This interview is part of COVID-19 vaccines: The road to recovery and beyond, a series that includes a broad array of voices leading the historic global effort to develop, distribute, and provide equitable access to COVID-19 vaccines, including the Africa CDC; CEPI; Gavi, the Vaccine Alliance; Moderna; and Pfizer.
Before COVID-19 emerged, viruses of epidemic proportions had been top of mind for leaders in global public health for decades. In 2017, the concern led to the creation of the Coalition for Epidemic Preparedness Innovations, or CEPI, with the purpose of financing breakthrough independent research projects to develop vaccines before pandemics could take hold. Launched by the governments of Norway and India, the Bill & Melinda Gates Foundation, Wellcome, and the World Economic Forum (WEF), CEPI is the largest vaccine-development initiative focused on viruses that are potential epidemic threats.1
The coalition, founded in the wake of the West Africa Ebola outbreak of 2014–16, funds clinical trials for vaccines against Middle East Respiratory Syndrome (MERS), Nipah virus, and Lassa fever, among other diseases. As a part of this effort, CEPI invests in innovative platform technologies—systems that can be adapted against different pathogens, such as mRNA2—that can be used for rapid vaccine development.
CEO Richard Hatchett leads the global vaccine-development fund following his previous roles in the public sector, including serving as acting director of the US government’s Biomedical Advanced Research and Development Authority (BARDA), a member of the US Homeland Security Council for then-president George W. Bush, and a member of the US National Security Council for then-president Barack Obama. Under Hatchett, CEPI is championing a global effort to compress the vaccine-development process from 300 days—a huge breakthrough achieved for COVID-19—to just 100 days.3 This effort has been embraced by the G-7 summit in its report, 100 days mission to respond to future pandemic threats.4
McKinsey’s Tania Holt and Lieven Van der Veken joined Hatchett to discuss the key components of CEPI’s strategic five-year plan, also called CEPI 2.0, which lays out the 100-day goal, as well as the tools that could help reduce COVID-19 variants and future pandemic threats. The following is an edited excerpt of their conversation.
McKinsey: What were some of CEPI’s goals pre-COVID-19, and how did they influence the pandemic response?
Richard Hatchett: We had not yet celebrated our third anniversary when the pandemic started. Our main goal before COVID-19 was to support vaccine development against emerging infectious diseases that we anticipated might have, at most, regional impact—such as Ebola in West Africa—and we were especially focused on ensuring equitable access to these vaccines, since the risk of emerging diseases is greater in lower- and middle-income countries.5 That’s where all of the diseases we worked on were principally found.
Pandemic flu was not on our agenda because there is a global architecture in place directed against pandemic flu. In retrospect, I see it as shortsighted to think that the only pandemic threat was influenza. But where we weren’t shortsighted was in recognizing that we might encounter new diseases where we needed to develop vaccines very rapidly. Many of us viewed coronaviruses as a particularly concerning threat, so we allocated around $140 million to developing vaccines for MERS, another infectious respiratory illness caused by a coronavirus [MERS-CoV].6 We had also made substantial investments in rapid-response platforms, including a couple focusing on mRNA-based approaches.
When COVID-19 emerged, we were able to ask our partners who were working on MERS and rapid-response platforms to turn their attention to COVID-19 and the ignition of COVID-19 vaccine programs. Within a couple of months, it became obvious that the vaccines were going to be needed at a global scale, and we started working on vaccine accessibility as well. Our experience with COVID-19 has been an extension of commitments that we made prior to the pandemic, which allowed us to leap into the pandemic response.
McKinsey: How did CEPI respond to the pandemic, and can you describe some of the impact it has had?
Richard Hatchett: CEPI formulated the COVAX7 concept with Gavi, the Vaccine Alliance,8 early in the pandemic to address the challenges of global vaccine development, allocation, distribution, and access. The COVAX mechanism, co-led by CEPI, Gavi, and WHO, with key delivery partner UNICEF, includes philanthropic and sovereign partners, the private sector, and civil society coming together to fight the pandemic.
A term sometimes used to describe these partnerships is “networked multilateralism.” Such efforts are objective-driven or mission-focused and bring together partners from different sectors, typically for a limited time to achieve a specified end. This was at the heart of designing the COVAX concept. The pooling of investment in R&D to have an expanded portfolio provides benefits to all, particularly in an uncertain environment where it was unknown what percentage of the vaccines were going to be successful.
As part of the initiative, we made a choice early on to use our R&D investments to secure access commitments from our partners. These investments had the potential to result in COVAX having a right of first refusal to up to three billion doses of COVID-19 vaccines—if the programs were successful. With this approach, we had hoped to provide more equitable distribution of vaccines. However, we’ve only been partially successful.
When the first shipments of COVID-19 vaccines went out from COVAX at the end of February 2021, we watched the footage of people in Ghana and Côte d’Ivoire receiving vaccines. It was incredible to have seen what, at that point, was nearly 14 months’ worth of effort resulting in vaccines being delivered to people who didn’t expect to see them that soon. It was really powerful and a vision of hope for the African continent. But subsequent deliveries were paralyzed by restrictions on the export of vaccines from one of our major suppliers. Consequently, as of September 2021, only about 3 percent of Africa’s population has been fully vaccinated.9 Vaccine supplies are beginning to increase now, but we need more equitable and efficient solutions for the future. Understanding why COVAX couldn’t deliver in the time frame needed will be an important lesson for designing better systems.
McKinsey: In March 2021, as part of a new initiative to tackle future pandemics, CEPI announced the ambition to develop a vaccine in under 100 days. How did this goal come about, and what will it take to make it happen?
Richard Hatchett: COVID-19 has been a catalyst for the rapid scientific and technological development of vaccines. It’s changed the face of vaccines. We now have the rapid-response tools in play that we believe—if coupled with investments in preparedness and advancements in regulatory science and process—could get vaccine development down to 100 days. The 100-day goal pushes us to define and prioritize what needs to be done first and identify what, if anything, needs to change to make it possible. We can then take strides to create the necessary change. Our 100-day ambition is based on a three-pronged approach.
First, preparing a library of vaccines against prototype pathogens10 that can be adapted rapidly to meet new threats. Virus taxonomy11 is changing all the time. Depending on how you count viral families, there are between 25 and 28 that we know can cause human disease. Each viral family presents viruses with a particular structure—whether DNA or RNA, single stranded or double stranded, encapsulated or not—that poses unique challenges from a vaccinology perspective. We have vaccines for pathogens from 15 of the families, which proves at least that vaccines are possible. But only one or arguably two of them have been developed on rapid-response platforms. Our ability to pivot to respond to new threats is currently very limited. We now want to develop vaccines on rapid-response platforms against prototype pathogens from each of the families. If we can do that, we hope to be able to accomplish what we were able to with COVID-19, which was to use what we knew about developing vaccines against one coronavirus [MERS] to accelerate the development of vaccines against another [SARS-CoV-2]. To be truly prepared, we need to be able to do that for any viral threat we might face in the future.12
The second component is optimizing and reducing the time required at every stage of the vaccine-development process. By focusing on every element of that process, we can begin to optimize and ideally shorten development timelines. Some of the time savings may be incremental and only shave a week off here or a few days there, but some may be more impactful. In aggregate, we think we can achieve significant efficiencies.
Third, we need to work with regulators to develop risk-adapted strategies for ensuring that safety and efficacy of new-candidate vaccines are carefully evaluated.13 Time savings may come on the back end with new approaches to carefully regulating safety and efficacy while working more efficiently. These strategies can also help us anticipate the need for new provisions if we face something that is even more threatening than COVID-19.
The 100-day goal is a quantum leap over what we did in 2020, but it’s not unattainable.
McKinsey: What are some approaches for the long-term management of COVID-19 and other epidemic diseases or potential future pandemics?
Richard Hatchett: COVID-19 is going to be with us for the foreseeable future, so we need to prepare ourselves for that and continue to work on COVID-19 until the world is well positioned to manage a long-term relationship with the disease.
The emerging issue of waning immunity and the threat posed by the evolution of the virus tell us that we need to produce broader and more enduring immune responses.
There is still work to be done to optimize the use of the vaccines we have. The emerging issue of waning immunity and the threat posed by the evolution of the virus tell us that we need to produce broader and more enduring immune responses. We are evaluating mix-and-match dose strategies, where first and second doses could be from different manufacturers, to improve the performance, as well as fractionated, or dose-sparing strategies, to boost coverage of the vaccines we have. We also need to determine the optimal sequence for “priming”—which refers to the intervals between doses and whether two or three doses are required.
The vaccines we have now represent only the first generation of COVID-19 vaccines. They have been terrific at helping reduce the impact of the virus. But there could also be improved vaccines for the long term, ideally ones that perform equally well against most or all variants and that protect broadly against coronaviruses, such as SARS, MERS, COVID, and all their cousins. There is some exciting data emerging that suggests that developing such a vaccine may be possible,14 which would likely help us reduce, or even eliminate, the threat that coronaviruses present.
We also know about other epidemic diseases like Ebola and Lassa fever, which may be lesser threats but are not going away. While the epidemics they can produce won’t have the kind of scale that a pandemic has, they can still have tremendous global and economic impacts. For example, the best estimate of the Ebola epidemic in West Africa is that it created a global social burden in excess of $50 billion on top of the direct impact that it had on the economies and livelihoods in the countries that were affected.15 We need to continue our efforts to develop solutions for such threats, even while we prepare for unknown fast-moving pathogens that could emerge as serious infectious diseases.
We can also endeavor to create a global architecture for response that connects efforts around the world—from national efforts to regional efforts to the international efforts that CEPI will support directly. This relates to making sure that the world is connected and able to coordinate its efforts and do that very rapidly in a crisis. Collectively, we can invest in building out clinical-trial networks, lab networks, networks for performing animal-model studies, and not leaving anybody behind by making sure that we include lower-income, lower-middle-income, and upper-middle-income countries in the process.
CEPI sees itself playing an important role in helping to knit together that global collaborative effort in partnership with WHO, the major international financing institutions, and our other multilateral and regional partners. Emerging regional efforts are already showing strong potential in playing an increasingly important role in preparedness. We’re seeing that in the efforts of the African Union to promote the development of manufacturing capacity in Africa16 and of the European Union to establish a Health Emergency Preparedness and Response Authority [HERA]17 modeled on BARDA. We’re likely to see a lot more of these types of efforts in the future.
McKinsey: What are some of the biggest challenges in increasing pandemic preparedness?
Richard Hatchett: The biggest challenges are around vaccine manufacturing—and these are manifold. For the COVID-19 response, we have experienced challenges around supply chains and making sure that our producers have the materials they need to make the vaccines.
As we think about manufacturing capacity for the future, we need to recognize the factors that have come together to produce the outcomes we don’t like in the current response—the fact that a handful of countries and regions have dominated the vaccine supply—and take these into account as we develop solutions for the future. And whatever solutions we propose need to be sustainable. There will undoubtedly be a strong desire by many countries to have their own vaccine manufacturing facilities. But the question is, how many facilities can the world support and sustain? A facility that is built and then mothballed to wait until the next pandemic is not going to be very functional. So we have to balance across those dilemmas and find solutions that maximize our ability to scale up rapidly when necessary but that can also produce vaccines sustainably when we are not responding to a global crisis.
Also, as we think about global manufacturing capacity, we shouldn’t do it with blinders on. We won’t necessarily have to be able to vaccinate eight billion people every time a pandemic threat emerges. If we detect it early enough and use an empowered public-health enterprise to respond and suppress transmission—while we do the compressed-vaccine development and bring countermeasures in—maybe we only need 100 million doses. We shouldn’t just focus on our productive capacity for vaccines without recognizing that we need to be able to address pandemics as efficiently as possible.
McKinsey: What has worked well in the current response efforts, and how might we need to improve our efforts moving forward?
Richard Hatchett: What’s gone well is attributable to the sense of global scientific solidarity—the degree to which the global science community came together to understand the virus, to understand its epidemiology, and to develop countermeasures. That has been extraordinary. And the industry effort to develop vaccines, in particular, at record speeds represents a historic accomplishment.
Vaccine access and delivery have definitely been a challenge, but 18 months into the pandemic we have distributed more than five billion doses of vaccines. That’s beyond the highest of high-side scenarios that we could possibly have imagined. Unfortunately, those vaccines haven’t been shared equitably, but the production of vaccines at that scale is also a historic accomplishment.
Now it’s time to capture the practical lessons learned. We can accomplish this by doing a credible, after-action review and being very honest and objective about anything we might have done that could have improved the response and choices that seemed rational at the time but may have contributed to a less-than-optimal outcome. We anticipated the risk of vaccine inequity and tried to hedge against it by investing in multiple technologies with manufacturing distributed across multiple geographies. And yet, we ended up in a position where some of those risks materialized, leading COVAX to experience severe and prolonged vaccine shortages. Facing these issues head on will allow us to emerge from this experience stronger and smarter.
The views and opinions expressed are those of the interviewee and are not necessarily those of McKinsey & Company. These materials are provided “as is” solely for informational purposes. The materials are not a legal, health, or safety resource, and organizations should engage their own experts to ensure compliance with applicable laws and standards. The materials are current as of the date indicated and may not incorporate the most recently available information. References or links to source materials do not imply any endorsement or recommendation by such source. McKinsey does not express an opinion or recommendation in the materials concerning COVID-19 vaccines.