The mRNA Vaccines Are Extraordinary, but Novavax Is Even Better

 Persistent hype around mRNA vaccine technology is now distracting us from other ways to end the pandemic.

By Hilda Bastian   The Atlantic

JUNE 24, 2021

Alastair Grant / AP

At the end of January, reports that yet another COVID-19 vaccine had succeeded in its clinical trials—this one offering about 70 percent protection—were front-page news in the United States, and occasioned push alerts on millions of phones. But when the Maryland-based biotech firm Novavax announced its latest stunning trial results last week, and an efficacy rate of more than 90 percent even against coronavirus variants, the response from the same media outlets was muted in comparison. The difference, of course, was the timing: With three vaccines already authorized for emergency use by the U.S. Food and Drug Administration, the nation is “awash in other shots” already, as the The New York Times put it.

Practically speaking, this is true. If the FDA sees no urgency, the Novavax vaccine might not be available in the U.S. for months, and in the meantime the national supply of other doses exceeds demand. But the asymmetry in coverage also hints at how the hype around the early-bird vaccines from Pfizer and Moderna has distorted perception. Their rapid arrival has been described in this magazine as “the triumph of mRNA”—a brand-new vaccine technology whose “potential stretches far beyond this pandemic.” Other outlets gushed about “a turning point in the long history of vaccines,” one that “changed biotech forever.” It was easy to assume, based on all this reporting, that mRNA vaccines had already proved to be the most effective ones you could get—that they were better, sleeker, even cooler than any other vaccines could ever be.

But the fascination with the newest, shiniest options obscured some basic facts. These two particular mRNA vaccines may have been the first to get results from Phase 3 clinical trials, but that’s because of superior trial management, not secret vaccine sauce. For now, they are harder and more expensive to manufacture and distribute than traditional types of vaccines, and their side effects are more common and more severe. The latest Novavax data confirm that it’s possible to achieve the same efficacy against COVID-19 with a more familiar technology that more people may be inclined to trust. (The mRNA vaccines delivered efficacy rates of 95 and 94 percent against the original coronavirus strain in Phase 3 trials, as compared with 96 percent for Novavax in its first trial, and now 90 percent against a mixture of variants.

Read: The differences between the vaccines matter

Pandemic-vaccine success, as I wrote last year, was never just about the technology. You needed a good vaccine, sure—but to get it out the door quickly, you also had to have a massive clinical-trial operation going, and it had to be situated in places where the virus would be spreading widely at just the right time. Even if your candidate worked amazingly well, if you weren’t testing it in the middle of a huge outbreak, you’d have to wait a very long time for the evidence to build.

The precise timing of these studies mattered a great deal in practice. The Phase 3 clinical trials for Pfizer and Moderna, for example, were up and running in the U.S. by late summer 2020, and so they caught the nation’s giant wave of infections in the fall. By the time Novavax had finished recruiting in the U.S. and Mexico, in February, case rates had been dropping precipitously. This fact alone, independent of any aspect of vaccine technology, did a lot to shape the outcome.

Corporate strategy was another crucial factor. To “win” the vaccine race, a company would need to be able to produce high-quality vaccine doses reliably and quickly, and in vast numbers. It would also need to field the challenges of working with multiple regulatory agencies around the world. And it would need to do all of this at the same time.

BioNTech, the German company that developed the Pfizer mRNA vaccine, could not have accomplished so much, so quickly by itself. Last October, the company’s CEO, Uğur Şahin, told German interviewers that BioNTech had sought out Pfizer for help because of the scale of the clinical-trial program necessary for drug approvals. That strategic partnership, and not simply the “triumph of mRNA,” was what propelled them past the post. (Moderna had the advantage of its partnership with the National Institutes of Health.) Consider this: The BioNTech-Pfizer first-in-human vaccine study appeared on the U.S. government’s registry of clinical trials on April 30, 2020—the same day as the first-in-human vaccine study for Novavax, which would be going it alone. In a parallel universe where Novavax had paired up with, say, Merck, this story could have come out very differently.

In the meantime, the early success of two mRNA vaccines pulled attention away from the slower progress of other candidates based on the same technology. Just two days after last week’s Novavax announcement came the news that an mRNA vaccine developed by the German company CureVac had delivered a weak early efficacy rate in a Phase 3 trial, landing below even the 50 percent minimum level set by the World Health Organization and the FDA. “The results caught scientists by surprise,” The New York Times reported. CureVac is the company that President Donald Trump reportedly tried to lure to the U.S. early in the pandemic, and the one that Elon Musk said he would supply with automated “RNA microfactories” for vaccine production. In the end, none of this mattered. CureVac’s mRNA vaccine just doesn’t seem to be good enough.

The “sobering” struggles of CureVac perfectly illustrate what epidemiologists call “survivor bias”—a tendency to look only at positive examples and draw sweeping conclusions on their basis. When the Pfizer and Moderna vaccines triumphed, The Washington Post suggested that a bet on “speedy but risky” mRNA technology had paid off with a paradigm-shifting breakthrough. Anthony Fauci called the gamble “a spectacular success.” Such analyses usually had less to say about the non-mRNA vaccines that had gotten into clinical trials just as quickly—and about the other mRNA vaccines that were hitting snags along the way.

Now we’ve seen what happened to CureVac, and that some mRNA formulations clearly work much better than others. By one count, nine groups were testing mRNA COVID-19 vaccines in animal studies as of May 2020, and six were expected to be in clinical trials a few months later. By the end of the year, only BioNTech-Pfizer, Moderna, and CureVac had reached Phase 3 testing, compared with 13 non-mRNA vaccines. Of the nine mRNA-vaccine candidates that were already testing in animals in mid-2020, just two have proved efficacy at this point, while no fewer than nine vaccines based on more traditional technologies have reached the same mark.

These other, non-mRNA vaccines have been widely used throughout the world—and some could still make an important difference in the U.S. Although the U.S. has plenty of doses of the Pfizer and Moderna vaccines available right now, demand for them has cratered. The Washington Post reports that in 10 states, fewer than 35 percent of American adults have been vaccinated. An international study of COVID-19 vaccine misinformation, published in May, found that among the most common online rumors were those alleging particular dangers of mRNA technology—that it leads, for example, to the creation of “genetically modified human beings.” The CDC has also made a point of debunking the circulating falsehood that COVID-19 vaccines can change your DNA. For a time, it looked as though the Johnson & Johnson vaccine would help address this worry. It’s based on a fairly new technology, but not as new as mRNA. However, concerns about tainted doses made at a Baltimore factory and the emergence of a very rare but serious side effect have pretty much dashed that hope. The Johnson & Johnson single-dose vaccine has reportedly accounted for fewer than 4 percent of doses administered in the country.

Read: Microchipped vaccines, a 15-minute investigation

In this context, the success of the Novavax vaccine should be A1 news. The recent results confirm that it has roughly the same efficacy as the two authorized mRNA vaccines, with the added benefit of being based on an older, more familiar science. The protein-subunit approach used by Novavax was first implemented for the hepatitis B vaccine, which has been used in the U.S. since 1986. The pertussis vaccine, which is required for almost all children in U.S. public schools, is also made this way. Some of those people who have been wary of getting the mRNA vaccines may find Novavax more appealing.

The Novavax vaccine also has a substantially lower rate of side effects than the authorized mRNA vaccines. Last week’s data showed that about 40 percent of people who receive Novavax report fatigue after the second dose, as compared with 65 percent for Moderna and more than 55 percent for Pfizer. Based on the results of Novavax’s first efficacy trial in the U.K., side effects (including but not limited to fatigue) aren’t just less frequent; they’re milder too. That’s a very big deal for people on hourly wages, who already bear a disproportionate risk of getting COVID-19, and who have been less likely to get vaccinated in part because of the risk of losing days of work to post-vaccine fever, pain, or malaise. Side effects are a big barrier for COVID-vaccine acceptance. The CDC reported on Monday that, according to a survey conducted in the spring, only about half of adults under the age of 40 have gotten the vaccine or definitely intend to do so, and that, among the rest, 56 percent say they are concerned about side effects. Lower rates of adverse events are likely to be a bigger issue still for parents, when considering vaccination for their children.

Don’t get me wrong—the Pfizer and Moderna vaccines have been extraordinary lifesavers in this pandemic, and we may well be heading into a new golden age of vaccine development. (This week, BioNTech started injections in an early trial for an mRNA vaccine for melanoma.) But even the best experts at predicting which drugs are going to be important get things wrong quite a bit, overestimating some treatments and underestimating others. Pharmaceuticals are generally a gamble.

But here’s what we know today, based on information that we have right now:  Among several wonderful options, the more old-school vaccine from Novavax combines ease of manufacture with high efficacy and lower side effects. For the moment, it’s the best COVID-19 vaccine we have.

The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.

Hilda Bastian is a scientist, writer, and founding member of the Cochrane Collaboration. She was formerly the editor of the PubMed Health project at the National Library of Medicine.

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We Know Enough About Omicron to Know That We’re in Trouble

 More data will soon be coming in. But how much do they really matter?

By Sarah Zhang, The Atlantic

DECEMBER 18, 2021

A lot has changed for Omicron in just two weeks. At December’s onset, the variant was barely present in Europe, showing up in 1 to 2 percent of COVID cases. Now it’s accounting for 72 percent of new cases in London, where everybody seems to know somebody with COVID. In the U.K. and Denmark, Omicron case numbers are doubling every other day. The same exponential growth is happening—or will happen—in the United States too, just in time for the holidays.

What seemed likely earlier this month is now quite certain: A big Omicron wave is coming, on top of an already substantial Delta wave. There are still some unknowns about the variant, such as exactly how severe these cases will be. But we know enough about Omicron to understand that the time to act is now. “If we wait until our hospitals look like they’re starting to fill,” says Lauren Ancel Meyers, the director of the UT COVID-19 Modeling Consortium, “then it will be too late.”

The most intriguing unknown—the one in which we might like to place our hopes—is whether Omicron could be milder than Delta. But a milder, more transmissible virus can easily sicken so many people that it ends up increasing hospitalizations and deaths on the whole. Here is some simple math to explain the danger: Suppose we have two viruses, one that is twice as transmissible as the other. (For the record, Omicron is currently three to five times as transmissible as Delta in the U.K.—though that number is likely to fall over time.) And suppose it takes five days between a person’s getting infected and their infecting others. After 30 days, the more transmissible virus is now causing 26, or 64, times as many new cases as the less transmissible one. Exponentials are one hell of a growth hack. If we are banking on the idea that Omicron is more mild to get us through winter, then we had better hope that it’s really, really mild.

Vaccines will lower the proportion of hospitalizations quite a bit in those extra cases, especially because Omicron is infecting lots of vaccinated people. But it’s a long climb down that exponential curve. Moreover, when so many cases pile up all at once, their effects start spilling over into the lives of those who aren’t sick. If Omicron runs through a workplace it may present a temporary inconvenience. But if that workplace is a school, then the school will have to close, disrupting the lives of every child and parent. If that workplace is a hospital, then doctors and nurses are unable to work. This has been an issue in South Africa, where Omicron is already dominant and nearly 20 percent of the health-care staff have COVID. Even if most of these cases are mild, huge numbers of people getting sick all at once will alter everyday reality.

Not every case will be mild, though, and even a small hospitalization rate on top of a huge case number will be a big number. With Delta, “we were already headed for a bad winter,” says Roby Bhattacharyya, an infectious-diseases physician at Massachusetts General Hospital. Now, as my colleague Ed Yong reports, Omicron could push a collapsing health-care system further into disaster. Hospitals are already dealing with the flu and other winter viruses. They’re already canceling elective surgeries. After another year of pandemic burnout, they simply may not have the staff to create the surge capacity that barely got us through last winter. Overtaxed hospitals mean care gets worse for everyone with COVID—but also everyone with a broken hip or a stroke or a baby that urgently needs to be delivered. Omicron’s transmissibility is a danger because high levels of COVID cases come with these second-order consequences that transcend the risk to individuals.

If there are no changes to behavior or policy, this year’s winter wave would peak at about double the hospitalizations of last winter at its worst, and 20 percent more deaths, according to the most pessimistic of projections from Meyers and her team at the University of Texas at Austin. The team gamed out a total of 18 scenarios, based on different guesses for the variant’s inherent transmissibility and immune escape, booster uptake, and the vaccines’ effectiveness against hospitalization and death. The most optimistic projection sees a caseload similar to last winter’s, but hospitalizations and deaths at about half of where they were back then, assuming the vaccines keep up their very high protection against severe illness.

Vaccine protection against severe illness should be more durable than it is against infection, but may still take a hit. Very preliminary data from South Africa’s largest health insurer suggest that two doses of the Pfizer-BioNTech vaccine were 70 percent effective at preventing hospitalization from Omicron infections, down from 93 percent before. If that holds, it’s a “huge decrease,” Meyers says, and one that matches the assumptions of her team’s grimmer—but not grimmest—projections. When they modeled scenarios where vaccine effectiveness against hospitalization dropped by about that much, they saw a difference of tens of thousands of deaths.

The available evidence on Omicron’s inherent severity is likely to be biased in ways that make it appear more promising. First of all, hospitalizations lag infections. “Omicron has been around for three weeks,” Bhattacharyya says. “But so many of those infections have happened in the last one week of those three because of exponential growth.” Second, the first people infected may skew young and are thus more likely to have mild cases regardless of the variant. And third, some of the mildness attributed to the virus may result instead from existing immunity. In South Africa, where doctors are reporting relatively low hospitalizations compared with previous waves, many cases are probably reinfections, given that the majority of people there have had COVID before. The South Africa health-insurer data suggest that Omicron might carry a 29 percent lower risk of hospitalization than the original virus, when adjusted for risk factors including age, sex, vaccination status, and documented prior infection—but many prior infections may be undocumented, which would make the reduction in risk seem bigger than it really is. (A recent analysis of early U.K. cases found “at most, limited changes in severity compared with Delta.”) Meanwhile, Omicron is “going to spread so fast that to wait until we have definitive answers will be to wait too long,” Bhattacharyya says. “If it’s anything but the best-case scenario, and we wait to find out, it’s going to be too late to mitigate the worst.”

Another unknown is where Omicron’s tendency to spread more quickly than Delta comes from. Is it inherently more transmissible, better at evading immunity, or both? And how much of one or the other? “We don’t understand the new equilibrium,” says Lone Simonsen, an epidemiologist at Roskilde University, in Denmark. In the long run, if Omicron’s advantage is largely based on immune escape, then Delta and Omicron could co-circulate like multiple lineages of the flu, says Katia Koelle, an evolutionary virologist at Emory University. Getting sick with one variant might not give you much protection from the other. But if Omicron has advantages in both immune escape and transmission, then Delta could eventually go extinct.

Either way, in the short run, we will have a massive number of Omicron cases on top of a massive number of Delta cases. Together they will infect huge numbers of people, vaccinated or not, and burden an already overburdened health-care system. Boosters, social distancing, rapid testing, and masks can slow down this impact. We will know more about Omicron soon, but we already know enough.

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This article originally misstated the University of Texas’s most pessimistic projection for COVID-19 deaths this winter. According to updated information from the university’s modeling team, the projection shows only 20 percent more deaths than last winter at its worst, not twice as many.

The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.

Sarah Zhang is a staff writer at The Atlantic.

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The Vaccine Scientist Spreading Vaccine Misinformation

 Robert Malone claims to have invented mRNA technology. Why is he trying so hard to undermine its use?

By Tom Bartlett   The Atlantic

AUGUST 13, 2021

Updated at 3:00 p.m. ET on August 23, 2021

Robert Malone—a medical doctor and an infectious-disease researcher—recently suggested that the Pfizer and Moderna vaccines might actually make COVID-19 infections worse. He chuckled as he imagined Anthony Fauci announcing that the vaccination campaign was all a big mistake (“Oh darn, I was wrong!”) and would need to be abandoned. When he floated that nightmare scenario during a recent podcast interview with Steve Bannon, both men seemed almost delighted at the prospect of public-health officials and pharmaceutical companies getting their comeuppance. “This is a catastrophe,” Bannon declared, beaming at his guest. “You’re hearing it from an individual who invented the mRNA [vaccine] and has dedicated his life to vaccines. He’s the opposite of an anti-vaxxer.”

Before going any further, let’s be clear that the back-and-forth between Bannon and Malone was premised on misinformation. The vaccines have repeatedly been shown to help prevent symptomatic coronavirus infections and reduce their severity. Malone was riffing on a botched sentence in a USA Today article, one that was later deleted but not before being screenshotted and widely shared. That kind of overheated, spottily sourced conversation is par for the course on shows like Bannon’s, which traffic in a set of claims that sound depressingly familiar: The vaccines cause more harm than experts are letting on; Fauci is a liar and possibly a fascist; and the mainstream news media is either shamelessly complicit or too stupid to figure out what’s really going on.

In that alternate media universe, Robert Malone’s star is ascendant. He started popping up on podcasts and cable news shows a few months ago, presented as a scientific expert, arguing that the approval process for the vaccines had been unwisely rushed. He told Tucker Carlson that the public doesn’t have enough information to decide whether to get vaccinated. He told Glenn Beck that offering incentives for taking vaccines is unethical. He told Del Bigtree, an anti-vaccine activist who opposes common childhood inoculations, that there hadn’t been sufficient research on how the vaccines might affect women’s reproductive systems. On show after show, Malone, who has quickly amassed more than 200,000 Twitter followers, casts doubt on the safety of the vaccines while decrying what he sees as attempts to censor dissent.

Read: How mRNA technology could change the world

Wherever he appears, Malone is billed as the inventor of mRNA vaccines. It’s in his Twitter bio. “I literally invented mRNA technology when I was 28,” says Malone, who is now 61. If that’s true—or, more to the point, if Malone believes it to be true—then you might expect him to be championing a very different message in his media appearances. According to one recent study, the innovation for which he claims to be responsible has already saved hundreds of thousands of lives in the United States alone; there’s talk that it may soon lead to a round of Nobel Prizes. It’s the kind of validation that few scientists in history have ever received. Yet instead of taking a victory lap, Malone has emerged as one of the most vocal critics of his own alleged accomplishment. He’s sowed doubt about the Pfizer and Moderna vaccines on pretty much any podcast or YouTube channel that will have him.

Why is the self-described inventor of the mRNA vaccines working so hard to undermine them?

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Whether Malone really came up with mRNA vaccines is a question probably best left to Swedish prize committees, but you could make a case for his involvement.  When I called Malone at his 50-acre horse farm in Virginia, he directed me to a 6,000-word essay written by his wife, Jill, that lays out why he believes himself to be the primary discoverer. “This is a story about academic and commercial avarice,” it begins. The document’s tone is pointed, and at times lapses into all-caps fury. She frames her husband as a genius scientist who is “largely unknown by the scientific establishment because of abuses by individuals to secure their own place in the history books.”

The abridged version is that when Malone was a graduate student in biology in the late 1980s at the Salk Institute for Biological Studies, he injected genetic material—DNA and RNA—into the cells of mice in hopes of creating a new kind of vaccine. He was the first author on a 1989 paper demonstrating how RNA could be delivered into cells using lipids, which are basically tiny globules of fat, and a co-author on a 1990 Science paper showing that if you inject pure RNA or DNA into mouse muscle cells, it can lead to the transcription of new proteins. If the same approach worked for human cells, the latter paper said in its conclusion, this technology “may provide alternative approaches to vaccine development.”

These two studies do indeed represent seminal work in the field of gene transfer, according to Rein Verbeke, a postdoctoral fellow at Ghent University, in Belgium, and the lead author of a 2019 history of mRNA-vaccine development. (Indeed, Malone’s studies are the first two references in Verbeke’s paper, out of 224 in total.) Verbeke told me he believes that Malone and his co-authors “sparked for the first time the hope that mRNA could have potential as a new drug class,” though he also notes that “the achievement of the mRNA vaccines of today is the accomplishment of a lot of collaborative efforts.”

Read: The pandemic’s wrongest man

Malone says he deserves credit for more than just sparking hope. He dropped out of graduate school in 1988, just short of his Ph.D., and went to work at a pharmaceutical company called Vical. Now he claims that both the Salk Institute and Vical profited from his work and essentially prevented him from further pursuing his research. (A Salk Institute spokesperson said that nothing in the institute’s records substantiates Malone’s allegations. The biotech company into which Vical was merged, Brickell, did not respond to requests for comment.) To say that Malone remains bitter over this perceived mistreatment doesn’t do justice to his sense of aggrievement. He calls what happened to him “intellectual rape.”

One target of Malone’s ire, the biochemist Katalin Karikó, has been featured in multiple news stories as an mRNA-vaccine pioneer. CNN called her work “the basis of the Covid-19 vaccine” while a New York Times headline said she had “helped shield the world from the coronavirus.” None of those stories mentioned Malone. “I’ve been written out of the history,” he has said. “It’s all about Kati.” Karikó shared with me an email that Malone sent her in June, accusing her of feeding reporters bogus information and inflating her own accomplishments. “This is not going to end well,” Malone’s message says.

Karikó replied that she hadn’t told anyone that she is the inventor of mRNA vaccines and that “many many scientists” contributed to their success. “I have never claimed more than discovering a way to make RNA less inflammatory,” she wrote to him. She told me that Malone referred to himself in an email as her “mentor” and “coach,” though she says they’ve met in person only once, in 1997, when he invited her to give a talk. It’s Malone, according to Karikó, who has been overstating his accomplishments. There are “hundreds of scientists who contributed more to mRNA vaccines than he did.”

Malone insists that his warning to Karikó that “this is not going to end well” was not intended as a threat. Instead, he says, he was suggesting that her exaggerations would soon be exposed. Malone views Karikó as yet another scientist standing on his shoulders and collecting plaudits that should go to him. Others have been rewarded handsomely for their work on mRNA vaccines, he says. (Karikó is a senior vice president at BioNTech, which partnered with Pfizer to create the first COVID-19 vaccine to be authorized for use last year.) Malone is not exactly living on the streets: In addition to being a medical doctor, he has served as a vaccine consultant for pharmaceutical companies.

In any case, it’s clear enough that Malone isn’t singularly responsible for mRNA vaccines. The process of achieving major scientific advancements tends to be more cumulative and complex than the apple-to-the-head stories we usually tell, but this much can be said for sure: Malone was involved in groundbreaking work related to mRNA vaccines before it was cool or profitable; and he and others who believed in the potential of RNA-based vaccines in the 1980s turned out to be world-savingly correct.

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Malone may keep company with vaccine skeptics, but he insists he is not one himself. His objections to the Pfizer and Moderna shots have to do mostly with their expedited approval process and with the government’s system for tracking adverse reactions. Speaking as a doctor, he would probably recommend their use only for those at highest risk from COVID-19. Everyone else should be wary, he told me, and those under 18 should be excluded entirely. (A June 23 statement from more than a dozen public-health organizations and agencies strongly encouraged all eligible people 12 and older to get vaccinated, because the benefits “far outweigh any harm.”) Malone is also frustrated that, as he sees it, complaints about side effects are being ignored or censored in the nationwide push to increase vaccination rates.

You might very well walk away with the skewed sense, after hearing Malone speak or reading his posts, that there is a far-reaching COVID-19 cover-up and that the real threat is the vaccine rather than the virus. I’ve listened to hours of Malone’s interviews and read through the many pages of documents he’s posted. He is a knowledgeable scientist with a knack for lucid explanation. It doesn’t hurt that he looks the part with his neatly trimmed white beard, or that he has a voice that would be well suited for a meditation app. Malone is not a subscriber to the more out-there conspiracy theories regarding COVID-19 vaccines—he doesn’t, for instance, think Bill Gates has snuck microchips into syringes—and he sometimes pushes back gently when hosts like Bigtree or Beck drift into more ludicrous territory.

And yet he does routinely slip into speculation that turns out to be misleading or, as in the segment on Bannon’s show, plainly false. For instance, he recently tweeted that, according to an unnamed “Israeli scientist,” Pfizer and the Israeli government have an agreement not to release information about adverse effects for 10 years, which is hard to believe given that the country’s health ministry has already warned of a link between the Pfizer shot and rare cases of myocarditis. Malone’s LinkedIn account has twice been suspended for supposedly spreading misinformation.

Read: The mRNA vaccines are extraordinary, but Novavax is even better

His concerns are personal, too. Malone contracted COVID-19 in February 2020, and later got the Moderna vaccine in hopes that it would alleviate his long-haul symptoms. Now he believes the injections made his symptoms worse: He still has a cough and is dealing with hypertension and reduced stamina, among other maladies. “My body will never be the same,” he told me. In media appearances, he often notes that he has colleagues in the government and at universities who agree with him and are privately cheering him on. I spoke with several of these people—vaccine scientists and biotech consultants, suggested by Malone himself— and that is not what they told me. The portrait they paint of Malone is of an insightful researcher who can be headstrong. They related accounts of him, pre-pandemic, getting booted from projects because he was hard to communicate with and unwilling to compromise. (Malone has acknowledged his penchant for butting heads with fellow scientists.) And they are taken aback by his emergence as a vaccine skeptic. One called his eagerness to appear on less-than-reputable podcasts “naive,” while another said he thought Malone’s public rhetoric had “migrated from extrapolated assertions to sensational assertions.” Stan Gromkowski, a cellular immunologist who did work on mRNA vaccines in the early 1990s and views Malone as an underappreciated pioneer,  put it this way: “He’s fucking up his chances for a Nobel Prize.”

It’s only in the curious world of fringe media that Malone has found the platform, and the recognition, he’s sought for so long. He talks to hosts who aren’t going to question whether he’s the brains behind the Pfizer and Moderna shots. They’re not going to quibble over whether credit should be shared with co-authors, or talk about how science is like a relay race, or point out that, absent the hard work of brilliant researchers who came before and after Malone, there would be no vaccine. He’s an upgrade over their typical guest list of chiropractors and naturopaths, and they’re perfectly happy to address him by the title he believes he’s earned: inventor of the mRNA vaccines.

The irony is that, to the audiences who tune in to those shows, the vaccines are seen as a scourge rather than a godsend. No matter how nuanced Malone might try to be, or how many qualifiers he appends to his opinions, he is egging on vaccine hesitancy at a time when hospitals in the least-vaccinated parts of the country are struggling to cope with an influx of new COVID-19 patients. If you want proof of that, scroll through the many comments from his followers thanking him for confirming their fears. Malone has finally made his mark, by undermining confidence in the very vaccine he says wouldn’t be possible without his genius. It’s a victory, of sorts, but one that he and the rest of us may come to regret.

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This article originally stated that Malone was once forced to declare bankruptcy. Although he has previously said that he "went bankrupt," he has never actually declared bankruptcy. The article has also been updated to acknowledge that Malone cited an unnamed scientist in his tweet about an alleged agreement between Pfizer and the Israeli government, and to include the year that Malone developed COVID-19.

The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.

Tom Bartlett is a writer in Austin, Texas.

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