peers in the industry. Provocatively titled Seed Investments in Insurrection, his argument was that venture capitalists needed to wrestle with their impact on democracy.
“It’s kind of hard to make money if the long-term consequences of your investments threaten the free and open democracy that underpins our society,” he wrote, “an extreme statement—until this past week,” when “domestic terrorists, at least in part radicalized on one-time venture capital backed platforms like Facebook, YouTube, Twitch and Twitter stormed the US Capitol building.”
The events in Washington forced technology companies to face a public reckoning over their role in promoting and amplifying extreme content. For years, critics called for social media platforms to enforce their own policies on hate speech, harassment, and incitement to violence, but the companies largely resisted. In the wake of the attack on the Capitol, however, they began taking action. Facebook and Instagram disabled Trump’s ability to post until after the inauguration, Twitter banned the president as well as 70,000 QAnon-related accounts, and YouTube prevented Trump’s account from posting for seven days.
But, as O’Donnell points out, one critical part of the technology industry has remained silent: the people who fund these companies. “I think the preference of most people is to stay out of things if they seem controversial,” he says.
“They wrote a check and moved on”
“Right now, they want to keep a low profile,” says Roger McNamee, who was one of the earliest investors in Facebook but has since become one of social media’s most vocal critics. “Many of them are associated with these platforms that are causing all the trouble, and they don’t want anybody to make that connection.”
Mitch Kapor, an early software entrepreneur turned investor, has long been outspoken about the role investors must play in acting responsibly and holding companies to account. He and his wife, venture capitalist and impact investor Freada Kapor Klein, were among the earliest to put money into Uber—but openly criticized the company in 2017 after sexual harassment claims by former employee Susan Fowler.
For years, the duo has called on fellow VCs to do better, and there have been moments of reckoning, including in the aftermath of the killing of George Floyd last summer. At best, however, investors’ actions have been “externally facing,” says Kapor Klein. “They put out a statement, they wrote a check, and they moved on, without changing how they do business.” (On the other end of the spectrum, some VCs echoed Donald Trump’s “few bad apples” ambivalence about white supremacist groups like the Proud Boys, while others applauded cryptocurrency company Coinbase’s decision to ban discussions of racial equity and politics from the office completely.)
But even the minimal level of self-reflection from last summer, Kapor Klein adds, has been largely missing since January 6. (The National Venture Capital Association put out a statement on January 7 condemning the “domestic terrorist attacks” but public positions from firms and individual investors, who have more influence on startup culture, have been extremely rare.)
For Mitch Kapor, today’s investors—who typically sit on the boards of these companies and are meant to guide their strategies—are trying to avoid being held responsible.
“They just retreat into silence,” he says. “They don’t want to admit that they’ve created a disaster that they bear responsibility for.”
In fact, according to corporate development adviser Arjun Gupta, VCs are more concerned with the optics of being drawn into the political fight. Most of them, he says, feel uneasy about the suggestion that investors should have any say on the politics of the companies in their portfolio—or of the user bases that they court.
He has had multiple conversations with venture capitalists on behalf of his clients since January 6, and says that some VCs are discussing pulling investments as a “risk mitigation strategy.” Rather than concern over the impact of the platforms they fund, he suggests they are afraid of “pressure from their staff” or the institutional investors whose money is managed by VCs to take action. Their aim is to avoid getting “sucked into this shitstorm … of political discourse.”
Some participants say that conversations about accountability are happening in private, including on Clubhouse, the audio-based social network that is popular among Silicon Valley investors and has also faced criticism for its slow response to its harassment problems.
But critics who call for actions such as deplatforming extremist content say they are not asking for companies to police political views, but rather, take action when those views are expressed in hate speech and incitements to violence—and to ensure that companies develop and apply content moderation policies. So why are investors so reticent to hold their companies to account?
“We are a catalyst of this”
While their users might be on the fringe of the political spectrum, many “alt tech companies” are not outsiders in the technology industry. Most are embedded in the Silicon Valley startup and fundraising system that often puts the potential for growth higher than utility or need. Services like Gab, MeWe, Minds, DLive, and Clouthub— which have been slow or unwilling to remove hate speech, conspiracy theories, and threats of violence, sometimes in violation of their own terms of service—have all received money as part of the pipeline of incubators, crowdfunders, angel investors, fundraising, and acquisitions.
They have also been indirect beneficiaries of the insurrection at the Capitol, with spikes in users as a result of the mainstream services’ deplatforming President Trump, his surrogates, and accounts promoting the QAnon conspiracy.
In a few cases, public pressure has forced action. DLive, a cryptocurrency-based video streaming site, which was acquired by BitTorrent’s Tron Foundation in October 2020, suspended or permanently banned accounts, channels, and individual broadcasts after the Southern Poverty Law Center identified those that livestreamed the attack from inside the Capitol building.
Neither Tron Foundation, which owns DLive, nor Medici Ventures, the Overstock subsidiary that invested in Minds, responded to requests for comment.
EvoNexus, a Southern California-based tech incubator that helped fund the self-described “non-biased” social network CloutHub, forwarded our request for comment to CloutHub’s PR team, who denied that its platform was used in the planning of the insurrection. They said that a group started on the platform and promoted by founder Jeff Brain was merely for organizing ride sharing to the Trump rally on January 6. The group, it said, “was for peaceful activities only and asked that members report anyone talking about violence.”
But there’s a fine line between speech and action, says Margaret O’Mara, a historian at the University of Washington who studies the intersection between technology and politics. When, as a platform “you decide you’re not going to take sides, and you’re going to be an unfettered platform for free speech,” and then people “saying horrible things” is “resulting in action,” then platforms need to reckon with the fact that “we are a catalyst of this, we are becoming an organizing platform for this.”
“Maybe you wouldn’t get dealflow”
For the most part, says O’Donnell, investors are worried that expressing an opinion about those companies might limit their ability to make deals, and therefore make money.
Even venture capital firms “have to depend on pools of money elsewhere in the ecosystem,” he says. “The worry was that maybe you wouldn’t get dealflow,” or that you’d be labeled as “difficult to work with or, you know, picking off somebody who might do the next round of your company.”
Despite this, however, O’Donnell says he does not believe that investors should completely avoid “alt tech.” Tech investors like disruption, he explains, and they see in alt tech the potential to “break up the monoliths.”
“Could that same technology be used for coordinating among people in doing bad stuff? Yeah, it’s possible, just in the same way that people use phones to commit crimes,” he says, adding that this issue can be resolved by having the right rules and procedures in place.
“There’s some alternative tech whose DNA is about decentralization, and there’s some alt-tech whose DNA is about a political perspective,” he says. He does not consider Gab, for example, to be a decentralized platform, but rather “a central hosting hub for people who otherwise violate the terms of service of other platforms.”
“The internet is decentralized, right? But we have means for creating databases of bad actors, when it comes to spam, when it comes to denial of service attacks,” he says, suggesting the same could be true of bad actors on alt tech platforms.
But overlooking the more dangerous sides of these communications platforms, and how their design often facilitates dangerous behavior is a mistake, says O’Mara. “It’s a kind of escapism that runs through the response that powerful people in tech … have, which is just, if we have alternative technologies, if we just have a decentralized internet, if we just have Bitcoin” … then everything will be better.
She calls this position “idealistic” but “very unrealistic,” and a reflection of “a deeply rooted piece of Silicon Valley culture. It goes all the way back to, ‘We don’t like the world as it is, so we’re gonna build this alternative platform on which to revise social relationships.’”
The problem, O’Mara adds, is that these solutions are “very technology driven” and “chiefly promulgated by pretty privileged people that … have a hard time … [imagining] a lot of the social politics. So there’s not a real reckoning with structural inequality or other systems that need to be changed.”
How to have “a transformational effect”
Some believe that tech investors could shift what kind of companies get built, if they chose to.
“If venture capitalists committed to not investing in predatory business models that incite violence, that would have a transformational effect,” says McNamee.
At an individual level, they could ask better questions even before investing, says O’Donnell, including avoiding companies without content policies, or requesting that companies create them before a VC signs on.
Once invested, O’Donnell adds that investors can also sell their shares, including at a loss, if they truly wanted to take a stand. But he recognizes the tall order that this would represent—after all, it’s highly likely that a high-growth startup will simply find a different source of money to step in to the space that a principled investor just vacated. “It’s going to be pissing in the wind,” he says, “Because that guy over there is going to be in.”
In other words, a real reckoning among VCs would require a reorientation of how Silicon Valley thinks, and right now it is still focused on “one, and only one, metric that matters, and that’s financial return,” says Freada Kapor Klein.
If funders changed their investment strategies—to put in moral clauses against companies that profit from extremism, for example, as O’Donnell suggested—the impact that this would have on what startup founders chase would be enormous, says O’Mara. “People follow the money,” she says, but “it’s not just money, it’s mentorship, it’s how you build a company, it’s this whole set of principles about what success looks like.”
“It would have been great if VCs who pride themselves on risk-taking and innovation and disruption … led the way,” concludes Kapor Klein. “But this tsunami is coming. And they will have to change.”
Correction: Brooklyn Bridge Ventures is an investor in Clubhouse, a product management software company, not Clubhouse, the social network as originally stated.
Salim Abdool Karim was at a cricket match on December 26, Boxing Day, when he made the mistake of looking at his email. He had received a new report and the news wasn’t good. A heavily mutated coronavirus spotted in South Africa appeared to allow the virus to bind more tightly, and more easily, to human cells.
Karim, an epidemiologist and lead covid-19 adviser to the South African government, knew what the report meant. It could explain a drastic change in covid-19 in his country, where rising case numbers were turning every province red.
“It simply went up, up, up, and up, into the equivalent of an Everest,” Karim says.
The rise in cases in South Africa has been linked to a new, highly mutated form of the covid-19 virus. And it’s just part of a wider pattern being seen around the world. Over the last month, weary researchers racing to understand new variants in Africa, Brazil, and the United Kingdom have pumped out a series of alarming reports on preprint servers, websites, and in official reports, describing a coronavirus that is changing in ways that appear to let it shrug off lockdowns, avoid antibodies, and retake cities, like London or Manaus, that already suffered through big first waves.
Indeed, in a few short weeks the perception among some scientists of the coronavirus has gone from a static, slow-changing virus that’s easily walloped by vaccine technology to something more like a terrorist shapeshifter that could put a decisive end to the pandemic out of sight.
Will vaccines still work?
Most the world’s attention has been on a so-called British variant of the covid virus; it seems to spread faster than the original version and has appeared in dozens of countries, including the US. On Friday, January 22, the UK prime minister, Boris Johnson, said government advisers warned this strain may also be more deadly, killing the infected about 30% more often.
Faster spreading, more deadly, versions of the coronavirus can still be dealt with using masks and social distancing. But the variant in South Africa, called 501Y.V2 and first described by gene sleuths on December 22, not only spreads faster but, alarmingly, also appears to evade antibodies from the blood of people previously infected by covid-19, and, in theory, could also lessen the effect of vaccines, society’s main hope of curbing the global outbreak.
Such lab evidence of “immune escape” makes the variant in South Africa “much more concerning” than the one in the UK, according to Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, speaking at his first press conference under the new Biden administration on January 21. “The real question that people are quite clearly interested in is: What is the impact on the vaccine?” Fauci said.
What Fauci didn’t mention is that we could have a real-world answer to that question as soon as next week thanks to a large vaccine trial that recruited thousands of South Africans between September and December, just as the dangerous variant spread widely.
That vaccine, from Johnson and Johnson, has been widely anticipated because it’s given as single shot and is easily stored, making it easier to get into arms than the super-cooled, two-dose messenger RNA vaccines from Moderna and Pfizer authorized in the US last month.
Now, though, the J&J trial may unexpectedly answer the big question of whether vaccines will protect against the 501Y.V2 variant in South Africa or not. That could be determined if data show the shot is less effective in South Africa than it has been in the US, where part of the trial occurred.
“It will be wonderful if it has equal efficacy against the South Africa strain. If it doesn’t, that is telling us something,” says Lawrence Corey, a virologist at Fred Hutchinson Cancer Research Center in Seattle, who leads the operations center for the COVID-19 Prevention Network, which coordinates vaccine trials financed by the US government.
Corey estimates that 7,000 South Africans joined the trial, and since it took place as the new virus spread, “most of the study in South Africa will be measuring the efficacy against the variant.”
The worry is that all major vaccines were constructed using the genetic information that became available on the virus a year ago. And since then, the virus has kept changing. If the vaccines aren’t as effective against new strains, that, in turn, would make it harder to “crush the curve” of cases, hospitalizations, and deaths.
During scientific presentations broadcast on January 18, Karim described how every province in South Africa saw a dramatic rise in cases during December. “This drastic change that we are seeing is being driven by a virus that certainly looks, biologically, that it can attach to human cells more efficiently,” he says. “Our second wave reached completely new heights, we are now seeing, today, more cases and more deaths than we ever, on any day, saw in the first wave.”
When it was first detected, the South African variant looked worrisome because of the large number of mutations it had gained, 23 in all, and how many of these were in the critical spike protein, which the virus uses to attach to human cells. That strongly suggested the virus was evolving to avoid antibodies.
Since then, researchers have gathered more alarming clues about 501Y.V2, including from a study that showed that antibodies in blood serum from around 50 people previously infected were frequently unable to block the new variant.
“When you test the blood from people in the first wave [we find] in nearly half the cases there is no recognition of the new variant,” Penny Moore, a researcher at the University of the Witwatersrand in Johannesburg, said during the same broadcast.
That’s concerning, but vaccinations may elicit a broader, more powerful immunity than a passing infection, so it’s impossible to say they won’t still work. And Moore said that blood from some patients, especially those who’d become very sick, were still able to neutralize the variant, at least in lab tests. “That is important when we think of vaccine, some vaccines elicit very high level of antibodies and others do not,” she said.
Another signal in favor of vaccines is that, so far, there is no clear evidence that the new strain is more likely to re-infect people who’ve had covid-19 before. If natural immunity does in fact hold up, then immunity gained from a vaccine likely would as well. “Are we seeing a systematic increase in reinfection? The data don’t allow us to say,” Karim says. Reinfection could still be prevented, he says, because the body “has two immune mechanisms, B cells that make antibodies, and T cells that go around gobbling things up and killing them.”
Researchers say that laboratory tests alone can’t prove whether vaccines will work against the new variants, and why they hope results from actual ongoing trials of vaccines in South Africa, the UK, and elsewhere may soon give better answers. “We are expecting an answer pretty soon,” Karim says. “But we want to see the actual data, and it is not yet available.”
Scientists are looking at two major possibilities where these variants are coming from. One hypothesis is the virus is evolving inside immune-compromised people, where it can persist for months while learning to dodge the immune system. Another idea is that variations are arising in cities like London, which suffered big infection waves early in 2020. Millions were infected, but if their antibodies waned over the year, then their bodies could be selecting for virus variants able to resist what remains of their immune response.
Some scientists now think that evolved variants are probably cropping up everywhere, not just in Britain and South Africa, but just haven’t been detected yet. “We expect as people increase genomic surveillance, multiple variants will be discovered, especially in places that have had a lot of cases for a long time,” says Tulio de Oliveira, who studies viral genomes at the University of Washington. “Unless we can suppress transmission to almost zero, the virus will keep outsmarting us.”
Scientists say they are fairly sure the variants in South Africa and the UK spread faster, causing about 50% more follow-on infections than the original strain from China. Part of the evidence is how fast the UK variant, called B.1.1.7, has taken hold elsewhere, outcompeting older versions. It already accounts for nearly half of cases in Israel, which is facing a peak in infections despite a big vaccination campaign. The 501Y.V2 variant, meanwhile, has already been seen in at least 10 countries.
Some of these variants share mutations, including one called N501Y, the one that lets it bind more tightly with human cells. To scientists, the copycat mutations arising in different continents means the virus is undergoing “convergent evolution.” That is, different variants of the virus are hitting upon the same strategies to escape the pressure of antibodies in the blood of those infected or vaccinated.
Waiting for answers
The big Johnson and Johnson study launched in September and finished enrolling 45,000 participants on December 17, according to the company, which says it will learn if the vaccine is effective by the end of January. If the results are positive, it could apply for authorization soon after.
Academic and government scientists, along with Johnson and Johnson, decided on an international approach for that vaccine and trialed the shot in Africa, Brazil, and other parts of Latin America, as well as the US. Now that move looks prescient. Their study launched exactly when the new variant was taking hold in South Africa. And it soon took over: more than 80% of cases in South Africa are now being caused by the variant.
“We wanted it to be globally relevant,” says Corey. “We hadn’t appreciated that strain variation would occur so quickly, but it’s allowing us to get an early read on what is happening and that is very fortunate.” A spokesperson for Johnson and Johnson said the company could not comment on the trial results until they become public. The company did not confirm how many South African volunteers were part of the study.
Researchers have started to plan how they could alter, or update, the vaccine shots to deal with new strains. The two messenger RNA vaccines can be reprogrammed fairly easily, according to the companies making them. That’s likely also the case with the Johnson and Johnson vaccine, which employs a harmless type of cold virus, to which a section of coronavirus is added.
To deal with variants, Corey says, it’s also possible the doses could be increased or boosted later on with “strain-specific” follow-up shots. Another idea is to aim vaccines at different parts of the virus that are slower to evolve than its spike protein, but such vaccines would take longer to develop and test.
Researchers in South Africa emphasized they can’t yet say that existing vaccines won’t work against the variant in their country, and several said they would definitely take a vaccine if it was offered. What they do believe is that the world has underestimated the virus, which is continuing to adapt and evolve.