The First Shot: Inside the Covid Vaccine Fast Track

Monday morning, 8 am. Neal Browning walked into the waiting room. He took in the reception desk, the play area for kids, the table full of magazines that he was too cautious to touch. There was another patient waiting, a woman in her forties with brown, chin-length hair. Browning wasn’t sure whether she was here for the same historic reason that he was, so he decided to follow standard waiting-room procedure and sat quietly—no conversation, no eye contact. After a few minutes, a nurse called the woman back and he watched her disappear behind a door. Another few minutes passed and it was his turn.

First, there were questions: Still no fever? Still no contact with anyone who’s been sick? Then there was a round of blood draws. Browning, a 46-year-old network engineer, had taken the morning off from his job at Microsoft, where he’d been unusually busy for weeks: His team was following the spread of a deadly new virus around the world, preparing firewalls and VPNs to allow a global workforce to suddenly start working from home. The engineers trailed the virus from Wuhan to the rest of China, to Europe, and to his own doorstep in Washington state.

Eighteen days before he walked into the waiting room, a teenager who lived 10 miles from Browning’s house in Bothell, Washington, had tested positive for the new virus. The teen hadn’t traveled abroad or had known contact with anyone with a positive case. Browning wrote on Facebook that Pandora’s box had been opened. The next day, officials announced that the first person in the United States had died from the virus, at a hospital just 5 miles from Browning’s house. (Earlier deaths would later be uncovered.) A few days later, when a friend texted Browning with news that a group of researchers were looking for volunteers to test a possible new vaccine, he marveled at how quickly the vaccine had appeared but didn’t hesitate to sign up.

The researchers got in touch, asking to check his blood work and his medical background. (For the earliest phase of trials, they were looking for participants with a clean bill of health, so it would be simpler to trace any changes caused by the vaccine.) Browning started Googling. Viruses, vaccines, RNA, DNA—so many details of his own biology to which he hadn’t spared a thought since an introductory science class back in college. He talked with his fiancée and his mother, both of whom are registered nurses, about the risks of offering himself as a test subject. There was the chance he’d have a bad reaction to the shot; the theoretical possibility that the vaccine might make his body produce antibodies that actually made the virus worse; and simply the inherent risk of unknowability associated with the brand-new. Still, to Browning, the risks seemed low when compared with the known danger. On the news, he watched as deaths mounted at a nearby nursing home, as the governor shut down concerts and then schools and then businesses. Now the moment was here, and he had no doubts. Only hopes.

Browning watched as his veins filled vial after vial, each of them a viscous red record of what his body was like now, in its “before” state. Then it was time for the shot. It took a few awkward tugs for the pharmacist to get the sleeve of Browning’s blue collared shirt above his deltoid, but that was the only drama visible for anyone to see. The needle slid in, the needle slid out. A news camera clicked. Twenty-five micrograms of fluid, the first and fastest hope for stopping a pandemic that had been officially declared just five days before, diffused into the muscle of his right arm.

To Browning, it felt like “a big nothing.” That’s what it looked like too. He pulled his sleeve back down. The pharmacist disposed of the syringe. From this moment on, any action would be invisible, hidden away inside Browning’s body, where the dramatis personae were proteins and cytokines, T cells and B cells.

In the exam room, where he was asked to wait an hour to make sure there was no immediate adverse reaction, Browning sent some texts, messed around on his phone, and tried to imagine what might be going on inside him. Right now, as far as he could tell, the answer seemed to be not much out of the ordinary. It was entirely possible that this would prove true—that nothing much would happen. This very first human trial of a vaccine designed to fight SARS-CoV-2, the newly emerged coronavirus that was disrupting the world, could lead to disappointment, just like so many trials for so many other vaccines for so many other diseases. To make a successful vaccine, to test its safety and effectiveness, and to get it licensed for widespread use in healthy humans, is usually a long and arduous process. Development commonly takes a decade or more; historically, for any given attempt, the statistical chance of failure is 94 percent.

But Browning was an optimist. He knew that the vaccine candidate now in his arm had made it there in record time. Instead of years, the timescale was measured in days: Just 66 of them had passed since the genome of the virus had first been published. Maybe more records were possible. He lay on the exam table and hoped, fervently, that at the gates of his cells something big was beginning.

Across a panicked world, anybody who saw the day’s news—that the first four human beings had been injected with a vaccine meant to fight a virus that seemed to be changing everything—had to hope the same. Please, we pleaded, as businesses shuttered and families stayed apart and ambulance sirens wailed. Please, as people risked their lives in ERs and grocery stores. Please, as we tried to imagine a future that could safely return to what we had once been so bold as to think of as normal life. Please, let us be lucky, and please, down in the microscopic battlefield of Neal Browning’s immune system, let some drama be starting.

For the great hope against a 21st-century virus, inoculation is a surprisingly old technology. As early as the 10th century, the Chinese were known to put material from the lesions of people infected with smallpox on the nostrils of the healthy, in an attempt to give them a less virulent course of the disease; by the 1600s, people in the Ottoman Empire were letting pus be grafted under the skin of their arms and legs. In the 1720s, an updated version of the practice was so accepted that Caroline of Ansbach, the Princess of Wales, had it performed on her two young daughters. (Still, the death rate for those inoculated was as high as 3 percent.) Edward Jenner, the English doctor who proved that exposure to a different virus, cowpox, protected people from getting smallpox at all, started shipping what are considered the very first vaccines (the word derives from the Latin word for “cow”) to his medical colleagues in the same decade in which Eli Whitney invented the cotton gin.

Since then, the process of vaccine creation has changed dramatically. In the 19th century, scientists discovered that they could teach people’s immune systems to fight off viruses by exposing them to versions inactivated with heat or chemicals. As methods advanced, they found they could breed less virulent versions of viruses in labs. They could also make effective vaccines by exposing human cells to only a small part of a virus, such as the protein structures that actually irritate the immune system, or even to synthetic structures, convincing enough to be thoroughly confused for the real thing. They could circulate those structures by attaching them to other, less dangerous viruses; they could even, theoretically, instruct human cells to make the structures themselves. What mattered was simply that the body could meet a convincing enough threat that it would prepare its own specially designed resistance in advance, before it ever encountered the real thing. The strategies changed, but their basic principle stayed the same: For all our technology, our best defense is still to activate the ancient protections that are already waiting inside us.

When something unfamiliar and possibly dangerous enters your body, the first response is from what’s known as your innate immune system. This is your fastest, oldest (evolutionarily speaking), and certainly bluntest response to invasion, with one basic arsenal of weapons to use against whatever it