By The Washington Post · Carolyn Y. Johnson, Eva Dou · NATIONAL, BUSINESS, HEALTH, SCIENCE-ENVIRONMENT, US-GLOBAL-MARKETS
The same day in mid-March that the United States launched human testing of its first experimental coronavirus vaccine, scientists in China announced their own trial would begin. Days after a company unveiled the partial data from the first U.S. human tests earlier this month, a complete report of the Chinese trial was published in a prestigious medical journal.
Both countries are also taking huge financial risks to scale up production of possible vaccines before they know any are safe and effective - a gambit to ensure their citizens won't have to wait. The nation's top infectious-disease expert said the U.S. will manufacture 100 million doses by year's end.
"We're going to start manufacturing doses of the vaccines way before we even know that the vaccine works," Anthony Fauci said in an interview with the Journal of the American Medical Association.
The nation that produces the first safe and effective vaccine will gain not only bragging rights but also a fast track to put its people back to work, a powerful public health tool to protect its citizens and a precious resource to reward allies. In an election year in the United States, the prospect of a successful vaccine by year's end could also be a potent campaign tool.
"The vaccine is partly about health, but it's absolutely equally as much about getting our engine of productivity back," said Lawrence Gostin, a professor of global health law at Georgetown University Law Center. "If China had it and we didn't, their economy could hum, and ours would continue to be in social distancing lockdowns and disruptions. This has economic, political and public health consequences."
And with the world increasingly jigsawed along nationalistic lines, the race has become one more facet of that geopolitical contest.
"Within China, the issue of the vaccine has taken on a symbol of whether China is going to be the leading power in the world," said Bonnie Glaser, director of the China Power Project at the Center for Strategic and International Studies.
Scientists see the race as one in which academic research groups, companies and countries are working in rare unity against a common enemy - the virus. But health policy experts already see "vaccine nationalism" creeping in. President Trump on Friday announced he would terminate the United States' relationship with the World Health Organization, which he accused of misleading the world about the coronavirus at the urging of the Chinese government. The United States skipped an international pledging conference in early May that put billions toward developing a vaccine for the world.
President Donald Trump has addressed the issue directly, saying in a Rose Garden news conference that if China wins the vaccine race, the U.S. would get access.
Political leaders criticized for their handling of the pandemic and eager to notch a win have already begun securing doses for their own citizens - as the United States did in making a $1.2 billion investment to secure 300 million doses of a vaccine being developed by the University of Oxford and the pharmaceutical company AstraZeneca. The first 100 million doses have been committed to the United Kingdom. Companies are spreading their manufacturing plants across multiple countries, a partial protection against the possibility that any nation prohibits exports.
Who gets the vaccine first matters not just for national pride but because that country's citizens will almost certainly get first access to limited doses - even if the virus is raging in another part of the world.
Recent history shows that countries inevitably look to first take care of their own citizens. During the 2009 H1N1 outbreak, countries pledged to donate portions of their influenza vaccine for equitable distribution "only after it turned out there was an excess of vaccine and the influenza was not so bad," Gostin said.
With its relations with the West increasingly fraught, China has focused its public diplomacy efforts on the developing world, pitching Beijing as an alternative ally to the United States that has deep pockets - and fewer objections on human rights issues in partner countries.
China's leader, Xi Jinping, recently said China would seek to ensure developing nations have access to any Chinese vaccine, an offer that could help to strengthen these diplomatic bonds if the Chinese vaccine proves effective. Xi also pledged to contribute $2 billion over two years to the international coronavirus response. But such offers could backfire if the Chinese vaccine turns out to be unsafe or faulty, as happened with its donations of face masks when they were found to be defective.
Top U.S. infectious-disease expert Anthony Fauci said in an interview with The Washington Post that it's too early to tell which nation will bring the first successful coronavirus vaccine to market, but he believes the United States and China are each on track to produce viable contenders.
"I think both countries are eminently capable of developing a vaccine," Fauci said. "I'm cautiously optimistic that both countries will be successful in developing a vaccine for their own country."
Fauci downplayed the U.S.-China rivalry, pointing out that the immense global need means multiple vaccines will be necessary. He also noted his team at the National Institutes of Health relied on the genetic sequence of the virus made public by Chinese researchers in January to begin their own work on a vaccine - before a single case in the United States had been reported.
But Trump and Xi have each made clear that developing a vaccine is a national priority, which has cleared red tape but also heaped additional pressure on researchers and made their work a proxy for their country's technological and manufacturing prowess. It will also be a test of how each country shares if they are successful.
For example, the Ebola vaccine was invented by Canadian researchers, but licensed to an American biotechnology company that partnered with one of the world's biggest pharmaceutical companies. The vaccine is produced in Germany.
The nationalist overtones have unnerved health experts, who fear they could complicate efforts to eradicate a deadly virus and also exacerbate already tense trade talks between the heavyweights.
"The danger of vaccine nationalism is that it undercuts efforts to end this pandemic in the shortest period of time," said Kendall Hoyt, assistant professor of medicine at Dartmouth's Geisel School of Medicine. "Once we have a vaccine, we will want to prioritize individuals who are most likely to transmit the virus, regardless of nationality or ability to pay."
Nationalist language around the origins of the virus, as well as the race to find a vaccine could also trigger a domino effect of protectionist measures, disrupting medical and other supply chains for which China is an essential source.
Some health experts remain optimistic, nonetheless, that vaccine diplomacy could prevail against a pathogen that has cut such a deadly swath across the globe. They note that even during the Cold War, for example, the United States and Soviet Union were able to collaborate on an oral vaccine against the scourge of polio.
"This is a planetary problem, and it requires a planetary solution," said J. Stephen Morrison, director of the global health policy program at the Center for Strategic and International Studies. "We have to be conscious and realistic about the nationalistic impulses that move through this. How do you get that collaborative finish to all of this that's not going to leave whole segments of the world at the side of the road?"
"Winning" the race, many scientists argue, is the wrong way to think about the problem, especially since the global economy will struggle if the virus continues raging in any significant part of it. A vaccine's passport into the world is the data that shows it is effective and safe, not who invented it.
And in a global economy, the notion that a vaccine "belongs" to one country or another is complicated by the multinational lineage of many efforts. Johnson & Johnson, for example, is building out manufacturing capabilities in the United States, Europe and Asia. Pfizer has partnered with a German firm and is establishing manufacturing capabilities in the United States and Belgium. Moderna has a factory in suburban Massachusetts but is partnering with a Swiss contract manufacturing firm to scale up production.
China has already struck some partnerships with other countries, such as the company CanSino Biologics' collaboration with Canada's National Research Council, which could be an avenue for quick adoption and manufacturing of CanSino's trial vaccine in Canada, if it proves effective.
Chen Wei, the Chinese military's top virologist, who is leading the research on another vaccine candidate, said in an email to The Washington Post that her team has made manufacturing preparations, even though the vaccine has only gone through initial safety testing.
"Production capacity of the vaccine is in place," she said. "We can vaccinate as needed."
For China, which has for years been vying to narrow the biomedical research gap with the United States, developing a vaccine first could be an important symbolic victory and a domestic morale booster amid a recession.
It could give the country a head start on reigniting its economy since the sports, entertainment and retail sectors cannot fully recover until large public gatherings can take place without significant risk of infection. A majority of China's economic activity is consumer driven, despite its reputation as a manufacturing giant.
There, as in the United States, widespread vaccination could also allow the resumption of full-scale manufacturing without social distancing requirements that slow output and add costs for masks and other protective equipment.
Paul Stoffels, Johnson & Johnson's chief scientific officer, said there will be a need for multiple vaccines - probably five to 10 to inoculate the world's population. He and other pharmaceutical leaders racing to develop vaccines said at a news conference Thursday that rival countries and companies must root for each other.
"The rival is only . . . covid, the virus right now," said Albert Bourla, chief executive of Pfizer.
Being first in medical science doesn't always mean winning the race. The first vaccines are likely to be eclipsed by follow-ons, as scientists learn more about which approaches work best.
"The first vaccines are not going to be the best ones, most likely," said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. "They may be partially protective, but they will be replaced over time with better vaccines. Maybe you can call it a race, but it's more of a marathon."