America is at war! We are fighting a malicious, microscopic, worldwide enemy that has already killed more in the U.S. than the total number of U.S. troops and civilians lost in World War II. In fact, we can find no more appropriate equivalency than WWII.
Even after 80 years, we still marvel at the accomplishments of the home front, totally mobilized on behalf of the war effort. The automotive industry completely shut down car production and re-tooled in record time to produce tanks and planes. The Kaiser shipyards, built from scratch, turned out thousands of Liberty ships. And let us not forget the Manhattan Project, the unprecedented mobilization of scientific and engineering talent operating under terrifying time pressure. At home, average Americans, ever fearful for loved ones overseas, sacrificed by accepting the rationing of sugar, meat, and gasoline.
It is with the immediacy of the WWII analogy that we turn for inspiration and wisdom to General Dwight D. Eisenhower, Supreme Allied Commander of the European Theatre, responsible for harnessing and unifying the efforts of the fractious allied armies to conquer the Nazi beast.
What if we had a Supreme Commander like Ike for our COVID-19 war?
Dressed in full wartime military fatigues, “Ike” addresses the nation:
You have all heard about the sacrifices that your grandparents made 80 years ago, during WWII. We are in a new world war with an invisible enemy. A brave eye doctor in Wuhan, China, spotted the enemy early, but no one listened. We all made mistakes in the beginning because we could not imagine the strength and speed of the enemy.
Now we have a plan to counterattack. We have tried many weapons, some with some limited success. We now have vaccinations. The previous administration funded Operation Warp Speed and it was a miracle. Standing on the shoulders of many scientists, we took a 10-year process down to one year. Chinese scientists released the gene sequence, a small biotech company in Germany immediately switched focus and developed an mRNA vaccine, and Pfizer recognized what they had accomplished.
Soon, we will have five vaccines with temporary licenses in the U.S. The present administration has a strong team, with much to do. Their main approach is a laser focus on getting vaccines to more than three million people per day. And states are steadily moving toward utilizing many small and large vaccination centers.
So, for all Americans, this is how we will win the first stage in the war against a powerful enemy. Please take the vaccine when your turn comes up. For those of you who don’t understand the science, the vaccines are clearly safe, with 50 million Americans having already received them. So far, for those who got the two courses of the vaccine, none have died from COVID-19 or gone into the ICU. For those African-American and Latino citizens who are hesitant about the vaccine, speak to your African-American and Latino doctors, nurses, pharmacists, faith leaders, and sports heroes.
We will soon likely have five vaccines with a limited license in the U.S and 10 throughout the world. But they all target the same viral element – so I am worried! COVID-19 is so widespread that we are already seeing mutations that will be resistant to the first-generation vaccines.
Sequencing and second-generation vaccines
The current team is very good, but just getting started. For this next phase in this world war they need a war footing with a command center focused on second-generation vaccines. We need to track these mutations by genomic surveillance. Nasal swabs cannot do this. The funding should be repurposed under The American Rescue Plan under “expand testing,” which has a $50-billion budget.
We need a plan for when and how to trigger the next generation vaccines. We need the FDA to approve an innovative program to do faster testing on multi-thousands of volunteers. We need to build new manufacturing facilities to handle new demand, which could be covered in part by the $10 billion already in the budget in the American Rescue Plan and by the Defense Production Act. Any new company doing early vaccine development should focus on mutations for a multi-valent vaccine. Pfizer and Moderna are already working on altering the mRNA to cover resistant strains. That is the good news!
There are no vaccines for HIV, which mutates often, but multiple antiviral drugs have effectively controlled this disease. We don’t have treatments for acute COVID-19, long-haul symptoms, severe lung disease or cytokine storm, or the infrequent but scary multisystem inflammatory syndrome in children. Monoclonal antibody cocktails will need to be modified to cover mutations. So far, clinical trials for these therapies have only shown marginal benefit despite being given to more than 100,000 people. Ongoing studies seem to show benefit in high-risk patients, but again, we need more randomized trials done more efficiently and quickly. While there are other therapies, their effect seems marginal.
We also need an Operation Warp Speed for all the clinical trials needed for vaccines and new treatments. Why would someone volunteer for an upcoming vaccine when there are two vaccines already in the marketplace?
Prepare for the future
At some point, sooner rather than later, COVID-19 vaccines should fit into the world program for yearly seasonal influenza vaccines. The WHO and CDC have a detailed and comprehensive program – after all, we have declared a world war on COVID-19.
For a return to normal life, documentation will be essential. We are ready for a domestic passport or certificate that is better documentation than the vaccination card people currently receive after their shots. It should be issued by states and be equivalent to an annual driver’s license (version 2021). There will likely be three more vaccines available through the FDA limited license this year. A 2022 passport would need to be issued based on getting a booster that covers mutant strains. A second pathway would be for those who have previously been infected with COVID-19, or have made a complete recovery from natural immunity, to have a recent positive blood test showing adequate levels of neutralizing antibodies – a recent study in Science shows protection for up to eight months.
Such a document would encourage people to get vaccinated. Passports would be useful for travel or for going to a concert or sporting event, yet would still require a current rapid saliva test. People would no longer need to quarantine after exposure to an infected person.
We should also consider an international COVID-19 passport (version 2022) to facilitate global travel and business. Additional strict guidelines would be required since we would have to accept vaccines used outside of the U.S and there ought to be confirmation based on an approved antibody test that shows high neutralizing antibodies against endemic mutant strains. Any use of the international passport in the U.S. would require a current PCR test.
In closing, let’s remember one final lesson from another war: WWI and the Spanish Influenza of 1918. This influenza pandemic attacked young, healthy adults in waves. At the end of September, Philadelphia, against public health advice, decided to have a large parade to sell bonds for the war effort. Thousands died. Public health still remains our first line of defense. Mask up and socially distance. Follow Dr. Fauci.
We all have pandemic fatigue and depression. It’s understandable. But now is the time for personal resolve. We are all in this together. We have a path to victory.
God bless the United States of America and all our front-line healthcare workers, public health workers, and vaccine scientists.
Daniel Teres, MD, is a critical care physician and a clinical instructor in public health and community medicine at Tufts University School of Medicine in Boston. Martin A. Strosberg is emeritus professor of health care policy, and bioethics at Union College in Schenectady, New York.