We w/@ICAP_ColumbiaU, published about our plan to for global vaccination for COVID by end of 2021. The plan relies on producing 16 billion doses of a highly effective mRNA vaccine at <$3 a jab, coupled w/ resources to ensure global distribution. 🧵1/24 nytimes.com/2021/01/12/opi…
Right now, even if everything w/ production goes perfectly, and EVERY leading vaccine candidate proves to be equally effective, current vaccine production will be insufficient to ensure universal global vaccination for COVID-19. 2/24 
The real situation is far more dire than that. The Chinese inactivated vaccines & the AstraZeneca\Oxford vaccines – the majority of planned global production -- are likely much less effective than the mRNA vaccines, and we don’t have data yet on the others. 3/24
And vaccine efficacy matters. A more effective vaccine means that you need to immunize less of the population to achieve “herd immunity”. Tl;dr if you use a more effective vaccine, its easier and faster to bring the epidemic under control. 4/24
The current way, giving the least effective vaccines (or none) to poorer countries, is setting up the fight against COVID for failure. It’s possible that some of these vaccines would be unable to achieve epidemic control, even if 100% of the population was vaccinated. 5/24
But the world lucked out. The most effective vaccines we have so far, the vaccines from @NIAIDNews/@modernatx & @pfizer/@biontech, are mRNA vaccines – a technology that is faster and cheaper to produce than most others. 6/24
Despite this, we are only making enough of Moderna’s vaccine – which is easier to store than Pfizer’s -- for 500 million people in 2021. That needs to change. 7/24
Part of the problem is that the world has never made a mRNA vaccine outside of research settings, so the industrial capacity doesn’t yet exist to produce these vaccines, and their constituent components, at such large scale. But we can change that. 8/24
Scientists and engineers at @ImperialCollege estimate that building such industrial capacity, to produce 16 billion vaccines/yr, enough for the entire world, would cost less than $4 billion, and be able to produce each jab at a cost of $2.02 per dose. 9/24 mdpi.com/2076-393X/9/1/…
This would be significantly less than the US spends *every day* on COVID related relief. 10/24
Another part of the problem is that vaccines are not like HIV drugs or other “small molecule” drugs. There are no generic vaccines. So you cannot increase production (rapidly) by *just* releasing or licensing the intellectual property. 11/24
This is because subtle changes in the manufacturing process of a vaccine can have profound impacts on its safety and efficacy. 12/24
Rapidly increasing production capacity for vaccines instead relies on contract manufacturing – where another manufacturer is contracted to make the EXACT same vaccine, using the same manufacturing process, with the guidance and cooperation of the original manufacturer. 13/24
This is how the majority of Moderna’s vaccine is made, not by Moderna itself, but by a contract manufacturer, @LonzaGroup, who is manufacturing the vaccine for Moderna in New Hampshire and Switzerland. 14/24 bloomberg.com/news/articles/…
Our plan extends this model. It uses the immense legal and financial power of the US government to build facilities to rapidly increase the production capacity for Moderna’s vaccine. USG facilities would be operated by a contract manufacturer experienced in production. 15/24
Our plan extends this model. It uses the immense legal and financial power of the US government to build facilities to rapidly increase the production capacity for Moderna’s vaccine. USG facilities would be operated by a contract manufacturer experienced in production. 16/24
Critically, this approach would preserve this industrial capacity for the USG, so once the COVID-19 pandemic is over, we would have sufficient standby mRNA production capacity to produce a huge number of mRNA vaccines to fight a future pandemic. 17/24
What about intellectual property licensing? This vaccine was developed by a partnership from the U.S. Government and Moderna. As @zainrizvi showed, the USG already owns patents on the vaccine and claims co-ownership of the vaccine. axios.com/moderna-nih-co… 18/24
But Moderna likely owns other IP that protects the vaccine. We will need to compensate Moderna for the use of this. A key to reducing the price of the vaccine is to decouple the price paid per jab from the amount we pay Moderna in licensing fees. 19/24
One approach to do this is for the US Government to pay a fixed price per year, a “subscription” price, for the intellectual property and know how, used to make the vaccine. This means that we could make as much vaccine as we want, for a fixed price. 20/24
This would allow us to ensure that low and middle income countries could access the vaccine at the cost of production. 21/24
The U.S. Government needs to, as it does in the global AIDS response, not only to greatly increase access to vaccines, but also to increase the ability for people around the world to store and administer the vaccine. 22/24
The COVID-19 pandemic is the largest global public health emergency we have faced since the advent of modern medicine. The only way that we are going to be able to end the epidemic in the US is if we end the pandemic globally. 23/24
Every day we delay in scaling up effective vaccines globally, we cause countless deaths and risk the development of more communicable or possibly resistant virus variants. We have the ability to end this pandemic rapidly. The only question is will we? 24/24
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