An Interview with Richard Hatchett
The recently launched Coalition for Epidemic Preparedness Innovations appointed its inaugural chief executive officer, Richard Hatchett. He talks here with IAVI Report about his plans for leading the new multilateral organization in its quest to fill gaps in the global response to infectious disease outbreaks.
By Michael Dumiak
By public health standards, the Coalition for Epidemic Preparedness Innovations (CEPI) is moving quickly. The idea for the coalition sprung from the largest and most recent Ebola outbreak in 2014-2015. Since then it has raised hundreds of millions of dollars in funding and issued its first call for proposals to develop vaccine candidates against three top pathogens with pandemic potential (see A Crisis Gives You Wings). Starting in mid-April, CEPI will forge ahead under the leadership of new chief executive Richard Hatchett.
From his time as head of the main triage facility near ground zero of the September 11, 2001, attacks on New York City, the former emergency room physician and oncologist has been thinking about how best to organize medical resources to meet public health emergencies. In the wake of the 9/11 attacks, Hatchett and a small group of fellow physicians proposed the idea of organizing a trained group of medical volunteers to respond to emergencies. This idea was expanded and eventually became the US Medical Reserve Corps, a community-based public health network with 200,000 volunteers located throughout the US.
From 2011, Hatchett worked at the Biomedical Advanced Research and Development Authority (BARDA), an effort established during US President George W. Bush’s administration to develop and deploy medical countermeasures such as vaccines, personnel, or infrastructure to man-made and natural threats. Hatchett started there as chief medical officer and then became deputy director. While with BARDA, he directed the team that designed and staffed the US government’s Monrovia Medical Unit during the 2014-15 Ebola outbreak.
As the concept for CEPI arose, Hatchett followed its development closely, dispatching representatives from BARDA to the developing organization and inviting it to participate in the annual BARDA portfolio review of its investments and strategy. The 48-year-old father of three will kick off his tenure with CEPI at the coalition’s current headquarters in Oslo, where he will first conceive and create a vaccine development team. Hatchett then plans to move to London, splitting his time between the three branches (London, Oslo, and New Delhi) of what will be a networked secretariat. He is driven by what he says is the unique opportunity CEPI offers the world to be better prepared for dangerous epidemics.
What are some of your strategies for CEPI, and do you feel a need to quickly show to the public or to donors that the concept works?
Quick successes are great if you can achieve them, and we’ll have a better idea of whether that is going to be feasible once we see the vaccine candidates that come in for the first call for proposals. We’re just getting our first look.
The only real metrics of success for CEPI are whether it can develop the vaccines we need and whether CEPI can ensure that they’re going to be available to the individuals and populations that need them.
One of my critical early missions and goals coming in is going to be building a strong vaccine development team. We’re beginning our recruitment process for a vaccine development lead and for the various areas where we’re going to need expertise internally. We are talking with a lot of people about different approaches to structuring the vaccine development team: who needs to be in-house, what kind of expertise can be contracted, and what kinds of expertise obviously can reside within our private-sector partners.
What type of vaccine development team do you envision CEPI needing?
I think there are a number of different models for how you can pull together the expertise that you need. I know how we approached this at BARDA, and I’ve had lots of conversations with the [Bill & Melinda] Gates Foundation to understand how they do it. I’ve also talked with some partners from inside industry and I’m continuing to talk to others.
It’s a very important issue for CEPI. A lot of people have used the expression “lean and mean,” in that it lets you be agile and fast. I want to make sure that we’re lean and mean, not emaciated.
My experience is that an organization’s needs evolve over the course of working with its partners. Many of BARDA’s partners on many of the projects ended up being small- to mid-sized biotechs, not big pharmaceutical companies. And the small- to mid-sized biotechs have certain advantages, but they also lack certain capabilities, and so we needed to build an internal capability as well.
CEPI has the great advantage of having very large vaccine partners. I’m sure that we’re going to have a number of small- to mid-sized biotechs come in, and what we’re going to need internally is going to depend to a certain extent, even to a large extent, on who our partners are. So this is a work in progress.
How might you approach building partnerships to accomplish the coalition’s goals?
We have signed a memo with WHO [World Health Organization], and have set up a partnership forum and a joint coordination group to engage with various stakeholders. CEPI’s mission requires close working relationships with industry partners and coordination with upstream funders. Coordination has to happen with agencies and organizations that may take responsibility for stockpiling and deploying eventual vaccines during an emergency response. The partnership model I am most familiar with is the US government’s Public Health Emergency Medical Countermeasure Enterprise, which enables coordination of medical product development across the entire spectrum of the product life cycle, from basic discovery to delivery. This is one I hope CEPI and its partners can emulate.
How will you see that CEPI avoids duplication of ongoing research efforts?
We are very focused on not duplicating ongoing research efforts, but on using CEPI’s investments catalytically, including through co-funding and creating synergies by supporting cooperation between existing efforts. The marvelous thing about CEPI’s creation is the commitment of the various partners to bring their own unique capabilities to the table to achieve a common objective of epidemic preparedness. We all have the same goal and will accomplish much more if we build on the capabilities that already exist.
Are multi-use vaccine platforms an explicit goal for CEPI?
Yes, supporting the development of rapid-response platforms is an explicit goal and we are planning a specific call for such platforms. Nucleic acid technologies have been around for a while, but [they] are beginning to be really exciting and lend themselves to a plug-and-play approach. You have a new pathogen, you identify a target that can produce an immune response, and if you have a well-developed platform where you plug in the information from the new pathogen that you need, then you can proceed, hopefully quite rapidly, with vaccine development.
How will you approach your new role? How will it differ from your role at BARDA?
I’m still in listening mode. I’ll start in Oslo for several months and then move over to London. And then I’ll be splitting my time. CEPI’s secretariat is divided between three main nodes right now: Oslo, London, and New Delhi. I will be looking at that organizational structure and trying to think about the allocation of functions across that structure that makes the greatest sense. Resource mobilization is a critically important role. CEPI is only about halfway to its billion-dollar goal for the first five years, so working to close that gap will be a major focus.
BARDA has a pretty broad mission to develop vaccines, biological therapeutics, small molecule therapeutics, diagnostics, and other medical devices against threats a terrorist can use: so chemical, biological, radiological nuclear weapons, pandemic influenza, and emerging infectious diseases. And more recently, that mission has been expanded to include the threat of antimicrobial resistance.
CEPI’s mission right now is more narrowly defined. It aims to develop vaccines against emerging infectious diseases with epidemic or pandemic potential. In a very smart move, CEPI has elected to focus its initial efforts on a limited number of pathogens. I would say that one of the keys to BARDA’s success over the years—and it’s become a pretty considerable success cumulatively over time—has been to define the mission and then stick to the mission very closely. CEPI has tremendous resources at its disposal, but in the context of vaccine development programs there are significant budget restraints. I think the choice to narrow the focus down to just a couple of high-priority pathogens is going to serve CEPI really well.
What I can bring to CEPI from BARDA is really a deep understanding of what has and hasn’t worked, how a successful medical countermeasures program should be organized and administered, and what it takes to succeed. I want CEPI to make its own mistakes, not repeat old mistakes.
Do you have any examples?
One of the signature US programs was an attempt to develop a recombinant protective antigen anthrax vaccine—a next-generation vaccine. One of the first programs that was funded when the program just got started was a vaccine program by a company called Vaxgen. The US government made close to a US$900 million investment in Vaxgen, which was a very small company that didn’t have deep vaccine development experience. That program did not succeed. The government was able to recuperate almost all of that $900 million, so it wasn’t that we lost a lot of money. But they weren’t cautious in how they represented the program. There was a lot of ballyhoo about it. When the failure came, it was damaging in a way that it, perhaps, shouldn’t have been.
We learned our mission. The US government was very successful in advancing flu vaccine manufacturing technology. At the time when the US flu program started or really got running in 2005 or so, there were no cell-based vaccines that had been approved, and certainly no recombinant influenza vaccines approved. Both of those technologies offered advantages in terms of scalability and potentially in terms of speed. That’s particularly true with the recombinant vaccine over the existing egg-based technology. We had large partners working with us. Even that comparatively incremental advance was fraught with a lot of risk, and so it took investing in six programs to end up with one that succeeded.
You have to take a risk-based approach, you have to invest in multiple programs, and you have to be tolerant of failure and keep your eye on the end objective and make sure that you make enough investments to ensure that you succeed.
Michael Dumiak reports on global science, technology, and public health and is based in Berlin.