The development and use of vaccines about 11 months after the description and sequencing of the SARS-CoV2 virus is a tale for the ages, one that will be in every history of the pandemic. Within that larger story of vaccines, that have already saved over 20 million lives and will continue to save many more, are many smaller stories, of people, places, healthcare systems, governments, organisations, companies and all of society and our relationships across a range for scales from individuals to all of nature. 

 In Peter Loftus’ book The Messenger: Moderna, the Vaccine and the Business Games that Changed the World, the story is that of a struggling company that against many odds developed one of two products that revolutionised vaccine manufacturing, and certainly saved many lives in high-income countries. 

Peter Loftus is a reporter with the Wall Street Journal who covers the biotech industry and has, throughout the period of Operation Warp Speed and the development of vaccines against SARS-CoV2, had access to the major players at Moderna, the little company that transformed itself into a major provider of a new class of vaccine. The story of the development of mRNA vaccines has been told by others before, who have told the story of the long process of the science behind mRNA vaccines and their delivery, but this telling focuses on the company and its leadership, and their relationships and decisions that led to Moderna being able to conduct the studies that led to the approval of the vaccine known as Spikevax. 

Real world threat 

There is some coverage of the science, alluding to the major players in the field and to their contributions, but Loftus’ business journalism background clearly influences his telling, in covering in detail how Derrick Rossi, Robert Langer, Kenneth Chien came on board and approached Flagship Ventures to establish a company initially called Moderna Therapeutics. 

The book’s prologue tells the story of how the National Institute of Allergy and Infectious Diseases and Moderna had just put in place a plan to jointly work on developing a vaccine for the Nipah virus, but when a mysterious new virus was reported from China, they decided that a real world threat might make a better target. The story then swings, as through much of the book, on the wheeling and dealing required to raise the resources to proceed to the next step of vaccine development and evaluation. 

Starting with Moderna CEO Stephane Bancel’s discussion in Davos coffee shops with Richard Hatchett of the Coalition for Epidemic Preparedness Innovations, to get the first grant through the subsequent interactions with the US government for funding and resources to run large scale clinical trials, the book tells the tale of the managerial, manufacturing and resourcing complexities in keeping a vaccine development effort moving forward during the pandemic. This builds on the recounting of the struggles of a biotech pioneer, with a short history of being able to raise large sums of money to keep pushing ahead with refining their transformative technology, but without getting a product to market. 

Loftus quotes emails and conversations that track the evolution of Moderna and its role from one among many early players in the vaccine space to a company that considers itself a front runner for future innovations in vaccines and mRNA technologies. Many controversial aspects are not covered in the detail that is needed for a fuller picture of Moderna — the issues of intellectual property, including Moderna’s decision to not include NIAID scientists in their patent filings, the amount of public funding that was received by Moderna and the access provided to prepare clinical trial sites which did not seem to influence the pricing decisions, the low supply of vaccines to the COVAX facility, the lack of willingness to share expertise during a pandemic. 

The pharma model 

Moderna’s approach aligns with the pharmaceutical model developed and embellished in the US, where first to market with a unique product enables companies to charge the highest price that the market will bear. The argument that companies carry all the risk discounts the contributions of the US government. Loftus cites a 2018 analysis that shows that every one of the 210 drugs approved by the US FDA between 2010 and 2016 had NIH funding contributing to their development and briefly describes the societal concerns that industry enables wealth creation with no considerations of access, and the counter arguments from industry that this is their purpose, and therefore justified. For a non-business reader these arguments and the compensation of key leadership are illuminating, highlighting how technology leadership needs to be more widely distributed globally to prevent the current monopoly of countries, particularly the US, that have supported biotechnology innovation for decades. 

The success story of the first generation vaccine leads into the discussion of the challenges of an evolving virus and what it means for a company to be a platform technology company, using messenger RNA for not just vaccines, but also therapeutics, as was originally intended when Moderna was established. The book is well-written and well-paced, a story told about an American company that delivered on its promise, from a US-centred view of the world. 

(The reviewer, Dr Gagandeep Kang, is Professor at the Wellcome Trust Research Laboratory, CMC, Vellore, and an eminent virologist) 

The Messenger: Moderna, the Vaccine and the Business Games that Changed the World 
Published: Harvard Business Review Press 
Pages: 320
Price: ₹1,250 

Check out the book on Amazon