In the latest in a series of video interviews on lessons from the COVID-19 pandemic, Brink Lindsey speaks with Nikki Teran, a senior biosecurity fellow at the Institute for Progress. They discuss in detail the steps required to ensure adequate preparedness for the next pandemic—and then struggle to understand why policymakers have thus far been unwilling to undertake these comparatively modest actions needed to prevent incalculable future harms.
Brink Lindsey: Hello. My name is Brink Lindsey. I’m Vice President at the Niskanen Center. Welcome to the latest in our series of videos on lessons from the COVID-19 pandemic. This video series is part of the Niskanen Center’s larger project on rebuilding American state capacity, and certainly pandemic response is an area where a lack of state capacity showed itself to fairly disastrous effect over the past couple of years. With me today is Nikki Teran from the Institute for the Future, who is a PhD geneticist, but now a think tanker. Welcome. Thank you for joining me.
Nikki Teran: Thank you for having me. So we’re the Institute for Progress.
Brink Lindsey: What did I say?
Nikki Teran: Institute for the Future.
Brink Lindsey: Sorry, Institute for Progress. Sorry. Of course. So tell me about the Institute for Progress.
Nikki Teran: We’re a nonpartisan think tank and advocacy organization where our goal is to advanced progress while safeguarding the future. So that’s where I come in, the safeguarding the future component…
Brink Lindsey: So you’re looking both to rev up good things, like supersonic travel, advanced geothermal, and also hold off bad things, like pandemics and AI risk and terrible stuff like that. So you’re on the doom and gloom side of the equation.
Nikki Teran: I also think that there’s a lot of progress to be had in the pandemic prevention space. There’s a lot of technologies that we need to advance, so it’s not all doom and gloom.
Brink Lindsey: Absolutely. Okay. So to back up a little bit, we’ve done other videos in this series so far, all of them have been primarily retrospective, just a sort of depressing postmortem on what went wrong and why, occasionally looking at things that went right, like Operation Warp Speed, but a lot of errors to uncover and diagnose and try to explain. But here we’re going to focus pretty much entirely prospectively, how do we upgrade our policies and systems and institutions to be better prepared for next time? And from what I gather, there’s a pretty decent consensus on what a good comprehensive pandemic preparedness program looks like. We have at least a couple of blueprints back in early 2021. The Bipartisan Commission on Biodefense headed by august bipartisan worthies like Tom Ridge and Joe Lieberman came out with this sort of Apollo project for biodefense, a big pull out all the stops blueprint for how to do better than we did last time.
And then sticking fairly closely, I think, you can tell me if I’m wrong, to that basic game plan, the Biden administration came out with its pandemic preparedness plan, which at one time was going to put into the ill-fated Build Back Better bill. Most of it never got in there, and then of course Build Back Better never got across the finish line. So what we have now, there is one piece of legislation working its way through Capitol Hill called the Prevent Pandemics Act. We’ll get to that later.
First, I want to think about sort of the ideal or the optimum of what do we need to be doing to protect ourselves better. So right at the start is early warning and monitoring. We want to know what viruses are out there that could make the jump to humans. We want to know ones that…, we want to be actively looking around to see if people are getting infected. And if viruses are making the jump from animals to humans and if that’s causing problems. So tell me, how do we go about doing those things better than we’re doing now? We had some international architecture for monitoring, which has played a role in previous pandemics and played some role in COVID, it didn’t work very well, but tell me how we can improve things on that front.
Nikki Teran: One of the big differences, I think, between what we’ve had before for monitoring and what we really need is for it to be pathogen-agnostic. So not searching out for a specific thing and checking if it’s there or not and really ubiquitous. Just everywhere all the time. So the hope would be to get a system where you can look for all of the nucleic acids, so that’s DNA or RNA of any pathogen, so any virus, any bacteria, and be able to see when it is growing in a population.
So say people keep coming in with some weird kind of pneumonia, you can swab inside their nose and mouth and sequence it, look for the genetic signature of anything there. And if you see that you keep seeing more and more of either something you haven’t seen before, a novel pathogen, or maybe something that’s similar to something you have seen before but you don’t usually have a bunch of people coming in with a coronavirus-related pneumonia, you can flag that as unusual and respond to it. So the hope would be not that you could just do this at one hospital, but that you could do it throughout the world at every hospital but also just in the general population – whether that’s looking at wastewater surveillance, whatever ends up in the sewage system, or potentially at blood banks. So you can imagine something like HIV might not have shown up in the wastewater but there would be other ways to detect it and to be able to collate all this information in actually a useful way where you have a whole bunch of team members looking at the same problem in the same way, in comparable formats. So this isn’t so much like going out into the middle of the jungle and searching for viruses because you don’t necessarily want to bring back things-
Brink Lindsey: That’s a double-edged sword I know, yes.
Nikki Teran: Yes. Yeah. Definitely a double-edged sword. But it’s like looking at people now, looking at our environment now and just seeing if anything unusual is arising.
Brink Lindsey: For the Biden plan, how much of its monies and programmatic focus was on just improving monitoring here in the United States and what was it doing internationally on that front?
Nikki Teran: I have numbers in front of me, so I’m actually looking at them. Currently, the request from the Biden administration that went out for five years of mandatory funding for a total of $88 billion requests $1.5 billion for genomic surveillance and so comparatively that’s actually not that much. I think that most of that is targeted domestically, but there are also currently international collaborations occurring. And actually a lot of those are done through USAID and the Department of Defense as opposed to here where we’d have it go through the CDC.
Brink Lindsey: There’s the actual gathering the data at blood banks, at hospitals, the waste water surveillance is a particularly wholesale version of doing this, you can see what’s happening in whole communities. But then for the data to be useful, it’s got to be collated and coordinated so it all fits together and is legible to decision makers. That seems to be an especially big challenge for the United States, given our highly privatized patchwork healthcare system. I know a lot of the sort of best genomic sequencing that’s been done during the pandemic wasn’t done here. Some of the best stuff was done in the UK. One of the reasons for that is they’ve got the National Health Service, they’ve got this state-run medical system, so it’s all monolithically coordinated. It may have some downsides on other fronts, but in terms of gathering data together they avoid challenges that we must face and surmount. So how do we go about knitting our very variegated private and public healthcare systems into a coherent data whole?
Nikki Teran: I actually don’t necessarily think the biggest issue is the private versus public healthcare services, because you can require reporting of this kind of data from hospitals. If we’re going to let you have Medicaid reimbursement, you’re going to need to provide us this data. So that’s not that difficult or not insurmountable. But a big issue in the United States is that public health is really fragmented, and so it’s not like the CDC is in charge of all public health. A lot of it is on the states and territories and tribal lands to actually monitor and implement their own systems. So the Biden administration has also requested funding for better information services to try to provide the networks necessary to report these kinds of data.
But you’re right there, there is a fragmentation of who gets to make these decisions. So there are a few coordinating bodies or people that are trying to coordinate this, especially globally, where the World Health Organization is putting together a group for this, or the Rockefeller Foundation has a group that also wants to be like the international leader for getting this genomics surveillance data together. It requires everyone to be on the same page. It requires funding to be tied to data standards. I think it’s going to require a lot of work, but I think that it’s going to be a worthwhile endeavor and so you’ve got to try.
Brink Lindsey: Yeah. So going back to the fragmentation and where the actual public health legal authority resides in the United States, it resides with governors and with public health officers at the state and sometimes local level, and they have pretty sweeping powers. When an emergency comes, they at least have the legal authority, whether or not they politically want to exercise it, to do some fairly sweeping things. But whereas the CDC, it gathers information, it sometimes shares information and it issues guidance, but it doesn’t have the actual power. Where the hammer hits the anvil, that’s at the state and local level. And as in many other policy domains, despite three decades of the internet revolution, we still haven’t done a very good job of getting our far-flung state and local governments to communicate with each other effectively. So that seems like it’s going to be daunting.
Nikki Teran: Yeah. And as a scientist by training, it’s just so amusing in a sad way to me that the issue isn’t the science so much as it is the political willpower and coordination, which-
Brink Lindsey: Yeah. And there’s just weird antediluvian things where to communicate with public health offices you have to use faxes and just wacky stuff like that, right?
Nikki Teran: Yeah. But there is at least requests for money. Everyone kind of agrees that the CDC should not receiving all their information by fax or that public health labs should have more tools for delivering information. So I do think that we will at least accomplish that goal.
Brink Lindsey: Small steps. Genomic sequencing is something that was very exotic 10 or 20 years ago and now really came to the fore as a major lens through which we could watch the progression of the pandemic, spotting all these variants in close to real time. How does that fit into an upgraded monitoring system and what are the pieces that are missing to put things together into an operating system?
Nikki Teran: That’s a great question. I think one of the key things to point out here is that when the Human Genome Project was run, when we first sequenced the human genome, not only did we not actually finish it at the time, but it took like 13 years and a billion dollars. And now you can sequence a human genome for under $1000, like on the order of a few hundred. I have a friend who went from a patient sample to the full genome to diagnosing what was wrong with them in something like eight hours. So we can use that same technology that we’ve really directed at figuring out what human DNA looks like to pointing it at viral and bacterial genomic sequences, so the question of what does that actually look like? How do you actually harness that?
Brink Lindsey: Or how does that fit into preparedness? I understand once the virus is up and running, you can watch it evolve, but how does it fit into the pregame?
Nikki Teran: This goes into wanting to buy as much time as possible to whatever, get your vaccines manufactured and distributed, or wanting to know as soon as possible where an outbreak is happening so you can isolate that outbreak and prevent it from becoming a pandemic. So it really is an early detection, and that’s where genomic sequence is very useful.
Brink Lindsey: So there at the outset, we were in pretty good shape, right? If the Chinese hadn’t just sat on things for a month, the actual – “Okay , we’ve got a problem. We’re going to sequence the genome here and we’re going to share it” – that all happened relatively quickly. So there wasn’t a big hold-up there, right?
Nikki Teran: Correct. But, the Chinese knew what they had and were willing to share it after a couple months.
Brink Lindsey: Right.
Nikki Teran: But then, we didn’t know. We couldn’t tell in the United States. So if you were able to just sequence everyone that came into any airport or other kind of port border crossing, you might be able to find SARS CoV-2 in them and be like, hey, we flagged you. This is a problem. We’re going to isolate you, or quarantine you in that case. But we just didn’t have that capability. The kinds of systems that we did have were very much like let’s check yes or no if you have something, but those need to be tailored yes or no to what? Something like metagenomic sequencing doesn’t need to know what I’m looking for. It can gather the information before you even really know what you’re looking for.
Brink Lindsey: Okay.
Nikki Teran: So again, that just buys you time. So, it’s like I’m from California. We have fires. We have a good system now of fire-spotting towers. So there used to be actual people up on a tower looking around for smoke, and now it’s a bunch of cameras, which are much more efficient. But it’s like, how quickly can you find that smoke? How quickly you detect that fire? Because it’s much easier to stop a fire at, I don’t know, two acres where it takes three helicopters, than it is once it’s become hundreds or millions of acres and you just need to protect the houses that you can as opposed to stopping the fire.
So yeah, really the key is like can we detect the pathogen early so that we can surround it, rather than do we have to wait until we have to surround ourselves for safety.
Brink Lindsey: I know that in the Bush Administration and Obama Administration, in the wake of various sort of outbreak scares like SARS, MERS, Ebola, and whatever, some international coordination mechanisms were established to set up sort of global fire towers. But then, that’s defeated by virus nationalism, by the Chinese sitting on the information they had for a good long time. So to what extent do we need to change things because we can’t rely on foreign governments to be forthcoming in the early days like we wish they were?
Nikki Teran: I mean, it’d be really great if we could require foreign governments to be more transparent. But if not, then that’s where the ubiquitous part comes in, where that if you were just like monitoring everything all the time, you don’t necessarily need that one warning from the source. You could detect yourself like, hey, these people with these symptoms are popping up in Washington and they’re popping up in whatever, Santa Clara, California, and they’re popping up in New York City. You could detect that trend without necessarily knowing what you’re looking for, because you would see this new anomalous virus in a bunch of different areas.
Brink Lindsey: In the case of the coronavirus, I mean, it could very well have been in the United States before the Chinese told us anything. Right?
Nikki Teran: Yeah.
Brink Lindsey: So that kind of pathogen panopticon, which you’re just looking at everything, the Eye of Sauron is looking at all times, scanning the landscape, then you’re less dependent on foreign government intelligence because…
Nikki Teran: Exactly. Yeah. And even if you just had the coordinating system in the United States, granted, we do still need to do more technology development so that the cost of sequencing is cheap enough that you could really, really get good ubiquitous sequencing – not just the sequencing, but also like sample prep requires humans with too many degrees. But if you can get the system working, then you can tell the difference between an anomalous thing of like, it’s just in New York City, maybe it’s not going anywhere, maybe it’s just a little blip versus it’s in New York City and San Francisco and Seattle.
Because that’s the kind of distribution you would not expect from something local. It would be likely imported from somewhere else.
Brink Lindsey: Okay. Once we move past early warning monitoring, another big element and what seems to me to be the most expensive element perhaps of a comprehensive pandemic preparedness system is the development, the anticipatory development of vaccines and treatments. So the idea is to identify all kinds of possible viral threats or other kinds of pathogen threats and then do research, find promising vaccines and treatments at the preclinical stage. You find on animal testing they’re working, but then to actually start doing human clinical trials on these things as well, at least through stage one and stage two, not the big, final dress rehearsal.
But, those preliminary clinical trials still take months, right? So if you actually had vaccine candidates for a whole slew of different families of risks, then that could cut many months off of vaccine development…
Nikki Teran: Potentially years.
Brink Lindsey: And that could save millions of lives.
Nikki Teran: Yeah. I think like we got really lucky with SARS CoV-2 that it was very similar to SARS which we’d already been developing a vaccine on for, I don’t know, 15 years. Because it’s not trivial to decide what exactly you need to put in the vaccine, or in the case of SARS CoV-2, how exactly to shape it different from what exists naturally, like you don’t just necessarily copy the exact sequence so that it can be stable enough for the immune system to recognize. And yeah, it’s cheaper if you have more time, but I don’t actually think the cost is so out of proportion of the benefit that you would get.
Brink Lindsey: Yeah. I certainly don’t dispute that. I’m just saying, like, if you look at the budget of the Biden plan, a big chunk of it is chewed up on this line item, I believe. Because there’s a lot of different threats and vaccine development and early stage clinical trials, even early stage clinical trials are expensive.
Nikki Teran: Yeah, I think the estimate is around a billion dollars for each vaccine, which, is more money than I will ever have, but the idea is to get vaccines for each of the 26 viral families. And I think we’ve got basically half of them, close to half of them. So I think they’re starting off looking for seven that are the highest priority. And so, okay, $7 billion. The United States is also ordering two Virginia class nuclear submarines this year and each of them are about three and a half billion dollars. So for the cost of seven vaccines, we can get two nuclear subs.
And I think that the goal for the United States is to order two nuclear subs every single year until we have 66. So I think that like the benefits that can come from having vaccines, not just in the pandemic, like Operation Warp Speed cost like $20 billion, and so for that price, we could have gotten 20 vaccines and been almost done with all of them, is that a lot of these pathogens are currently infecting people and currently killing people and currently have cost. Like obviously there’s cost in lives, but there’s also just like a financial cost of that.
And so, it’s, I think, like a worthwhile investment and it is a large portion of the cost, but it’s a thing that we need.
Brink Lindsey: Yes. I wholeheartedly agree. Pandemic economics is just crazy.There’s no cost benefit analysis. If you find something that works, the benefits swamp the potential costs by just many orders of magnitude.
So we’ll get to the fact that we haven’t actually done any of this stuff yet because people are balking at the price tag. But in the grand scheme of things, there is just no way to do any of this stuff without just ginormous social benefits, net social benefits.
Well, let me talk a little bit more about vaccine development and how difficult that is, because maybe we got an erroneous picture from the COVID experience and in particular from the mRNA vaccine experience. So from the news accounts, the Moderna people cooked up a vaccine over a weekend. They had the basic idea there in a few days after having gotten the sequence of the virus. So to what extent was that just crazy luck because we’ve been working on coronavirus vaccines for a while, or to what extent is that just because mRNA technology is so wonderful and supercharged that things that used to take horrible laborious years and years can now be accelerated manyfold?
Nikki Teran: Obviously, some of both. And I don’t want to say it’s luck because it’s preparedness. We’d invested in it for a while. They’d been a lot of work on it for a while. So it’s like saying someone who can like shoot a basketball from the three point line is lucky. Like, okay, sure, a little bit, but also there’s a lot of practice that goes into that.
Brink Lindsey: No, but it just did happen that this, the first global pandemic we had in 100 years was very similar to pandemic scares we’ve had over the past couple of decades. If it’d been a completely different threat, all of that experience and preparedness would’ve been irrelevant.
Nikki Teran: Yes that’s right. But, it is also true that the mRNA-based vaccines, or also there’s also DNA-based vaccines, which like were not quite to the same point yet, but should have similar properties and be more like easy to ship around because DNA is a lot more stable than RNA. There are just really great technologies because before what you would need to do is either coax the virus into being less pathogenic so you could give it to people or hope that once you killed the virus, it still gave the same kind of immune response, or grow up just a little part of the virus and hope that you can grow it up in like a close enough way to how it grows in your cells…
But all of these are very exogenous and other, whereas a virus literally does just hijack your cells to make itself. And so that’s exactly what the mRNA vaccine does, except for in a less hijacking way, in a more small byproduct kind of way. And so it really does look a lot more like a natural infection than a lot of the older technologies and it’s a lot easier to manufacture. You don’t have to coax the virus into being less pathogenic, or it’s actually really hard to produce just a small part of the virus in an accurate way, but it’s not that hard to print out RNA or DNA, which is a fortunate, more recent technological advance.
Brink Lindsey: Yeah. Again and again in assessing how doomed are we, we have this sort of race between advancing institutional sclerosis and gee-whiz 21st century technology that’s advancing incredibly rapidly and can the latter bail out the former seems to be the question. And so, of course, we need to work on the sclerosis as well, but there, it’s a hard grind. Whereas we’re making just amazing leaps over the course of our lifetimes from 13 years for sequencing to doing it in hours and cost going down and so forth. So, our tools are getting better and better, but our sort of policy software for implementing those tools needs to be improved.
So you wrote something for the Institute for Progress, I’m sorry for bumbling that at the outset, in particular, because the Institute for Progress has a lot of Niskanen Center DNA. So Alec Stapp, one of the co-founders and co-CEO, worked with us, Jeremy Neufeld in the immigration section, he’s a Niskanen alum. So anyway, we’re happy to have an even newer kid on the block doing such interesting work. But there’s a paper you wrote that’s on the Institute for Progress’ website about expanding the role for BARDA. Now a lot of the retrospective talk about what went wrong has focused on the CDC a lot and also on the FDA.
BARDA is something that — I’ve been reading up a lot on the pandemic, tried to keep up during the course of the crisis, and I’ve been reading up a lot to prepare for these interviews – but BARDA’s pretty obscure. Even when you’re reading a lot, it remains pretty obscure. So tell me about BARDA and how its mission could be expanded to make it a bigger player in what we need to do.
Nikki Teran: I think the interesting part is that its mission doesn’t need to be expanded. Its mission is to prepare medical countermeasures for these public health issues. So within their purview is also nuclear threats, chemical weapons, biological weapons and also pandemics, or naturally occurring pandemics. So it doesn’t need to be redirected in a way, it just needs to be given more resources. So what BARDA does is it-
Brink Lindsey: Let me interrupt you just for a second. My understanding was that… When was it created? Do you recall?
Nikki Teran: I think it was created in 2006 as part of the Pandemic and All-Hazards Preparedness Act.
Brink Lindsey: Okay. So my thought was that its remit was broad including naturally occurring pandemics as well as manmade biosecurity threats, like germ warfare as well as nuclear war and so forth, chemical weapons. But my understanding is that its attention had been more on the bioweapon side and less on the pandemic side.
Nikki Teran: Sure, because that’s what was seen as the larger threat, especially after the anthrax attacks.
Brink Lindsey: Right.
Nikki Teran: It was very clear how a biological hazard could be used maliciously. And it’d been, I don’t know, 100 years since there’d been a pandemic to the scale that most people noticed. So HIV is a pandemic, there’s been other influenza outbreaks that have been considered pandemics since then. But that was what people were noticing. And so you’re right. I think there’s a little bit of tension too about preparing for all of the hazards that we know about versus preparing in such a way that we’re prepared for any hazard. And so there’s an act that was proposed in Congress called the Disease X Act which would try to have BARDA prepare for disease X, which just means getting good at preparing for threats to the point where you could prepare for any threat very quickly.
Brink Lindsey: And where is BARDA housed? Is it part of HHS?
Nikki Teran: Correct. BARDA is inside the Assistant Secretary for Preparedness Response.
Brink Lindsey: Okay.
Nikki Teran: Which is inside Health and Human Services.
Brink Lindsey: And so if it’s already got the right focus and mission, what does it need to prosecute that mission more effectively? Or let me back up a little bit, what role did it play in the COVID pandemic response? To what extent was it involved in Operation Warp Speed? Yes.
Nikki Teran: So BARDA’s main job is to say, “Okay, here’s a threat that exists that the market doesn’t normally, I don’t know, want to prepare for.” Generally, there’s no buyer for, I don’t know, smallpox vaccines, right, because it’s not a threat we usually have to deal with. But it is a concern of the U.S. government because if smallpox was to infect the United States that would be very bad. And so BARDA will find people who are capable of making those vaccines and have the technology and help them develop that technology. So help them get it to a point where it can go through clinical trials, help them get it through clinical trials, help them work with the FDA to get it to the point where they could throw it in the stockpile. And so for Operation Warp Speed, they worked with the Department of Defense because BARDA already had those relationships with those groups that could produce vaccines. So it was already integrated into the American biotechnology community.
Brink Lindsey: Okay.
Nikki Teran: And had practice working with those groups. So it was able to support this interagency group to get the vaccine to the finish line. And so the argument of who did more, DOD or BARDA? They worked together. They wouldn’t have been able to do it without each other.
Brink Lindsey: Okay. So for this development of vaccines and treatments in a anticipatory way, do you see BARDA as the organ of the U.S. government currently best situated to play the lead role in that?
Nikki Teran: For developing vaccines for each of the viral families? Yes, that’s what they were created for, to create these technologies with the private sector. And they also have the ability-
Brink Lindsey: And did the Biden plan, did the Bipartisan Commission, did they specify BARDA’s ramped up role in this?
Nikki Teran: I believe yes. Definitely the Biden plan very specifically says ASPR and BARDA is part of ASPR.
Brink Lindsey: Okay. There’s a unit in BARDA where the acronym, I can’t remember what it stands for acutely, but it’s DRIVe and it’s an in-house nonprofit venture capital firm. I did not know that there was an equivalent, not in-house, but affiliated nonprofit venture capital firm for the CIA called In-Q-Tel, which invests in groovy technologies the CIA thinks might be useful for intelligence gathering. DRIVe is an analog in the biosecurity space. So it at least has been stood up and given the authority, if not the money, to pick promising companies whose research is interesting, to support them and push them along towards development. But right now, they have some pittance of money that they can deal with. That is correct?
Nikki Teran: That is correct. Maybe you have the number in front of you, I don’t, but it’s something on the order of hundreds of millions of dollars when any good biotech VC has billions.
Brink Lindsey: So would BARDA operating through DRIVe be an important part of this vaccine development process?
Nikki Teran: I think that BARDA without DRIVe could do a lot in the vaccine development space because it can pick existing groups to do work with. But for getting new technologies that will help us more in the future, yeah, that’s where DRIVe comes in because they can bet on new promising technologies in a way that the larger BARDA might not. Larger BARDA might go for a little safer, although if they really had like all the finances that they need, then maybe they could be more risk taking. But they don’t currently have that bandwidth. And so DRIVe’s able to invest small amounts in technologies that might be promising. A few years ago, that could have been intranasal vaccines. So rather than using a needle, you can try to pop something in someone’s nose. Or I mentioned DNA-based vaccines.
Brink Lindsey: Right.
Nikki Teran: They’re true DNA-based, not inside a virus, a viral vector, they just haven’t really gotten there yet. It’s a little hard to get DNA into cells.
Brink Lindsey: Okay.
Nikki Teran: And so companies that can come up with the technologies to overcome that hurdle are the things that BARDA DRIVe could invest in the vaccine space.
Brink Lindsey: Okay. Let’s switch gears to lab safety and regulation. There’s a lot of double-edged swords in the biosecurity field. All these technological developments that are making it easier to study and to defend against pathogens are also making it easier to weaponize pathogens, if one had a mind too. The spreading global network of labs that are studying pathogens is great for developing potential cures. It’s also introducing the possibility of security lapses and lab leaks. And those are not rare events from what I read, they happen with some regularity. Of course, there’s a big controversy over the origin of the novel coronavirus and whether it escaped from the Wuhan Institute of Virology lab. We don’t know. I think probably we’ll never know.
But it’s not a crazy idea that, with lots of labs studying dangerous viruses and other pathogens, that we could be hoist with our own petard, that through the very means we are trying to use to better defend ourselves occasional lapses in operational security could lead to unintentional release. Meanwhile, putting ever more power in smaller groups’ hands where you can sequence things and print out genomes at your basic terrorist group’s budget rather than a nation state’s budget, that’s nightmare fuel. So what do we need to do to dull the bad edge of this double-edged sword?
Nikki Teran: From a lab safety standpoint?
Brink Lindsey: Yes.
Nikki Teran: You definitely need to invest in just technologies to keep things inside of labs. It’s appalling how that’s not a field really. There are very few groups that are actually studying it. How do lab accidents happen and how do we prevent them? There’s a lot more groups that are studying the things that you would want to prevent from coming out of a lab. And there’s also really not that much oversight of laboratories that handle pathogens. For things like select agents, which include Ebola, MERS, smallpox, the things that are likely to show up in a James Bond movie of like, “Oh, man, this really bad thing,” there is regulation around there and it’s restricted for who can work on them. You need government oversight. You need to tell the government what you’re doing. If you don’t, you can go to jail. But for working with pathogens that are the next step down, no one is keeping tabs on that. And as you mentioned, you can change the pathogens, you can make them worse and even if you make them worse, they don’t fall on that list of things you can’t touch.
Brink Lindsey: One of the scariest of these double-edged swords, one that gives off a real Frankenstein vibe, is the whole gain of function research where you’re manipulating viruses, changing them in a completely public-spirited, scientific effort to see how this virus might evolve in the wild. But at the same time, you may be creating superbugs. And then if your lab doesn’t have great security, they could get out in the wild to kill everybody. So this whole idea of gain of function research became something that people were focusing on during the pandemic. And it sounds scary and it sounds insane. It sounds like here’s something that has potentially disastrous consequences. There doesn’t seem to be a lot of security associated with it. So how wigged out should we be? And what should we do about it?
Nikki Teran: I don’t want to scare people, but also we need to do something about it. It shouldn’t be up to the individual scientist to decide if the research is worthwhile, right, because their motives are not the same as the general public. So not talking about mad scientists doing crazy experiments, but for scientists to advance their career, they need to publish interesting things, journals and other scientists and actually people in general are interested in these viruses that can kill people and ways in which they might be able to do that better. And so there’s this weird incentive for people to do this risky research. And a lot of this risky research isn’t necessarily like, “Let’s make a vaccine for this bad pathogen.” It’s like, “How could this pathogen be worse?”
Brink Lindsey: Right.
Nikki Teran: And so it’s like is the juice worth the squeeze? The juice is worth the squeeze for the scientists who needs to publish to get tenure, but it’s not worth the squeeze for the general public who are like, “Hey, you’re making things that could kill me. Who gave you permission to do that?” And so there really does need to be more oversight of these research labs. And there needs to be an independent body looking at these proposals and being like, “Okay, this is work that would directly lead to a vaccine, go for it.” Or like, “This is more curiosity driven and includes risk that is not necessary.” So some questions can be just answered in a less dangerous way.
Brink Lindsey: Yeah.
Nikki Teran: You don’t need to necessarily make the pathogen to figure out what components could be more detrimental.
Brink Lindsey: So who exercises this oversight?
Nikki Teran: Currently, no one.
Brink Lindsey: Who ought to?
Nikki Teran: Who ought to? Ideally I would like there to be an independent agency that oversees biomedical research, something that’s not inside NIH who again has their own incentive structure to publish interesting research to get grants funded.
Brink Lindsey: Yeah, this doesn’t seem like an area where self-regulation is terribly dependable. There seems to be a real clubbiness among the virologists that’s like, “Hey, no problem here. Go away. All these gain of function scare stories are alarmism. Leave us alone, let us be curious.”
Nikki Teran: Yeah.
Brink Lindsey: It’s shouldn’t be their call, right?
Nikki Teran: It should not be their call. If it was truly only the virologists that could get sick, if they could only infect themselves, then I might feel differently about it, right? If they’re taking their own lives into their hands, although I could argue they’ve got grad students working in their labs who maybe don’t fully understand nd athere’s weird power dynamics.
But again, it’s just not even just the scientists. It’s the general public that might have to suffer. So I do think that the government needs to step in and create some kind of independent body that can, not just like do the research into how do we make labs safer, not just like keep track of all the labs because literally we don’t know how many different labs there are in the United States that can do this kind of pathogen pandemic-potential research, but also to look over kinds of grant proposals and look over the kind of research that’s being done and be like, “Hey, that’s not cool. Stop.” And it’s just kind of absurd. And I feel like a lot of Americans don’t understand that there aren’t those things in place.
Brink Lindsey: Let me touch briefly on one other element of these kind of more comprehensive proposals, which is development of next generation PPE, personal protective equipment, masks and other sort of body protection.
So what does next generation stuff look like? Right now, the kind of gold standard for personal protection is an N95 mask. Those kinds of things are what doctors use in infectious disease settings, in hospitals. So is there some new technology we need or do we just need to scale up production of these things and stockpiles of them so that we’re ready?
Nikki Teran: I do think that we need new technologies. So I don’t even think a N95 is sufficient for COVID. It doesn’t seal perfectly. Stuff can be on the outside that you then take the mask off and that’s hazardous. And COVID is not the most infectious possible virus.
So an N95 is not sufficient. I actually own a P100, which is like the next level up, which I wear when traveling or in crowded places. Not only could I not wear that for that many hours, it’s just not that comfortable. But it’s possible that that isn’t sufficient.
Because my eyes are exposed still or my skin is exposed if I have any open wounds. And there are pathogens that can literally blow miles through the air and infect things. And so next generation PPE would be cheaper, more comfortable, and have features that current PPE doesn’t.
So it’d be really great if my mask was antibacterial, antiviral on the outside. So that if something does touch it, it will be dead before I have to handle it again. I don’t know if you’ve ever seen… You’ve probably seen in like movies and stuff, there’s those like kind of space suit kind of systems, where like all of you is covered and the air into it is being filtered. Those are incredibly expensive, like multiple thousands of dollars, and very clunky and difficult to use. And if we were at the point where something like that was necessary, I would very much like the grocery stores to stay open. I would very much like to be able to get food or medical care. Healthcare providers should be able to have systems like this. And they’re just not at the scale of price or usability for people to actually utilize.
So it would be great if we had more antimicrobial air filtration, personal more closed-off units because you can’t get sick if it can’t get to you. We just need more investments in that. So making a whole bunch of N95’s will be more useful than nothing, but doesn’t necessarily cover us for all possible pathogens.
Brink Lindsey: Okay. So we’ve been talking about new and improved ways to prevent pandemics. As it happens, there’s a legislative vehicle currently winning its way through Congress called the PREVENT Pandemics Act. Alas, it doesn’t really do any of the things we’ve been talking about. So what does it do?
Nikki Teran: I was just very amused that it’s called the PREVENT Pandemics Act, where PREVENT is an acronym, which is prepare for and respond, where it does not in fact actually have the mechanisms to prevent pandemics.
So there is a little bit in it about genomic surveillance, but it doesn’t have the kind of funding that is necessary to actually implement these comprehensive ubiquitous metagenomic sequencing systems. Even in that component, it currently doesn’t even allow CDC to work with any capable partner. It’s very restricted to working with academic institutions or national labs, for certain funding components anyways. And that’s just not who’s doing the best work. The private sector is actually now jumping into this and doing very…
Brink Lindsey: And I don’t want to just slag this bill. It’s not constituted to be a big funding bill. It’s more of an institutional change bill. So it authorizes a 9/11 style commission on the pandemic to dig out lessons that’s exactly what a lot of people have been doing in a decentralized way, but in an authoritative official way.
It sets up in a permanent office in the White House for pandemic response. That seems like a good idea. If such a thing existed, would that be the place that was quarterbacking this larger comprehensive effort? So with BARDA playing one role on vaccine and treatment development, but the whole panoply of other measures ultimately coordinated out of this White House office – is that the idea?
Nikki Teran: Yeah, that’s the idea. That you can coordinate between different parts of HHS, like CDC, FDA, ASPR in HHS, as well as potentially within departments. So Department of Homeland Security has some programs on genomic monitoring and Department of Defense also has some programs that look similar to what would be done on the domestic side.
Brink Lindsey: Okay. So it’s setting up the institutional structure for people whose full-time job is to worry about these things at a level very close to the ultimate decision makers. That seems sound.
It gives or it authorizes some funding for monitoring and preparedness. It doesn’t actually appropriate it. So even if this thing passes, there’s yet another step to actually get any money out the door. Is that correct?
Nikki Teran: Correct.
Brink Lindsey: And there’s not an obvious vehicle for that happening. But meanwhile, there’s just no funding for the expensive jobs, not expensive relative to the risks, but still multi-billion dollar expensive jobs that they need to do, there’s no funding for it right now.
So as I mentioned, the Biden administration had come up with this $65 billion plan for five to seven years of spending. By the time it got time to put something on the floor, Build Back Better, it gotten shrunk to $2 billion or $3 billion and then that fizzled.
So now we’ve got PREVENT Pandemics Act, which again is a couple billion dollar price tag, I think, on the authorization front. But that leaves out what looks like should be about $10 billion a year in perpetual spending to stay on top of this.
Is there any explanation for… I mean, Congress spent several trillion dollars in just bailing people out of the fiscal costs of this pandemic. But spending 10 billion a year seems like a bridge too far right now while we’ve still got people dying of this pandemic.
So that it seems unlikely that people get more attentive to these risks and more willing to open their pocketbooks a year or two from now. It feels like the iron is as hot as it’s going to get, and yet nobody’s striking.
Nikki Teran: Yeah. And it’s just really sad that it’s not anyone’s priority. Most people agree that preventing pandemics is important. Diseases are bad. We can do something about it. But it doesn’t work well into the political structure that we have in the United States, where you don’t get elected because you prevented something from happening, unless you can really show it started to happen and you clamped down and it was good. And even then, people are going to be like, “Well, was it really going to be that big of a deal?” And so there just isn’t the correct political incentive structure. It’s not going to help you get elected.
Brink Lindsey: Exactly. I mean, in fact, optimal reaction is consistent overreaction to things that… getting all ready for the next killer virus when it doesn’t really pan out. But doing that, overreacting, causes all kinds of political grief.
Back when I was a kid, the swine flu debacle seems to be what was a real turning point in the history of the CDC from being a disease fighting organization to being an increasingly politicized and bureaucratic and academic kind of institution. That it cried wolf, “Swine flu is coming.” It rushed into producing vaccines. There were some initial false reports of bad side effects and then some actual bad side effects. And then the swine flu didn’t really materialize as a big problem. So the whole thing – rather than, “Well, okay, we got ahead of that one, we dodged a bullet” – it was the CDC had egg on its face. The director was fired with the incoming new administration. And then they’ve had a political director ever since. Then the character of the agency changed. So it is a vexing problem of democratic political life that preventing bad things from happening doesn’t generate much credit.
Nikki Teran: Yes, especially when you can’t arrest some terrorist and talk about what their plan was. That’s a very like, “Here, I can hold up this example,” but that doesn’t really work with pandemic preparedness in that people…. it’s not as visceral, like I can see that. You just have to imagine these potentially bad things were happening. And in reality, probably if people were thinking in their best interest, they wouldn’t think this way.
But a lot of people would be a lot happier with $5,000 checks or multiple couple thousand dollars checks than being like, “Okay, great, we averted another pandemic,” because it just doesn’t feel the same. And so it really comes down to our leaders need to do what is best for us, even if it’s not popular. And that’s not how our leaders got into office and that’s likely not what will keep them in office. And so I understand the conflict for them, but people will die.
If the congressional budget office actually scored pandemic preparedness in proportion to what the actual financial benefits would be, then maybe that would be different. That if you can say, “We invested $100 billion and saved $10 trillion,” that might actually motivate people to work on this. But we don’t currently operate that way.
Brink Lindsey: Well, thank goodness there are candles in the darkness, like the Institute for Progress, people who are pushing policy makers to listen to the better angels of their nature and pay attention to the public interest in an area here where pennies of prevention are worth enormous tons of cure.
Nikki Teran: Yeah. Thank you for bringing light to this. Because I do think that by letting people know that there are options for preventing pandemics and it is in their best interest, if it’s an individual’s priority, they can let their Congress people know that.
And they can vote for individuals that do have pandemic prevention as a part of their platform. And so even though the status quo might be that there isn’t a real incentive, we can change the status quo.
Brink Lindsey: Great. Well, thank you, Nikki Teran from the Institute for Progress for being with me today. I really enjoyed our conversation.
Nikki Teran: Thank you for chatting with me.