When everyone from the president to your primary care doctor declared loudly and wholeheartedly in December 2020 that the newly FDA-authorized COVID-19 mRNA vaccines were “safe and effective,” what were those claims based on?
In this article, I will review the contractual and regulatory framework applied by the U.S. government to the initial development, manufacture, and acquisition of the COVID-19 mRNA shots. I will use the BioNTech/Pfizer agreements to illustrate the process.
- The COVID-19 mRNA vaccines were acquired and authorized through mechanisms designed to rush medical countermeasures to the military during emergencies involving weapons of mass destruction (WMD).
- These mechanisms did not require the application of, or adherence to, any laws or regulations related to vaccine development or manufacturing.
- The Food and Drug Administration’s (FDA) Emergency Use Authorization for the vaccines was based on clinical trials and manufacturing processes conducted with no binding legal standards, no legally prescribed safety oversight or regulation, and no legal redress from the manufacturer for potential harms. (This last point is being challenged in multiple court cases, so far to no avail.)
Contractual Framework for COVID-19 mRNA Vaccines
When the U.S. government entered into its COVID-19 vaccine agreement with Pfizer, which was acting on behalf of the BioNTech/Pfizer partnership, in July 2020, the agreement encompassed a minimum of 100 million doses of a “vaccine to prevent COVID-19” and a payment of at least $1.95 billion. The agreement also allowed for future procurement of hundreds of millions of additional doses.That’s a lot of money for a lot of items, especially since the vaccines had not yet been tested, approved, or manufactured to scale and, as the agreement stated, were purely “aspirational.”
Obviously, this is not normal procedure. But, then, those were not normal times. The government declared that we were “at war” with a catastrophically dangerous virus that would kill millions and millions of people of all ages unless we could develop “medical countermeasures” (a military term) and get everyone to take them as quickly as possible.
Military Acquisition
The government side to the agreement with Pfizer was the Department of Defense (DOD), represented by a convoluted chain of parties, each operating as a subcontractor, or co-contractor, for the next.You’ll find details about the role of each of these military procurement groups in Part 2 of this article. The important point to recognize is that all of these bodies are charged exclusively with military objectives: “ensuring military readiness,” “enhancing the mission effectiveness of military personnel,” and “supporting the Army and Unified Land Operations, anytime, anywhere.”
This is crucial, because the laws and procedures governing military procurement have a very different set of assumptions and cost-benefit considerations than those used in civil society.
In fact, agencies governing civilian and public health, such as the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, and the Department of Health and Human Sevices (HHS), do not have the authority to grant certain types of special acquisition contracts, which is why the COVID-19 vaccine contracts had to be overseen by the DOD.
Other Transaction Authority/Agreement
(NOTE: OTA is used interchangeably to refer to Other Transaction Agreement and Other Transaction Authority.)What types of transactions are we talking about?
In other words, OTA is not a pathway for government acquisitions primarily intended for civilian populations.
What About OTAs for Medical Products?
In 2015, the DOD announced the establishment of the CBRN Medical Countermeasure Consortium, whose purpose was to use the OTA acquisition pathway to “work with DOD to develop FDA licensed chemical, biological, radiological, and nuclear (CBRN) medical countermeasures.”Broadly speaking, this included “prototype technologies for therapeutic medical countermeasures targeting viral, bacterial, and biological toxin targets of interest to the DOD.” Furthermore, such technologies could include “animal models of viral, bacterial or biological toxin disease and pathogenesis, assays, diagnostic technologies, or other platform technologies.”
Note that there is a mention of FDA licensing, which means a medical product cannot be purchased through OTA without any FDA involvement. The extent of that involvement will be discussed in the section on regulations below.
Pfizer’s OTA
The DOD can make three types of agreements under OTA: research, prototypes, and manufacturing. Importantly, according to National Defense magazine, the agreements (which are “other than contracts”) are supposed to start with prototypes and then move “from prototypes to production contracts.” In other words, you start with an OTA for a prototype and then get an actual production contract.So the military acquisition branch of the government is paying Pfizer to show that it can manufacture 100 million doses of a never-before produced or tested product, while also acquiring those 100 million doses, and potentially hundreds of millions more. The “prototype” somehow includes not just the manufacturing process, but also the 100 million doses created through that process.
Regulatory Framework for COVID-19 mRNA Vaccines
What about regulatory oversight of the development and manufacturing processes?For pharmaceutical products, such as vaccines, this would include: 1) clinical trials to demonstrate the safety and efficacy of the products, and 2) compliance with good manufacturing practices to ensure that what is in each dose is actually what is supposed to be in each dose.
“Pfizer will meet the necessary FDA requirements for conducting ongoing and planned clinical trials, and with its collaboration partner, BioNTech, will seek FDA approval or authorization for the vaccine, assuming the clinical data supports such application for approval or authorization.”
What are the FDA requirements “for approval or authorization?”
According to the Pfizer OTA, those requirements are whatever it takes to “grant an Emergency Use Authorization (‘EUA’) under Section 564 of the Federal Food, Drug, and Cosmetic Act.”
Emergency Use Authorization
EUA is a very special way to authorize a medical countermeasure in very specific types of emergencies. It was designed, according to the Department of Justice, to quickly make available effective vaccines and treatments against—among other CBRN agents—potential biowarfare/bioterror agents such as anthrax, botulinum toxin, Ebola, and plagues.You can read about the details of EUA regulations in Part 2 of this article. In summary, an emergency use authorization can be granted by the Food and Drug Administration once HHS and/or the DOD have declared that there is an attack, threat of an attack, or national security threat created by a CBRN agent (a weapon of mass destruction).
Significantly, as the Harvard Law article explains, EUA was not intended to cover brand-new vaccines:
“The only vaccine ever to have received an EUA prior to the current pandemic was AVA, an anthrax vaccine that had already been formally approved for other purposes.”
This is extremely important: EUA was meant for dire situations of warfare or terrorism, not to protect the entire population from naturally occurring pathogens. For this reason, EUA products do not require the type of legal safety oversight that is applied in civilian contexts by the FDA.
No Legal or Regulatory Standards Apply to the FDA’s Decision to Grant EUA
Here’s the kicker about EUA: because it was intended to be issued only in war and WMD-related emergencies, there are no legal requirements for how it is issued, beyond the determination of the FDA that such authorization is appropriate. There are no legal standards for how clinical trials are conducted. There are no laws regulating the manufacturing processes. There are only “reasonable beliefs” based on whatever evidence is available to the FDA at the time that it makes its determination.“Criteria for Issuance of Authorization
- that an agent referred to in a declaration [by the HHS Secretary] can cause a serious or life-threatening disease or condition.
- that, based on the totality of scientific evidence available to the Secretary, including data from adequate and well-controlled clinical trials, if available, it is reasonable to believe that
a. the product may be effective in diagnosing, treating, or preventing such disease or condition.
b. the known and potential benefits of the product outweigh the known and potential risks, taking into consideration the material threat posed by the CBRN agent(s). - that there is no adequate, approved, and available alternative to the product.”
PREP Act
If you agree to develop, manufacture, and sell hundreds of millions of aspirational products to the government under the contract-like OTA and bioterror-contingent EUA, you need very good liability protection.This is provided by the PREP (Public Readiness and Emergency Preparedness) Act, which was designed to go hand in hand with EUA. Again, it is possible to envision a bioterrorism scenario, such as an anthrax attack, in which the government needs to get lots of countermeasures very quickly. Many people will inevitably die in the attack, but if there’s a chance that the countermeasure will work, it needs to get made and distributed as quickly as possible. If it has some bad side effects, or even if it kills some people, one could argue that the manufacturer should not be held liable.
Clearly, this was never intended to apply to a new, untested vaccine used to counter a naturally occurring virus in hundreds of millions of people.
What, then, are the standards for determining the necessity of a PREP Act declaration?
“In deciding whether to issue a PREP Act Declaration, HHS must consider the desirability of encouraging the design, development, clinical testing or investigation, manufacture, labeling, distribution, formulation, packaging, marketing, promotion, sale, purchase, donation, dispensing, prescribing, administering, licensing, and use of the countermeasure recommended in the Declaration. HHS may also consider other relevant factors.”
Conclusion
The BioNTech/Pfizer COVID-19 mRNA vaccines were authorized for use in the entire population of the United States based on the application of the following sequence of agreements and determinations:1. The DOD uses “contract-like” OTA to buy aspirational products. The DOD is not responsible for overseeing clinical trials or manufacturing. Pfizer is responsible for getting authorization from the FDA.
2. The FDA is permitted to issue EUA to Pfizer for mRNA vaccines because the HHS secretary declares that there is an emergency that warrants EUA.
3. FDA makes its EUA determination based on whatever evidence and considerations it feels are appropriate, given the emergency situation. There are no legal standards that apply to the FDA’s considerations, except that it believes the product may be effective, the benefits outweigh the risks based on available information, and there is no alternative product.
4. The HHS secretary grants total legal immunity through the PREP Act to anyone involved in developing, making, shipping, or administering the vaccines, based on his determination that there is an emergency that justifies this action.
Questions About the Legality of the EUA
It sounds like something in this whole process must be illegal, right?So far, trying to charge pharmaceutical companies with wrongdoing related to COVID-19 vaccines has failed, because the EUA and PREP combo means they were not required to apply any legal or regulatory standards to their clinical studies or manufacturing processes.
But what about the government?
Moreover, even if the government considered COVID-19 to be a disease caused by a potential bioterror agent, how could the HHS secretary justify an EUA that required him to determine that “there is a public health emergency that has a significant potential to affect national security” when it was known that COVID-19 was deadly almost exclusively in old and infirm populations?
In December 2020, the following facts were known about COVID-19 without a reasonable doubt:
• The infection fatality rate (IFR) for the entire population was less than 1 percent.
• The IFR for anyone under 55 was 0.01 percent or lower.
• The IFR for children was near zero.
A disease that has significant potential to affect national security has to be very severe, especially in its effect on the military. Yet in December 2020, military-aged people were known to be at nearly no risk from COVID-19. And still, the HHS secretary determined that there was an emergency that warranted EUA for the mRNA vaccines. And all military personnel were mandated to get the injections.