As business leaders consider how the availability of a COVID-19 vaccine will affect their organizations, how can they look at such a complex problem and make choices with confidence?
Mick Costigan and Noah Flower contributed reporting to this article.
As President Trump publicly disagreed with the Centers for Disease Control and Prevention’s (CDC) guidance around the distribution of a vaccine and the efficacy of masks, the public is digesting a lot of new information about the global race for a COVID-19 vaccine.
For starters, there’s news the U.S. government plans to widely distribute a free vaccine as soon as possible. Russia says it could sell up to 300 million vaccines to India before the end of the year. China says they may be ready with a vaccine in November, as billionaire vaccine advocate Bill Gates predicts Pfizer will be the eventual distributor of a winning vaccine in early 2021.
All this comes about a week after AstraZeneca a leader in the race for a COVID-19 vaccine — halted its late stage trials due to serious neurological symptoms in one participant. As Pfizer expands its own efforts to release a vaccine with limited publicly available details, concerns are mounting about the generally secretive nature of these vaccine trials, the safety of vaccine rollouts on fast-tracked timelines, and the lack of alignment between Trump and the CDC, which is widely considered to be the world’s leading agency devoted to public health.
It’s safe to say that conflicting information is rampant and uncertainty abounds around the timing and safety of a future vaccine. (And that’s of course, without diving into all the dialogue on social media.)
The availability of a vaccine will have obvious repercussions for individuals. And business leaders are also considering how it will affect their organizations. But how can these leaders look at such a complex problem and make choices with confidence?
Since March, my team at Salesforce has been tracking this and many other uncertainties around COVID-19, and developing scenarios that clarify the range of possible outcomes, to help our own company and our customers make clear-eyed choices.
Typically, the art of scenario planning aims to lengthen decision-makers’ planning horizons. But, in my nearly 50 years of scenario planning, including seven as the Salesforce chief futurist, I’ve never seen uncertainty like that arising from the COVID-19 pandemic.
As a result, we’ve found the need for scenarios on a shorter 9-month timeframe to support critical decisions for companies and governments. You can learn more about these in depth right here.
If and when a vaccine arrives, it will be a game-changer that introduces its own unique dynamics, which is why we drafted vaccine scenarios separately from the other scenarios for the spread of the pandemic. Let’s take a deeper look at the three central uncertainties that define the track to a vaccine and the three potential outcomes that illustrate the range of possibilities.
Three pillars of uncertainty
1. Timing of availability of an effective vaccine
Most conversation about a vaccine centers on the uncertain timeline. As of this writing, only a handful of the nearly 200 vaccines being pursued had entered final (Phase III) trials or received partial approval. While millions of doses are already being manufactured in advance, for them to be released they have to clear the Food and Drug Administration’s (FDA) requirement of effectiveness in at least 50% of subjects.
Relatively less attention has been paid to the challenge of effectiveness. Epidemiologists can’t predict how long immunity will last in individuals; a vaccine that lasts just a few months is barely useful, while one that lasts a year is much more so. Two-year immunity is on the high end of expectations, since coronaviruses are “notoriously famous for not granting durable immunity,” in the words of Michael T. Osterholm, the widely-respected head of the Center for Disease Research and Policy (CIDRAP) at the University of Minnesota.
“However, in order to mount a global program, which will be needed in over 200 countries, at least four years’ immunity and a single dose (rather than booster shots) and no cold chain would be nearly essential for WHO to have the best chance at controlling the pandemic,” says Dr. Larry Brilliant, a CNN medical analyst, founder of the Pandefense Network and a renowned epidemiologist who was part of the team that eradicated smallpox.
It is also possible that the best vaccine will only make the disease milder rather than protecting against it altogether. “We have to be very, very careful in making assumptions that … [a vaccine] will protect us from not only illness, but from infection,” said Osterholm. “We may not get a vaccine like that. We may ultimately get a vaccine one day that reduces the severity of illness.”
Predictions of the endgame for approval and distribution fall into three camps:
Optimistic: The Trump administration continues to insist that a vaccine will be available by the election. The FDA could announce approval before November 4, which Trump would claim to mean that the vaccine was available, in spite of the fact large-scale production will require many months more.
Mainstream: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), agrees a vaccine could be approved by year’s end, and the CDC is now guiding states that one could be distributed by mid-2021. This accords with the views of many epidemiologists, including Brilliant. “I expect that by the new year we’ll have 3-5 vaccines that meet the low bar of 50% efficacy established by the FDA,” he tells us. However, he does worry that rare but dangerous side effects will not be discovered with only thirty to forty thousand subjects getting the vaccine. And if they arise later, they will contribute to anti-vaccination sentiment.
Historical trend: Experts note we’ve never released a coronavirus vaccine for humans before and, in any event, the fastest we’ve ever developed an entirely new vaccine was the four years it took to create one for mumps. While optimism among epidemiologists is high that we will beat that timeline, the previous benchmark stands.
2. The challenge of getting a vaccine into people’s bodies
The challenge of vaccine development is matched only by the incredible complexities of production and distribution. In the U.S., the National Governors Association are among those raising questions, such as: how will it be quickly and efficiently delivered and dispensed? Who gets it first?
Complicating matters, the majority of vaccines under development will require two doses given 21- or 28-days apart, and two of the leading candidate vaccines have different handling requirements and must be stored at different temperatures; in Pfizer’s case extremely cold, at minus 94 degrees. These types of cold chain requirements will likely slow rollout in the low- and middle-income countries as well.
To create herd immunity in a population, experts estimate that 60-80% of the population will need to receive an effective vaccine. However they fear the decision to get a vaccine — similar to personal decisions around wearing masks and social distancing — will be influenced more by politics than science. There’s already a general hesitancy about vaccines among “anti-vaxxers,” who have been heavily promoting their position. And two-thirds of Americans polled by USA Today/Suffolk Poll, say they won’t get a vaccine when it’s first available. Pfizer CEO Alberta Bourla warns that people who don’t take the vaccine will be the “weak link” that allows the virus to continue to spread.
Depending on the gravity of these challenges, herd immunity may be a distant goal.
3. Vaccine producers’ approach to distribution
Russia is calling its vaccine initiative Sputnik V. America named its effort Operation Warp Speed. As these monikers indicate, the race to develop a vaccine resembles the space race on steroids. Drug companies around the world are working on incredibly accelerated timelines, often subsidized by governments. The U.S. government, for example, is contributing $1.2 billion to AstraZeneca’s efforts.
Concerns that this acceleration could lead to less-than-safe vaccines caused major western drug and biotech companies to publicly pledge to only seek approval for vaccines that are demonstrably safe and effective.
Meanwhile other nations are already claiming vaccine advancements. On September 11, the Wall Street Journal reported that a Chinese pharmaceutical company injected hundreds of thousands of people with experimental vaccines, as they and Russia “appear eager to start using their homegrown vaccines, seeking to restart their economics and claim a global public relations victory.” Priority access to vaccines may be used as a tool to drive new geopolitical alignment on contested issues like trade, energy, defense, 5G technology, and other national interests.
Three possible outcomes
These uncertainties can be combined to create a range of plausible scenarios that highlight the many possibilities to consider. When one considers the flurry of activity around vaccine development, it may seem prospects are rosy, but we still have a believable path to many less-than-ideal outcomes.
If and when a vaccine arrives, some of the details will doubtless be different than any of the particular stories told below. We offer them in an attempt to illustrate the range of variation that leaders should plan for, and most importantly, to drive home the importance of keeping tabs on what possibilities are currently on the table. If an outcome could plausibly occur, and it would have a meaningful impact, it is a leader’s responsibility to have a contingency plan at the ready. That preparation is what allows us and our customers to move forward with confidence.
We’ve chosen to highlight three of these possible futures, including the most hopeful.
Scenario 1: “Zero Hurdles”
In this most-optimistic scenario, an effective vaccine is approved early next year, with a traditional and inexpensive design that provides year-long full immunity to 70% of the population. The U.S. administration reverses its current position and decides to work through COVAX, the multilateral arrangement designed to ensure orderly and equitable global distribution.
COVAX brokers deals for the vaccine’s creator to license production around the world, allowing a rapid ramp up of global manufacturing early in 2021, anchored by the large capacity of India’s Pune Serum Institute. Distribution runs smoothly and even low-income countries have easy and timely access, achieving at least selective vaccination where mass vaccination is not achievable. Thanks to unified leadership, messaging, and investment from a wide range of international organizations, public trust in the vaccine is high and herd immunity reduces transmission by early 2022.
Scenario 2: “Sprint and Stumble”
China and Russia are first to emerge with vaccines, after testing them on their militaries, and immediately begin offering access to low- and middle-income countries to build their global support base. Meanwhile, Moderna and Pfizer see positive results early enough to earn emergency FDA authorization. Production scales up quickly and the U.S. provides free access to all in the winter of 2021, creating a climate of heady optimism that the pandemic is all but finished.
Then the Russian vaccine begins to show issues with efficacy, as large numbers of Filipinos who received it begin to get reinfected, causing other countries to back away from their plans to rely on it. Next to emerge are problems with the Chinese vaccine, which appears to cause fatal complications for pregnant mothers. Only weeks later, the news breaks that the Moderna vaccine causes heart attacks in people over forty, leading demand to shift to the Pfizer vaccine until it is revealed that it is causing mysterious deaths in the elderly.
These developments significantly expand the global anti-vaxx movement during 2021, which amasses large numbers of celebrity evangelists and deep-pocketed supporters, including the growing ranks of America’s QAnon. Its growth is further accelerated by the misinformation sown by Russian bots. While at least one of the existing vaccines appear safe for most of the population, rumors fly that pharma and government conspire to hide the worst risks. Across the globe, a stalwart fact-based minority do accept the vaccine by 2022, but the numbers never get beyond the threshold of herd immunity.
Scenario 3: “Long March”
After repeated disappointments that exhaust the public, with one promising candidate after another failing to provide the needed combination of efficacy and durability, a usable vaccine is finally approved early in the summer of 2022. Fortunately, this is the vaccine that will serve the world: it appears to confer long-lasting immunity and can be administered as a simple spray, allowing anyone to be a vaccinator.
It gets rolled out around the world much like any other vaccine, with COVAX working with countries around the world to ramp up local production. Several countries nearly eradicate the virus within 18 months, and a larger group is successful within 2 years. The virus is never fully eradicated, as it continues to persist in the most unstable parts of the world, but for most of us life can finally move on.
There is no way to know now which vaccine(s) will work which is why, as the Guardian noted, “wealthy countries are paying upfront for something that has not yet been proven to work [and are] willing to spend whatever it takes to get their economies running again. And yet, they could back the wrong horse. It’s a lottery on an unprecedented scale.” As we all play that lottery, we hope that these stories give organizations a framework within which to stress-test their own expectations, improve their plans, and navigate today’s unprecedented uncertainty with confidence.
You can watch Salesforce’s Chief Futurist Peter Schwartz explain the 3 short-term COVID scenarios.