11) The Grand Plan

Part 11 of the 12-part series - 'A Grand Machine to Beat Covid-19' - outlines an overarching strategy for solving C-19 and proposes ambitious ‘success criteria’ to evaluate our efforts.

As C-19 spreads through the global population, we’ll probably build up some sort of ‘herd immunity’, but it’s not clear precisely what this means. For most coronaviruses, post-infection immunity doesn’t last for very long, so it seems improbable that natural immunity will provide an enduring solution. We might get lucky, but it wouldn’t be sensible to rely on the problem just going away on its own.

Defensive Measures

The first line of defence, for most of the world, has been to go into strict lockdown – with the imposition of travel restrictions, social distancing and rules prohibiting physical contact. National lockdowns have taken some of the pressure off health systems and helped to fend off the first wave of the pandemic. However, as discussed previously, it’s very possible that such blunt, hard-line measures have caused more harm than good overall... and the approach certainly isn't (economically or psychologically) sustainable over the long-term.

A few countries managed to meet the first wave with coordinated national test-and-trace systems – greatly reducing infection rates and minimising mortality. Well-implemented operations can avoid the need for full-scale lockdowns – replacing them with more moderate measures and individually-targeted self-isolation. It seems fair to conclude, from cross-country comparisons, that test-and-trace has proven effective and should now constitute the world’s primary line of defence, with all nations attempting to get systems in place. And of course, a high level of international cooperation and systemic interoperability will be necessary to get global transport properly moving again. Deploying test-and-trace should save a lot more lives from C-19, but it clearly doesn’t constitute a long-term solution.

Vaccines and Treatments

The ideal way to solve C-19 would be to quickly develop an effective vaccine and then rapidly distribute it across the world. This would be great, but there are certain problems with the plan. One issue is that we’ve never successfully created a vaccine for any of the coronaviruses… even the ones we’ve known for decades. It may well be that these types of virus are simply impervious to any vaccine technologies that lie within our near-term innovation horizons.

Even if it is possible to develop a vaccine, it may not be possible to do it safely within the kind of timeframe most people are hoping for. This is due to the unavoidable trade-off that needs to be made between safety and speed. Most vaccines take 10-20 years to develop and by the time they get approved for mass distribution, it’s been several years since they first got tested in humans – with all test-subjects having been closely monitored throughout the process. This is sensible, because experimental vaccines sometimes have serious, negative side-effects… and these won’t necessarily become immediately apparent.

If we’re planning on giving the vaccine to seven billion mostly-healthy individuals (our whole species), then we better make sure it doesn’t have any serious side-effects! Even if one of the drugs currently being tested in humans seems to work, will it really be safe to vaccinate everybody in the world in six months’ time? Or 12 months? We need to decide what balance to strike between safety and speed. This should ideally be decided on a global level, with several levels of debate and discussion systematically involving scientists, medics, governments and citizens within the decision-making process.

Common-sense dictates that we’ll need to leave a decent amount of time between the first-in-human test and the full-scale vaccination of our species. So perhaps, in the best-case scenario, a drug currently being tested might be deemed safe (enough) for mass deployment by late 2021, or early 2022. But, if we don’t hit the jackpot with our first volley of innovations, then it could be significantly longer before a vaccine is ready.

Three to five years would seem an unbearable length of time to wait… and it could be longer than that… or never. So whilst we should do everything we can to create a safe and effective vaccine, it’s important that we develop timelier solutions in the interim. Instituting effective medical treatments seems to be the answer. If we can develop a reliable therapy to substantially reduce mortality, post-infection, then we could downgrade C-19 to the status of a normal disease… ending the Coronavirus Crisis. Realistically, we’ll probably need to build up a suite of treatment options, in order to do this.

There are several reasons that treatments can be deployed faster than vaccines. Firstly, some of our existing (pre-safety-checked) drugs have already been found effective against C-19… and there may be more.

Secondly, unlike their vaccine-focused counterparts, treatment trials don’t need to wait for a year to see whether their participants naturally get infected (because the participants are already infected).

Thirdly (and most importantly), the safety and risk considerations are very different for new treatments compared to vaccines. Treatments are going to be used on a few millions (or tens of millions) of people – those who are already severely-impacted and at substantial risk – whereas vaccines would be given to billions of healthy individuals. So, although we still need to be careful with new treatments, we can afford to approve them relatively quickly.

A Global Grand Plan

Thinking about the Grand Plan raises other significant questions. Notably, will we stand together against the pandemic as a species… or will we face the threat as separate nations? Will the rich world sort themselves out with treatments and vaccines and then leave C-19 to rampage around the poorer regions of the planet (forgotten… like so many other diseases)? It could work out like that, but hopefully, humanity’s better side will win out and we’ll drive through a global solution that genuinely includes everyone.

So, perhaps the backbone of our Grand Plan can be summarised as:

1. Mitigate pandemic with test-and-trace systems and targeted self-isolation measures

2. Develop technologies, systems and policies to reduce the wider negative impacts of C-19

3. Establish a suite of effective treatment therapies

4. Create a safe and reliable vaccine

5. Distribute and deploy all key innovation solutions worldwide

And what about our ultimate end goal? What would success look like, in terms of tackling the pandemic? Staying true to the Challenge-centric thinking discussed throughout this paper, we should ask: What success criteria need to be fulfilled in order to solve the Grand Challenge of C-19? What are humanity’s ‘Victory Conditions’?

Of course, the ideal solution would be to wipe C-19 from the face of the earth. This is an easily-definable and perfectly realistic objective, but there’s a possibility that it might be unachievable. In which case, our next-best option would be to substantially reduce the damage that the Coronavirus causes – learning how to manage it effectively, as we do with more familiar diseases. Defining this metric would be a complex business, but success would clearly involve: significant reductions in mortality levels; the removal of threats and disruptions to health systems; and a general return to economic and social ‘normality’.

Clearly, our successes and failures are going to be greatly defined by the cold metric of calculating the number of deaths attributed to C-19. In order to get the most realistic picture, we should probably count both direct and indirect deaths (including fatalities caused by the inability to access normal medical care, late diagnosis of Cancers, increases in suicide-rates, etc.). Measuring the long-term difference between average mortality rates and levels during the pandemic is probably a good way to do this. And if we really want to get the most meaningful statistics, then maybe we should think in terms of life years lost (multiplying early deaths by the time that those dying, would otherwise have been expected to live).

Should we specifically aim to keep lost lives/ life-years below a certain level? Would seem logical… but certainly a depressing ‘success’ metric to set. Perhaps, less disheartening to try and work out how many life-years we save, by estimating what would have happened without our concerted defensive efforts? That seems more inspiring, but it’s still just about minimising something negative… so even the best-case result might end up feeling like a hollow victory.

But then, how could it be otherwise? Disease is a terrible business, so surely the best we can hope for is to minimise the damage? And of course, on an individual level, nothing can truly make up for the early death of a loved one. Although, on a macro-level, there is one thing that can make up for a life-year lost – a life-year gained. And perhaps the unique circumstances arising from the pandemic, actually give us the opportunity to make something positive out of all this tragedy. Is it possible that humanity could snatch a genuine victory… from the jaws of defeat?

The March to Victory

Because, if we push through the Grand Plan over the next few years – using test-and-trace and other systems and technologies to mitigate the pandemic, before rolling out new treatments and vaccines across the world – then we’d likely end up in a very interesting position:

· Wartime-style global economy, fully-mobilised towards healthcare and life sciences, with vastly expanded medical-technology and pharmaceutical-production capabilities

· Healthcare systems receiving significantly increased funding across the world

· Improved health and medical infrastructures in the developing world (set up to deliver C-19 vaccination and treatment programmes)

· New types of medical technology with wide-ranging applications (RNA vaccines? Advanced remote diagnostic devices? Sophisticated medical 3D-printing? etc.)

· International research and development efforts focused obsessively around medicine and pharmaceuticals

· Significantly-improved innovation system – based on open principles and capable of delivering technological and scientific advances much faster than previously possible

· A greater level of human solidarity building up, as together, the Citizens of the World begin to turn the tides on the pandemic

In this position, we really would have the chance to seize a meaningful victory. Building up global drug-production capacity and poorer country’s health infrastructures, would enable the delivery of all sorts of life-saving technologies, to communities that are usually hard-to-reach. We could comprehensively distribute our existing treatments and vaccines for diseases such as polio, measles, tetanus, malaria, etc. And in these peculiar circumstances, they could be dispersed in a highly efficient manner, for relatively little additional cost.

Then there’s all those new healthcare technologies – some with broad wider applications – and the next-level innovation system to facilitate their rapid development and exploitation. Imagine the sweeping improvements to healthcare as we institutionalise new systems enabling video-conference medical appointments alongside multi-purpose, remote/ wearable diagnostic devices. And if we manage to develop our first RNA vaccine during the fight against C-19, then we’ll likely be able to use variations of the technology versus many other infectious diseases… and even Cancers (also, RNA pharmaceutical-production should be radically cheaper than traditional vaccine manufacturing).

Ultimately, if we play our cards right, there’s a very real chance that over the long-run – our response to the pandemic could save more lives/ life-years than we lose to C-19. Looking at the worldwide figures for deaths attributed to preventable diseases, it’s easily possible to see how we, in macro-level statistical terms, could more than counter-balance our global Covid casualties. And the new, spin-off medical innovations should save many more additional lives across the world. Perhaps, most of us can increase our life expectancy by a few years, compared to how it would have been had the Coronavirus never struck.

So, we should be bold and frame it positively:

We stand together as a species. Our aim is to save as many lives as possible. For every life we lose to the pandemic, we vow to win back two lives in return. We will remember our dead. We will count every single one. We cannot return lost years to the individuals who die, but we can honour them by saving others in their name… winning life to compensate for death.

A memorial will be built, on a virtual wall, by the entrance to the Grand Machine. On it, we will record the names of every individual who dies due to the Coronavirus. We will not forget any of them… for each name on the memorial, we will save two lives. In indirect cases, it may be hard to determine whether specific people died due to the pandemic, but we will remember the numbers as well… every loss will be returned twice over. This should be our end goal – the ‘Victory Conditions’ for the C-19 Grand Challenge:

For every life-year lost, due to the pandemic, we will save two life-years in return.

The Role of the Machine

As discussed throughout this paper, the Machine can assist humanity in solving the problem of C-19 by helping us:

1. Improve our foundational understanding of the disease and the science behind it

2. Enhance and enrich our Coronavirus data and information resources

3. Build effective forecasting models to advance our planning capabilities

4. Develop strategies, systems and policies to organise our pandemic response on multiple fronts

5. Design and institutionalise gold-standard test-and-trace systems

6. Coordinate the full spectrum of emergency management efforts

7. Facilitate global debate and engagement between citizens, scientists, medics and governments

8. Innovate all sorts of new technologies and systems to help tackle C-19

9. Develop medical treatments and vaccines

10. Organise and implement a global vaccination programme

11. Raise morale by enabling anyone to get involved and contribute towards the Grand Plan

12. Create a truly international response, led by the Citizens of the World

The Machine is exactly what we need in this situation. Not just an online platform – a revolutionary new innovation system. Designed to help us face C-19 on every front. A meta-level strategy – a plan for formulating plans – enabling anyone to develop a project or initiative and implement it through the MMM. Our species can collectively develop a ten (billion) step Grand Plan and then systematically work through it, until we achieve the end-goal – liberating humanity from the scourge of the Coronavirus.

Except, the obvious problem is – the Machine does not yet exist. When really, we needed it in place and ready-to-go at the beginning of 2020. It’s September now, so even in the best-case scenario, it wouldn’t be until the end of the year before the basic bones of the platform could be constructed. If it all happened at breakneck speed, then the MMM might attain the capacity for high-level, technical functionality by late 2021. But it will take a long time before serious money begins to flow through the Machine… and years before the incentivisation impacts, of big prizes and IP buyouts, transform the fundamental economics of the innovation system.

Ideally, we’ll be able to innovate our way out of the Coronavirus Crisis by late 2021. In which case, the MMM wouldn’t be ready in time, to contribute in all the ways we’ve explored. (Although, there is quite a bit of functionality that could be quickly up-and-running – as discussed in the following section.)

It’s perfectly possible that we’ll be able to develop a package of innovation solutions good-enough to ‘end the crisis’ by late 2021. Although, it’s unlikely that vaccines will be safe to roll out by then, there’s a decent chance that the vaccines we eventually use, will already be in the testing stage of clinical trials. And it’s quite possible, that improved medical understanding and new treatment options will have reduced the mortality rates to more ‘acceptable’ levels.

Attaining adequate innovation solutions by late 2021 would certainly be an impressive (and historically-unique) achievement. However, it doesn’t seem overly unrealistic, given that we’re taking a ‘throw-everything-including-the-kitchen-sink-at-it’ approach. Governments are scrambling to fight on all fronts, enacting wartime economies with wide-ranging market interventions. The usual rules have gone out the window and national taskforces are building ad hoc innovation systems specialised to face the crisis. Companies, non-profits and citizens are reacting with an enormous surge of innovative energy – millions and millions of highly-intelligent brains, wrestling with every facet of the problem.

But, whilst it’s possible we’ll rapidly succeed, it’s also possible that we won’t. It’s perfectly plausible that our first volley of innovation attempts won’t solve the problem. After all, most successful innovations are proceeded by a large number of failed attempts (not least, new pharmaceutical technologies). The war may not be over by Christmas 2021… it could drag on for years.

Whilst we should always hope for the best, it’s sensible to plan for the worst… especially with the stakes as high as this. Thus, we need to get a proper plan in place – strategy as well as tactics – a new model innovation system, that plays the percentages and maximises our chances of success. If this whole thing is destined to drag on for years, then the MMM could indeed come to play a central role in confronting the Coronavirus.

In either the best or worst case scenarios, one key advantage of taking the MMM approach lies in how the Grand Challenge is formulated. The victory conditions specify mitigation of C-19 deaths and an end to social disruption, but the central end-goal focuses on counter-balancing pandemic-deaths by saving lives in other areas. In this way, the Machine tackles the most significant danger posed by the Coronavirus – the terror-induced tunnel-vision that has led us to drop our guard against the rest of the world’s problems.

Framing the Grand Challenge to save lives in general, but in a way that’s clearly and emotively related to the C-19 pandemic, should help us smoothly and subtly shift focus. Guiding a transition towards a more balanced and holistic approach to tackling the Coronavirus Crisis – one that truly makes sense. And giving us the opportunity to make something genuinely positive out of all this death, chaos and misery.

When human beings are feeling emotional (individually or collectively), it’s very difficult to counter these powerful feelings with something as bland as rationality – emotions, such as fear, almost always win out. That’s why the MMM Grand Challenge Victory Conditions are designed to connect with the high emotions surrounding the pandemic… and then attempt to channel this energy towards a rational, positive end-goal.

Therefore, in respect to the Coronavirus Crisis, the most significant thing about the Machine, is that it gives us the chance to turn this (extremely-negative) historical event into an overall ‘win’ for humanity. As mentioned, it’s likely that our unprecedented scientific efforts to combat C-19 will provide us with a number of new technologies that hold the potential for broad application in other areas. RNA pharmaceuticals could likely be used against all sorts of diseases and should substantially reduce scientific research-times and pharmaceutical production costs. And it’s probable we’ll build up a whole catalogue of new, multi-purpose, component technologies, such as protein-binders.

So, imagine that a C-19 RNA vaccine passes a key development milestone sometime in 2022, with the Machine up-and-running and ready to move into overdrive. Multiple Challenge Programmes could be launched simultaneously, aiming to find RNA-based pharmaceuticals for 100+ different diseases, with the full-force of the holistic MMM process coming into play. Innovations could be mass-produced with an unprecedented level of efficiency and sophistication – churning out solutions for all sorts of health conditions, whilst minimising the market price for such technologies.

The Machine could be used to implement a global vaccination programme against C-19, alongside multiple other diseases, and it would be great to see the Grand Challenge of Cancer presented and approached using the MMM methodology. And the next time a new virus appears, we’d be ready for it – the Machine guiding a tried-and-tested, yet versatile, emergency response, right from the outset. Whilst providing a production-line of novel, prototype solutions within weeks of the new threat being identified.

Then, there are the Grand Challenges of Climate Change, Artificial Intelligence, and Radical Life-Extension. With all these new technologies and associated business opportunities generating just the kind of economic response we need to climb out of the Great Coronavirus Depression.

Summary

Fundamentally, the MMM is not primarily a solution to C-19. But rather, C-19 has provided us with a unique opportunity to build the MMM. The Coronavirus Crisis doesn’t have to be the biggest historical event of the early 2020s… the biggest historical event, could be the development of the Machine.

Read the final blog in the series - Part 12 - The Way Forwards