As the nation gears up for a massive vaccination effort, the Trump administration is doubling down on a novel, unproven injection device by providing more than half a billion dollars in government financing for something still awaiting Food and Drug Administration approval.
Later Thursday, the U.S. International Development Finance Corp, or DFC, is expected to announce it has extended a $590 million loan to ApiJect Systems America, NPR has learned. The Connecticut company makes a disposable injection device that it says can be mass-produced to deliver vaccines and medications around the world.
The single-use, self-contained devices are designed to be an alternative to traditional vials and syringes. "This is going to be, we believe, the next generation of safe injections worldwide," ApiJect Systems Corp. Executive Chairman Jay Walker told NPR.
The hefty investment in an unproven device is also part of the administration's attempt to hedge its bets against any potential for equipment shortages and supply-chain glitches as it starts to roll out COVID-19 vaccines. Unforeseen shortages of swabs and chemical reagents plagued early efforts to distribute coronavirus tests, and it took months to catch up.
"I think it is sensible to have backups to glass vials," said Nicole Lurie, a strategic adviser at the Coalition for Epidemic Preparedness Innovations who served as the assistant secretary for preparedness and response at the Department of Health and Human Services. She said the fact that the administration has placed such a large bet on a technology that hasn't cleared FDA hurdles gives her some pause.
"The challenge that I see is that it is a completely untested technology, and it is not clear to me what kinds of conversations ApiJect has had with the FDA or any other regulators," she said. "What testing has been done to ensure that the materials inside the containers don't interact with the compounds of various vaccines? They probably need to be tested for each vaccine and especially each vaccine platform."
The Pfizer vaccine, for example, needs to be kept at arctic temperatures. ApiJect said that its devices can handle that, but the FDA hasn't certified that they can. The new loan is on top of some $150 million in previous contracts ApiJect landed with both the Defense Department and HHS — all for the single-dose plastic injection syrette, as they call it, a little bigger than your thumb.
The FDA hasn't approved its use, but the Trump administration clearly sees ApiJect as a component in the next phase of the race for a vaccine. As companies such as Pfizer and Moderna prepare to apply to the FDA for emergency use authorization of their COVID-19 vaccines, they'll soon need the means of packaging, distributing and injecting perhaps billions of doses of those vaccines.
There is concern among public health and Trump administration officials that this so-called fill-finish part of the vaccine manufacturing process — producing glass vials, filling them with the vaccine, securing syringes and then distributing them across the country — will create enormous bottlenecks and prevent the vaccine from reaching Americans in a timely way.
That's what happened during the first phase of the pandemic when Americans rushed to doctors' offices and medical centers to get coronavirus tests, only to be turned away because of a shortage of reagent chemicals, testing kits and nose swabs. State laboratories that were also facing shortages began competing on the open marketplace for pipettes and lab materials they needed to process the tests.
Two major purveyors of medical vials are Corning Inc. in New York and Schott Pharmaceutical Systems in Germany, and the worry is that any unforeseen production problems at either of their factories could have a disastrous effect on the administration's vaccination efforts. As it is, built into the glass vial production estimates is a 20% overrun, to account for breakage. If something goes wrong — say there is a shortage of vials — that could derail the whole enterprise.
ApiJect's Walker said: "We are the backup plan."
The DFC financing is meant to help ApiJect build a million-square-foot campus in North Carolina for a speedier fill-finish operation. It will take pharmaceutical-grade plastic resin, pour it into a mold and then move it to a sterile filling space, where the drug or the vaccine will be inserted before it is sealed.
ApiJect said when the GigaFactory, as the firm calls it, is fully operational it will produce as many as 3 billion single-dose injectors a year. The company expects the project will create some 650 jobs in North Carolina's Research Triangle Park.
ApiJect has to raise $200 million on its own to qualify for the federal funds.
The company first came to the attention of the administration by chance. Walker, one of the founders of the travel booking website Priceline, found himself sitting next to Adm. Brett Giroir, now the assistant secretary for health, at a medical conference several years ago, and he happened to have an ApiJect device in his pocket.
Giroir thought it might be a solution that could change the national stockpile. Instead of warehousing material, the thought was, they would just have the production capacity to produce something fast. To test the theory, in December, ApiJect got a small $13 million contract from HHS to build out its capacity. A few months later, COVID-19 happened.
The $590 million ApiJect loan from DFC is the first high visibility loan the agency has awarded since its ill-fated decision to give Eastman Kodak in Rochester, N.Y., a $765 million loan to refashion itself into a pharmaceutical company to produce generic drugs. That deal is now on hold as various agencies and congressional committees investigate allegations of insider trading and concerns about how the loan was awarded in the first place.
The ApiJect loan was made possible by an executive order President Trump signed in May that cleared the way for the DFC — which had previously been called Overseas Private Investment Corp. — to make loans to ramp up domestic production to address the coronavirus. The DFC is run by Adam Boehler, a health care professional, White House senior adviser and former roommate of Trump son-in-law Jared Kushner. ApiJect said company officials never dealt with Boehler directly.
ApiJect's technology has been used for years in the liquid pharmaceutical market, typically including solutions for ophthalmic, respiratory therapy and injectable drug products.
It hasn't been used in precisely this way before, however, and it is unclear whether it will get FDA approval to do what it wants to do. That means it is unclear whether the Trump administration's gamble on the company will pay off.
Walker, ApiJect's chairman, said the FDA has been working with the company and "we're through all the hard parts."
A FDA spokesperson said federal rules preclude the administration from talking about products that have not been approved.
NOEL KING, HOST:
When the time comes to vaccinate the world against COVID-19, will there be enough glass vials and syringes to get it done? The Trump administration appears to have a backup plan in case there aren't. Later today, it's expected to announce that it will loan about $600 million to a company in Connecticut that makes an injection device that can be mass produced. Here's Dina Temple-Raston of NPR's investigations team.
(SOUNDBITE OF MACHINERY WHIRRING)
DINA TEMPLE-RASTON, BYLINE: That's the sound of a COVID-19 vaccine backup plan.
(SOUNDBITE OF MACHINERY WHIRRING)
TEMPLE-RASTON: It's a production line in Columbia, S.C., that's churning out a novel injection device that the Trump administration is counting on to help deliver the COVID-19 vaccine as early as this spring. NPR has learned that later today, the administration will add to its already hefty investment in a company called ApiJect Systems America and extend more than half a billion dollars to its effort to backstop the country's COVID-19 vaccine program.
JAY WALKER: I'm Jay Walker, and I am the chairman of ApiJect Systems.
TEMPLE-RASTON: And you founded another company we've heard of, right?
WALKER: Yes. I am best known as the founder of Priceline.com.
TEMPLE-RASTON: The founder of Priceline, the man who put William Shatner back on the map, is now producing a single-use self-contained injection device that's designed to be an alternative to glass vials and syringes.
WALKER: We call it a syrette.
TEMPLE-RASTON: It's a little bigger than your thumb, and it looks a little like those single doses of eye drops that you get from the eye doctor. It has a hypodermic needle that you screw into the end like you do when you screw in a nozzle on a tiny bottle of Krazy Glue. Only in this case, it would carry any number of approved COVID vaccines. Walker said it's that effort that the U.S. International Development Finance Corp. is funding with a $590 million loan.
WALKER: The U.S. government is announcing a plan to support the biggest and fastest vaccine syringe filling factory - up to 3 billion doses a year.
TEMPLE-RASTON: That's billion with a B, even though the injection device has yet to be approved by the Food and Drug Administration, which worries Nicole Lurie. She served at the Department of Health and Human Services during the Obama administration.
NICOLE LURIE: The challenge that I see is that it is a completely untested technology. What testing of the ApiJect product has been done to ensure that the materials inside the ApiJect containers don't interact with the components of the various vaccines?
TEMPLE-RASTON: The vaccine being produced by Pfizer, for example, needs to be kept at arctic temperatures. Walker says the ApiJect devices can handle that, but the FDA has yet to certify that that's true.
But then you can say that about a lot of the projects funded by the Trump administration to try to combat the virus. Tens of billions of taxpayer dollars have been spent to fund a roster of vaccines, some of which are bound to fail. The point is to try and find a solution.
Darin Zehrung is the global program leader for medical devices at PATH, which is focused on improving global public health in developing countries. And he's been tracking ApiJect's progress for a while. And he says it's hired some people who are really good at prefilled technologies.
DARIN ZEHRUNG: From our perspective, a low-cost prefill is something that we've always been aiming towards for low- and middle-income countries.
TEMPLE-RASTON: He doesn't think the administration is making a particularly risky bet.
ZEHRUNG: I'm excited about what could be. I mean, we could truly have a low-cost, scaled-up prefilled system that could be used for a number of different drugs or vaccines, biologics that could benefit low- and middle-income countries.
TEMPLE-RASTON: ApiJect is getting a cash infusion. Now it needs FDA approval to become the backup plan the Trump administration is banking on.
Dina Temple-Raston, NPR News. Transcript provided by NPR, Copyright NPR.