Since the COVID-19 pandemic began in early 2020, much of the media attention has focused on policy controversies over short-term public-health measures such as masking and social isolation. But when viewed by historians, the real story will be the race for a vaccine—which has proved to be the single most important anti-COVID public-health weapon. This urgent project represented a once-in-a-generation technological challenge, arguably on par with the Manhattan Project or Apollo Program.
Most of us know the names of the companies and collaborations that announced the first major vaccine breakthroughs—including Pfizer–BioNTech, Moderna, and Oxford-AstraZeneca. Yet relatively few appreciate how much of this success was owed to Operation Warp Speed (OWS), the $US18 billion public–private partnership initiated by the United States government in the spring of 2020 with the goal of “accelerat[ing] the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.” Those wishing to learn about the subject will find a wealth of information in a newly published first-hand account by healthcare expert Paul Mango, Warp Speed: Inside the Operation that Beat COVID, the Critics, and the Odds.
Mango, a West Point graduate and former healthcare executive, served Donald Trump as deputy chief of staff for policy at the Department of Health and Human Services (HHS) from 2019 to 2021. Prior to joining Trump’s administration, Mango made an unsuccessful run for governor of Pennsylvania in 2018, losing in the Republican primary to former state senator Scott Wagner. But aside from setting out a generally conservative approach to healthcare policy (more on this below), Mango hasn’t written a partisan or self-promotional book of the kind one might expect from a former (or future) political figure. Instead, he focuses on acknowledging and applauding the efforts of other Warp Speed protagonists, including project lead Moncef Slaoui, HHS secretary Alex Azar, development lead Colonel Matt Hepburn, Peter Marks of the Food and Drug Administration, National Institutes of Health director Francis Collins, HHS Assistant Secretary for Preparedness and Response Bob Kadlec, Chief Operation Officer General Gus Perna, and Carlo De Notaristefani, OWS’s lead advisor manufacturing & supply chain.
As that list will attest, OWS’s leaders came from a range of specialties and organizational backgrounds. But from the beginning, Mango appreciatively recounts, Slaoui (formerly the head of GlaxoSmithKline’s vaccine unit), emphasized the value of teamwork: “When someone in the room would refer to himself as a member of his originating organization (e.g., BARDA, NIH, CDC), [Slaoui] would interrupt and say, ‘You meant to say you are a member of the Operation Warp Speed Team.’ Everyone got the message instantly.” Indeed, Mango’s criticism of former White House Coronavirus Response Coordinator Deborah Birx (who recently testified before a congressional committee investigating the federal pandemic response) is based largely on the contention that she was not a good team player and acted in an unnecessarily confrontational matter at meetings.
Mango’s emphasis on loyalty, duty, and teamwork as guiding values may stem from his career in the army, which began in the 82nd Airborne Division in Fort Bragg, and included training at the US Army Ranger School, US Army Airborne School, and US Army Jumpmaster School. “My involvement in Operation Warp Speed was simple,” he writes. “It was the partial fulfillment of an obligation I incurred over forty years before, when I raised my right hand on The Plain at West Point for the first time.”
Mango helped lead the effort to expand US national COVID testing capacity to over three million tests per day. But he writes that his work at OWS was always guided by a mission to “rigorously prevent the federal government from engaging in any activity the private sector could perform better.” In fact, much of his work was aimed at overcoming the slow pace of government operations as much as marshalling government assets, especially in regard to the cumbersome protocols surrounding vaccine development. He reports that the Warp Speed team “design[ed] a governance structure that bypassed the slow grind of bureaucratic decision-making,” and that vaccine candidates were “select[ed] for investment in ways that spread our risk as a venture capitalist would over a variety of technologies and companies.”
This decision to spread OWS’s financial bets across multiple private-sector candidates reflected Slaoui’s desire to maximize the possibility that at least one candidate vaccine that proved effective against severe forms of COVID disease could be deployed by the end of 2020. (As it happened, the first vaccines did begin to roll out in late 2020, though distribution fell short of the announced goal of providing an initial dose to 20 million Americans by December 31st). This proved to be a far-sighted approach, as only a small share of the dozens of candidate vaccines announced worldwide ever made it to mass distribution.
Crucially, producers of candidate vaccines were provided with advance purchase commitments, thus creating a locked in market incentive sufficient to encourage rapid development of any vaccine that proved safe and effective. (This kind of “pull-funding” model, which incentivizes late-stage product development, is distinct from so-called “push” incentives that simply use direct public subsidies to compensate private actors for their costs. By creating a market incentive for any product that meets the public’s needs, pull-funding aims to avoid the practice of government bureaucrats picking winners and allocating capital inefficiently.) Moreover, bureaucratic red tape was removed thanks to the implementation of an accelerated FDA review process at each stage. And so a vaccine-development process that typically took many years, or even decades, in the case of other diseases was compressed into mere months.
As Mango recounts, the US military was critical to the success of OWS in a number of ways. Years before COVID emerged, the Pentagon’s Defense Advanced Research Projects Agency (DARPA) was already funding the development of a pandemic-focused vaccine platform based on the same mRNA technology that would eventually be implemented by both Pfizer–BioNTech and Moderna in their COVID-19 vaccines. Secondly, as noted above, many of OWS’s key personnel were either current or former members of the military (including Kadlec, who spent a quarter-century as a physician in the US Air Force before joining the FDA). Finally, key operational responsibilities relating to production and distribution were handled by the military, which is perhaps the only organization with the resources and experience to take on a project of this scale.
Again, this book isn’t a political manifesto. But Mango’s message does have political implications, insofar as the model of applying military and government leadership so as to unleash the creative magic of private profit-seeking actors offers a model for addressing not only future pandemics, but also the defense against engineered biothreats more generally.
While the free market, acting alone, can’t fully address such apocalyptic national threats, the OWS template (in regard to antiviral medications as well as vaccines) at least allows for the maximization of private involvement while mostly confining the government role to bare (mostly financial and logistical) essentials. In particular, assuring drug companies that their vaccines will be purchased by the government on profitable terms has a huge incentivizing effect, as it ensures that these companies won’t be left with warehouses full of medicines they can’t sell.
The idea of advance market commitments had been developed and promoted by University of Chicago economists Rachel Glennerster (who served as chief economist at the UK’s ministry for international development cooperation under Boris Johnson) and Michael Kremer (who won the Nobel Prize in part for his work in this area). George Mason University economist Alexander Tabarrok was among the first to realize how important this concept was in regard to addressing the COVID-19 pandemic. A publicly funded “prize,” as he called it, “can be announced quickly. A billion-dollar prize for a new vaccine against COVID-19, for example, does not require investigating or evaluating scientific hypotheses or scientific teams. It doesn’t even require a billion dollars. It requires only a credible announcement and a clear measure of vaccine effectiveness so that candidates can be evaluated and rewarded.” The advance purchase commitments implemented by Warp Speed effectively constituted such a prize.
As Senator Tom Cotton writes in his foreword to Mango’s book, Warp Speed represents a success that the US government needs to build on. While Joe Biden was quick to phase out the OWS brand (on the basis that “Warp Speed” had been the “Trump team’s name for their program”), the policies of advance market commitments, regulatory acceleration, and military-biothreat funding shouldn’t be a matter of partisan dispute. Even now, the Walter Reed Army Institute of Research in Maryland is developing a potential “pan-variant” COVID vaccine, a project that many believe needs more funding than Biden has provided so far. Meanwhile, development of intranasal and oral “second-generation” COVID vaccines has been delayed by a lack of regulatory clarity and administrative urgency, problems that might be addressed by implementing a regulatory fast track for biothreat countermeasures modeled after the Warp Speed approach.
The current administration should acknowledge that OWS was a success, even if Americans’ overall response the pandemic was tragically deficient. Biden should reach across the aisle, and launch a second iteration of Warp Speed aimed at not only creating improved COVID vaccines, but also a permanent federal stand-by capacity that ensures the rapid deployment of the sort of market-friendly pull-funding approach that Paul Mango describes.
He and his OWS compatriots deserve the world’s thanks for their efforts. We will have to see who picks up their mantle in the war against future diseases.