Seek a vaccine, but not at the expense of fighting the coronavirus now
By ROBIN WOLFE SCHEFFLER | Special to The Washington Post | Published: July 24, 2020
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The ink is still drying on a $1.95 billion deal between the United States and Pfizer to deliver 100 million doses of an experimental coronavirus vaccine to Americans as soon as this winter. The contract is the largest awarded by “Operation Warp Speed,” the Trump administration’s ambitious plan to accelerate the production of a vaccine, and arrives on the heels of billions of dollars channeled to other pharmaceutical firms.
It’s a potential milestone in the course of the coronavirus pandemic, but the fate of a government intervention in the fight against cancer provides an important cautionary note: Vaccine development can’t come in a vacuum. It needs to be combined with addressing the social and political factors that exacerbate disease and limit the access of many Americans to basic medical care.
In the mid-20th century, there was no room for the federal government in biomedical research. Even after the extensive mobilization of the federal government in drug and vaccine development during World War II, the medical establishment resisted this role continuing in peacetime. The American Cancer Society opposed calls for a “Manhattan Project” to cure cancer, despite the widespread public support it garnered in the immediate aftermath of the war.
The most striking public health success of the 1950s, the polio vaccine, was developed by a voluntary organization, the National Foundation for Infantile Paralysis, which had joined its Republican allies in Congress to blast the idea of federal spending on polio as a “totalitarian” idea.
The savvy efforts of Mary Woodard Lasker broke this impasse. An ardent New Dealer and medical philanthropist, Lasker advocated for national health care and birth control and firmly believed that the government needed to assume responsibility for health care alongside other social welfare programs.
Yet in 1948, Lasker and other activists failed in their campaign for national health insurance. Opposition from the American Medical Association and business groups defeated President Harry S. Truman’s national insurance plan. With the escalation of the Cold War, the political prospects of future bills also looked bleak.
Faced with this setback, Lasker charted a new path: federal investment in biomedical research.
She came to see medical research as a powerful means of fostering the nation’s health. The successes of polio vaccination and antibiotics lent credence to her ambitions and helped her avoid the politically fraught issues surrounding medical care. Her motto — “If you think research is expensive, try disease!” — echoed through the halls of Congress.
Cancer, the most dreaded disease of the 20th century, provided Lasker with an ideal target. Most experts were hesitant to say that cancer could be cured, but Lasker embraced a new approach to treating the disease: chemotherapy. Unlike surgical or radiological treatments, chemotherapy suggested that drugs could be developed to eradicate cancer just as antibiotics attacked bacteria — cutting off cancer at is biological roots. When such work quickly overwhelmed charities and hospitals, Lasker pushed the government to get involved.
Through astute lobbying that focused on boosting funding rather than building new government agencies, Lasker’s new coalition of legislators, administrators and doctors reshaped the National Cancer Institute in the 1950s. Although founded toward the end of the New Deal, the institute had taken a back seat to private anticancer efforts. Yet, by the end of the decade, Lasker and her allies had quintupled its budget and pushed it to the forefront of the nation’s cancer research effort.
As Lasker’s efforts proved politically successful, advocates for research on other diseases followed suit in demanding federal support.
But legislators were not satisfied to support free-ranging scientific inquiry. They wanted results — and quickly. And although they were willing to invest heavily in these efforts, accountability was frequently lacking. Critics of its expansion pointed out that the National Institutes of Health had no plans for managing research. In one infamous incident, Stanford University appeared to have spent federal research funds on a decorative pool for its medical center.
This drove the leadership of the National Cancer Institute to unveil what Life magazine termed a “super-plan” to combat leukemia in 1964 — the Special Virus Leukemia Program. The institute embraced the idea that cancer had viral causes, which was scientifically controversial, but offered the allure of a planned and accelerated solution to the disease.
From 1964 to 1978, the National Cancer Institute spent more than $6 billion on the effort to develop a cancer vaccine, more than was later spent on the Human Genome Project. To accelerate research, the institute turned to military planning methods devised by Rand Corp. Just as these methods were criticized for becoming unmoored from reality when they were deployed by the military in Vietnam, critics charged that the institute was becoming cut off from the biological reality of cancer. For example, there was no known human cancer virus during all the years of the program’s operation.
Despite their critics, the planning approaches used for a cancer vaccine in the 1960s formed the backbone of the “war on cancer” of the 1970s, which promised to produce a cure for cancer in time for the nation’s 1976 bicentennial. This initiative promised that the government would go beyond sponsoring biological research; it would translate that research into therapies. Like Operation Warp Speed, the National Cancer Institute relied upon large contracts with private companies to accelerate the speed of its efforts, especially through the expanded Virus Cancer Program, its vaccine research arm.
But this strategy had consequences. Time spent investigating vaccines was time spent not looking at the environmental, behavioral or social roots of cancer. Tobacco companies, seeking to deflect attention from the link between cigarettes and lung cancer, were ardent proponents of viral cancer theories. In contrast, environmental health activists and epidemiologists started to emphasize that cancer’s roots would be better addressed through legal regulation of tobacco and public health measures that could have a more immediate impact.
Indeed, throughout the 1970s, cancer rates continued to climb, as the National Cancer Institute failed to produce a vaccine. In 1978, the war on cancer was abandoned as a “medical Vietnam” and the Reagan Revolution of the 1980s dismissed the idea that the federal government should direct biomedical research.
Nonetheless, the dream of a cancer vaccine was not entirely misplaced. The link between liver cancer and infection by hepatitis B had been identified in Taiwan just as the war on cancer ended, and a vaccine followed shortly. The National Cancer Institute later played a vital role in the development of the human papillomavirus vaccine in the 1990s, a virus linked to many cancers. Yet the challenges of producing and distributing these vaccines shows that their benefits need a strong public health infrastructure to be fully realized.
Similar issues surround any prospective coronavirus vaccine. Alex Azar, the secretary of health and human services, claims that the vaccine will be made available free to all Americans. However, given the complexities of producing, testing and distributing hundreds of millions of doses, even a free vaccine may still fail to reach those mired in the chronic inequalities of our health care system in a timely fashion. These details have not been discussed as part of Operation Warp Speed, which has emphasized the creation of vaccines alone.
We have no doubt of the link between the new coronavirus and the disease COVID-19 or of the urgency of developing a vaccine, but the lessons of the National Cancer Institute’s super plan for a cancer vaccine matter in this conversation. These efforts, however well-meaning, led the government and scientists to fail to take actions, from banning smoking to accelerating vaccine distribution to improving access to care, that might have saved many more lives in the moment.
Focusing on vaccine development in the laboratory and clinical trials, and not the broader constellation of social factors and policy failures that have enabled, and continue to sustain, the spread of the coronavirus, reduces the chances of minimizing the damage done by the pandemic. We must have a strategy that addresses both the social and biological realities of the disease.
Robin Wolfe Scheffler is associate professor in the science, technology, and society program at Massachusetts Institute of Technology and author of “A Contagious Cause: The American Hunt for Cancer Viruses and the Growth of Molecular Medicine.”