Mind Crunches #8: The O-Ring Problem of Covid-19 Vaccines
Alternatively: We are not future-ready
The O-ring theory of economic development is a model of economic development put forward by Michael Kremer in 1993, which proposes that tasks of production must be executed proficiently together in order for any of them to be of high value. The key feature of this model is positive assortative matching, whereby people with similar skill levels work together. The name comes from the 1986 Challenger shuttle disaster, a catastrophe caused by the failure of a single O-ring.
Once you start to think about O-ring problems, you see them everywhere. A bank is useless if you can’t trust it to keep your money safe from hackers. The most stylish and comfortable car is worth nothing without reliable brakes. You can build a sophisticated factory in a jungle but your efforts will be in vain if you can’t keep the road to it open.
O-ring economies are self-perpetuating. If an economy has undrivable roads, unreliable electricity, impassable queues at customs, corrupt courts, and untrained workers . . . well, where is progress to come from? Improve the roads and you’ll still be foiled by the electricity; train the workers and the crooked legal system will still take you down.
The Covid-19 Vaccine Ecosystem & The Weakest Link
As you probably already know, a few days ago, a Covid-19 vaccine being developed by Pfizer and Germany’s BioNTech was found to be more than 90% effective, in a breakthrough that could make the shot available for use by the end of the year if drug authorities give it the green light. On top of that, Anthony Fauci, the leading US infectious disease expert, predicted positive data from a second Covid-19 vaccine could also come quickly (from the biotech group, Moderna).
This is indeed amazing news, giving us (desperately needed) hope during these difficult times, as we witness a new Covid-19 outbreak in Europe and U.S.
What is not adequately reported is the ecosystem that needs to be developed to properly support a new vaccine and save lives worldwide. Or as Kremer would ask, have we checked all the weak links?
In other words, you can’t drive a Ferrari in a road with potholes.
To properly assess what could be the weakest link that could doom the vaccination to fail, we need to know the basics of the science behind the vaccines.
Gene-Based Vaccines, Transportation & Distribution
The new Covid-19 vaccine is based on an entirely new technology. It’s an mRNA vaccine; rather than injecting weakened or dead virus materials, it harnesses our own cells to make the antigens that prime our immune system to fight future infections, exactly where those antigens are needed. This is a brilliantly simple idea with many advantages over existing technologies that rely on virus material – but like most brilliant ideas, it takes lots of effort to make it actually work.
Just to imagine the complexity of gene-based vaccines, the strength of the vials play a very important role in the protection of vaccines.
Drugmakers and health authorities are counting on Corning’s new medical glass container, named Valor, to protect Covid-19 vaccines better than conventional ones, especially during initial months when supplies will be limited and little can afford to be lost.
Thanks to their special recipe, Valor vials can be filled faster than conventional counterparts, and then withstand the subzero temperatures required to store the leading vaccine candidates. The vials are also embedded with identifiers visible under black light to prevent counterfeiting.
One downside to mRNA vaccines is that they have to be stored an an extremely low temperature, which makes them more difficult to transport. mRNA is an unstable compound, and keeping it cold makes sure it won’t break down before its injected into the arm of a patient.
Someone would imagine that it will be fairly easy to transport something in low temperature in 2020.
At the end of the day, if humans can manufacture an mRNA molecule making the virus proteins that cause the chain of events leading to immunity, they can also build intelligent, fast and efficient supply chains.
It seems that we are not there yet! We have made amazing scientific advancements empowering us to face a new pandemic but we haven’t kept a similar pace of innovation in the “world of atoms”.
Are airlines ready to transport the vaccines?
The answer is maybe. Most air freight is carried not by freighters but in the belly holds of passenger aircraft. Since the pandemic started, airlines have slashed international routes, resulting in a cargo capacity crunch just as cargo demand and profits started to rise. A second challenge is maintaining the “cold chain,” or keeping the vaccines cool from manufacture to delivery. It’s not a matter of life and death if the cold chain fails for a shipment of fresh fruit. It could be if a shipment of vaccines is exposed to high temperatures, during land transport to the airport, on the tarmac, or even at the delivery airport if the shipment is held up by customs.
Even if we solve the challenge of “cold chain”, there is still not an official plan on how to distribute a Covid-19 vaccine. Many thousands of people are dying every week but governments haven’t figured out how to run an effective and fair distribution. Alex Tabarrok seems to be one of the very few academics who has a structured proposal.
To further simplify the logistical challenges of distributing the vaccine, it might make sense to run such a lottery by place rather than by individual. Each hospital, fire station, police station and nursing home would be entered into the lottery -- weighted according to the number of individuals at each place. The lottery would then determine the order in which those sites would receive vaccines.
Are We Truly Ready for the Future?
We know by now that the Covid-19 pandemic has accelerated the adoption of new digital technologies and the transformation of industries. I also believe that Covid has challenged us to use more of our human ingenuity to solve complex problems. For example, the recent program of the Slovakian government to test its entire population in one weekend was a true example of how symbiotic is the relationship between humans and technology.
At the same time though, Covid has brought to surface the arteriosclerosis and fragility of our systems. We keep advancing in science and technology but we are still centuries behind in modernizing the “o-rings” like our healthcare system or our supply chain capabilities. Nearly everything about how we evaluate, manufacture, deliver, administer, and pay for our healthcare will need to change. As our medicines become programmable, we will need to reprogram our healthcare system to absorb them—otherwise, our innovations will overwhelm our infrastructure.
The sad reality is even if we had the cure for cancer in hand tomorrow—or if we discover we can program our immune cells to fight off COVID-19—our current system couldn’t handle it. Every new technology introduces second-order effects, and more questions: What happens when a therapy becomes part of your own biology? Who’s responsible for payments if a patient changes insurance? What new ecosystems might form around all this?
Living medicines made of cells and genes are blurring lines all across the industry: from medicines as products to procedures, from paying per pill to mortgages for health, from managing care to creating real cures. But even the most effective therapies don’t work if they can’t reach patients. Innovation needs new infrastructure: cars needed roads and highways; telephones needed cables and wires. All of the stakeholders in the healthcare system—regulators, manufacturers, payors, and providers—need to prepare.
The cures are coming. Now is the time to build those roads. Or we may find that we aren’t able to take our medicine.
QUICK MIND CRUNCHES
“The next decade could be even worse” - excellent profile of Peter Turchin from The Atlantic. Turchin believes he has found iron laws that dictate the fates of human societies and has founded a new area of research called “cliodynamics”!
Greylock on an insightful post about the future of cloud the inherent advantages of cloud native organizations.
How startups are building “cults”. Excellent post on the religions of technology!
Geology is destiny! Great thread on how geology shapes voting behaviors.
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