The Case for a Pandemic Moonshot

The Covid-19 pandemic has killed an estimated fifteen million people around the world, ravaged health systems, and destroyed economies. It has also exposed destabilizing divisions at home and abroad, and revealed domestic and global weaknesses in biodefense. The United States alone has seen a million lives lost to the virus and an estimated $16 trillion in economic costs, making it the deadliest pandemic in our history and the costliest catastrophe since the Great Depression. The turmoil and grief Americans have faced reflect their justified frustrations with the government’s ineffectiveness in handling the crisis.

From the Special Series:

The Coronavirus Pandemic

This ineffectiveness also contributed to the extreme politicization of the crisis. Mask mandates were understandably frustrating and lockdowns maddening, and public health and political leaders were flummoxed when it came to basic communication. Our reliance on century-old responses spurred civil and political unrest as the public lost faith in leaders to protect them.

But there were also some bright spots in our response to the pandemic. Within weeks of recognizing the existence of a novel coronavirus, scientists mapped its genome and developed and produced vaccines faster than ever before. Living through this pandemic has created momentum to build technologies that we had lacked the will and resources to pursue before. We must build on that progress and push for greater advances that will protect us from the next infectious disease threat.

The Apollo Program for Biodefense is an ambitious plan from the Bipartisan Commission on Biodefense, a private organization founded in 2014 to assess the state of U.S. biodefense efforts and to issue recommendations for how to protect Americans from biological threats. We are, respectively, its co-chair and executive director. The program calls for the government to develop and deploy the technologies needed to defend against all biological threats, empower public health, and prevent pandemics, no matter what the source. It calls for groundbreaking solutions across fifteen different technology priorities, aiming to reshape the world we live in to keep us safe from infectious diseases.

We can create a world where we detect new pathogens early and continually trace them to their sources, where we can distribute rapid tests for novel pathogens to every household within days of detection, where effective treatments are already in hand and vaccines are developed and rolled out in weeks rather than years, and where we build our indoor environments in a way that allows us to gather safely with one another. We envision a time when people will look back and wonder how we ever let infectious diseases wreak havoc on our society.

This challenge will take sustained bipartisan support and political leadership. Both public and private sectors must work together, with the private sector providing research, talent, and manufacturing, while the government provides structure, oversight, and incentives for innovation. And since pandemics are a threat to all, we must work with other countries in a U.S.-led initiative, strengthening our international relationships while aiming to make not just America but the whole world a safer place.

We are at a turning point. It is time to harness America’s ingenuity, optimism, and grit to achieve resilience against biological threats. Anything less could have dire consequences — another pandemic triggering a human, economic, and political catastrophe, perhaps even worse next time. We can achieve this extraordinary mission in ten years, but only with dedicated leadership, resources, and public resolve that go beyond the usual pattern of crisis followed by neglect.

Trust in public health institutions was badly shaken by the pandemic and the government’s ineffective response to it. If we had possessed the technologies that the Apollo Program for Biodefense recommends, we could have avoided many of the pandemic’s worst effects with much less disruption to daily life.

Take masks, for example. If the government asks us to wear poorly fitting, uncomfortable masks that we are not even sure provide much protection, many can be expected to oppose wearing them. Next-generation personal protective equipment can help to rectify this by developing masks that are comfortable, reusable, and provide more protection than the masks available today. More sensible mask designs that are clearly effective might have prevented at least some of the politicization surrounding mask usage in the United States.

Another point of politicization throughout the pandemic has been vaccine uptake. Though hardly the whole story, one meaningful contributing factor may be fear of needles. The Apollo Program for Biodefense recommends developing methods to administer vaccines without using needles, making them easier to distribute and more comfortable to receive. Examples of promising technologies include pain-free microneedle patches, pills, and inhalable sprays, all of which individuals could even use themselves, without a visit to the doctor.

The search for the origin of Covid-19 was also highly politicized in ways that hampered investigations. The troubling truth is that we are still not certain where the virus came from. A laboratory accident and natural spillover both remain plausible hypotheses. The Apollo Program for Biodefense recommends developing and deploying technologies that would enable us to determine the sources or perpetrators of biological threats quickly and efficiently. Whether Covid-19 turns out to have come from a lab or not, we know that lab leaks are not rare and pose a serious hazard. To make them less likely, we must improve laboratory safety and security.

Other technologies recommended by the Apollo Program for Biodefense would address public frustrations with nationwide lockdowns by allowing for more targeted interventions instead. The three main justifications leaders offered for nationwide shutdowns were: first, we did not know where the virus was spreading or who was infected; second, indoor environments facilitated the transmission of the virus; and third, we lacked vaccines and therapeutics to reduce the severity of disease and the strain on the health care system.

We can eliminate the justifications for nationwide lockdowns with the right technologies to help detect infection and track disease spread: ubiquitous genetic sequencing of pathogens; less-invasive ways to detect infections; mechanisms for testing a person for numerous different diseases at once; at-home diagnostic tests; digital methods for disease surveillance; a national system for gathering, analyzing, interpreting, and communicating public health data; and integrated disease surveillance and forecasting. Better testing technologies would allow people to test themselves routinely, non-invasively, and with minimal disruption to their daily lives, allowing them to go to work or school safely. Better biosurveillance and disease forecasting would allow for targeted interventions in communities where the disease is actively spreading, without burdening the entire country with lockdowns.

We should also work to develop ways to prevent the transmission of pathogens indoors. Imagine if we treated this the same way we treat other building safety issues. All buildings in the United States must incorporate technologies and follow guidelines to help them be resistant to fires and explosions. Many areas require owners and operators to make buildings resilient against other threats such as earthquakes, hurricanes, and floods. Infrastructure improvements like affordable air filtration and sterilization systems, better airflow design, self-sterilizing surfaces, and real-time pathogen-sensing equipment can do for disease transmission what building codes have done for fires and natural disasters. This would allow us to go to work, children and teachers to go to school, and all of us to conduct daily life with confidence that our environment helps to protect us from infectious diseases.

Finally, a lack of vaccines and therapeutics early in the pandemic meant that there was no other way to reduce hospitalizations, deaths, and the strain on the health care system. The Apollo Program for Biodefense proposes to develop a vaccine candidate for a pathogen in each of the twenty-six virus families that infect humans. We were able to develop the Covid-19 vaccines more quickly because of the work that had previously been put into trying to develop vaccines for related SARS and MERS viruses. And now that we have actually developed vaccines for Covid‑19, we will be that much further ahead in developing vaccines for other variants of the virus as they emerge, or for other novel coronaviruses. If we do the same for other virus families, we could have approved, safe, and effective vaccines within a hundred days of recognizing a new viral threat.

We can do the same with therapeutics for treating a wide variety of pathogens, and before new threats emerge. Since we will not know what the next biological threat will be, the traditional approach of developing a therapeutic for a single virus will not adequately prepare us. Broad-spectrum antivirals could counter a wide variety of viruses, much like broad-spectrum antibiotics can counter multiple bacteria.

We must also further establish flexible and scalable manufacturing capabilities for vaccines and therapeutics, to be able to produce enough for the entire population within a month after approval. Having vaccines and therapeutics on hand means we would be able to significantly reduce deaths and hospitalizations caused by any infectious disease threat, without needing to resort to crude, blunt, restrictive measures like lockdowns.

The Apollo Program for Biodefense offers a more effective way for dealing with infectious disease threats than what we have done in the past. It promises millions of lives and trillions of dollars saved that will otherwise be lost to future pandemics and other biological threats. It offers a path forward that is more effective, that would strengthen our national vitality, and would inspire confidence in Americans that we will be ready.

Now is the time to advance technological solutions to the problems that Covid-19 has revealed with horrific clarity. Operation Warp Speed took some first steps, making the most of new technologies, helping fields of study converge, and introducing many promising innovations.

When the original Apollo Project began, the know-how needed to get to the Moon did not exist. Today, we already possess the scientific capabilities we need to achieve the mission of the Apollo Program for Biodefense. Now we must harness them to deliver on this promise.