Dr. Francis Collins, Director of the National Institutes of Health (NIH), testifies in July 2020 on the plan to research, manufacture and distribute a coronavirus vaccine.

Dr. Francis Collins, Director of the National Institutes of Health (NIH), testifies in July 2020 on the plan to research, manufacture and distribute a coronavirus vaccine. Photo by Saul Loeb-Pool/Getty Images

NIH Director: We Need an Investigation Into the Wuhan Lab-Leak Theory

Francis Collins calls for a “thorough, expert-driven, and objective” inquiry, and shares what most surprised him about the virus.

As Francis Collins, the director of the National Institutes of Health, recounted the moment, his eyes welled with tears.

A few months before, he and his colleague Anthony Fauci had confided in each other their hopes for a COVID-19 vaccine. The FDA had set the threshold for approval at 50 percent efficacy, roughly what the flu vaccine achieves each year. They would have been quite happy to hit 70 percent.

Then, on December 9, 2020, Collins received a phone call reporting the first results of the Pfizer vaccine trials. “It was breathtaking,” he told me in a recent interview. “It was just so far beyond what Tony and I had dreamed the answer might be.” The efficacy for the Pfizer vaccine was 95 percent.

“I will admit, I cried,” he said. “A lot of prayer had gone into that.” A week later, Collins received the early results from Moderna, whose vaccine roughly matched the efficacy rate of Pfizer’s. It was a medical miracle.

Collins called the development of the vaccines “one of the most dramatic examples of scientific advancement, especially in the face of a worldwide crisis, that we have had the chance to witness.”

“I’ve been part of other scientific advances that were highly significant, like the Human Genome Project,” he added, “but nobody was going to live or die if we ended up being a couple years late. We weren’t, happily—we were a couple years early. But this one was so different.”

I last interviewed Collins, a longtime friend, in March 2020 for The Atlantic. At the time, he was focused on delivering a warning, which proved remarkably prescient, about the need to control the coronavirus. This time, though, I wanted to ask him about the origins of SARS-CoV-2, in light of speculation that it emerged from a laboratory in Wuhan, China.

“Far and away, the most likely origin is a natural zoonotic pathway from bats to some unidentified intermediate host to humans,” he told me. “But the possibility that such a naturally evolved virus might have also been under study at the Wuhan Institute of Virology and reached residents of Wuhan—and ultimately the rest of the world—as the result of a lab accident has never been adequately excluded.”

That possibility, Collins believes, calls for a closer look. “A thorough, expert-driven, and objective investigation, with full access to all information about events in Wuhan in the fall of 2019, is needed,” he said. “That should have happened right away, but did not.”

Collins was careful to qualify that the coronavirus is “absolutely not” man-made. “The genome sequence of SARS-CoV-2 has a number of unanticipated features that are not consistent with what international experts would have expected from an emerging and dangerous coronavirus,” he told me. “Thus, the hypothesis that this was a human-engineered bioweapon is hard to support. It’s unfortunate that the lab-leak hypothesis has been muddled up with the intentional-bioweapon hypothesis in 16 months of tortured and politically driven rhetoric. That has given way too much credibility to the latter and not enough to the former.”

Senator Rand Paul has accused the NIH and the National Institute of Allergy and Infectious Diseases of funding “gain of function” research into bat coronaviruses at the Wuhan Institute of Virology (WIV). (Gain-of-function research is intended to make pathogens more deadly or more transmissible for the purpose of producing knowledge that would benefit humans.) But Collins finds such claims misleading. “There’s a terminology problem here that is causing a lot of confusion,” Collins said. “Lots of scientists study harmless organisms like plants and bacteria to try to identify how life works, or how genetic changes might be useful for tackling a medical or societal problem. For example, if you want a harmless bacterium to acquire the ability to clean up an oil spill, you might use a bioengineering approach to provide those bacteria with gain of function to metabolize hydrocarbons into less harmful substances.”

Such research, he explained, is different from enhancing viruses that affect people. “The gain of function that is of much greater concern, and for which the United States has in place stringent oversight guidelines, relates to experiments that might make a human pathogen more transmissible or more virulent,” Collins said. “NIH has never supported such experiments on human coronaviruses. The now-terminated subcontract to the WIV was to support the isolation and characterization of viruses from bats living in caves in China. Since we knew those were the original source of SARS and MERS, it would have been irresponsible not to try to learn more about them. But the terms of the grant were limited to bat viruses, and absolutely did not allow gain-of-function research in the sense of studying human pathogens.”

However the coronavirus first emerged, by the early months of 2020, it clearly posed an enormous challenge. “As soon as you could see this pathogen beginning to spread across the world, we knew that the only way we were really going to have a chance ultimately to vanquish it was going to be with a vaccine,” Collins said. “But the historical record would say that if you worked flat out, you might have something in five years. That’s the best we’d ever done. And yet looking at the rapidity with which this virus was spreading and taking lives, that was simply not going to be acceptable.”

The solution was mRNA: messenger ribonucleic acid. In essence, mRNA can be chemically engineered to instruct cells in your body to produce proteins that mimic some essential feature of a particular virus. The immune system, in turn, builds a response tailored to that virus, so that if the body then confronts the real thing, it’s well prepared.

“Messenger RNA was unprecedented at this scale—there had never been a vaccine approved with messenger RNA—but it was also elegant and very quickly responsive to the need to get started,” Collins said, “because all you needed was to know the sequence of the letters of the viral genome to start making that vaccine.”

The idea of using mRNA to develop vaccines has been around for decades, but it was considered on the fringes of the possible. The concern was that if you injected RNA into a cell, it would set off a wildly rapid and severe cellular inflammatory response, uncontained and uncontrollable. But the Hungarian American scientist Katalin Kariko, now a senior vice president at BioNTech, and her collaborator Drew Weissman, at the University of Pennsylvania, figured out how to chemically modify RNA so that it would no longer set off cellular alarm bells but could still code for a virus’s spike protein. Such an mRNA vaccine could inspire the production of antibodies that could attack a virus with “the precision of a well-trained military,” in the words of The Atlantic’s Derek Thompson.

Animal experiments with an mRNA vaccine began almost immediately after the basic genetics of the coronavirus became known. And just over 60 days after the original sequence of the virus was published—on March 16, 2020, five days after the World Health Organization declared COVID-19 a pandemicJennifer Haller became the first human injected with an mRNA vaccine. “Then I really began to watch closely,” Collins said. “Okay, are the humans making antibodies against the spike protein? That would be a really good sign that this is working. And within a month or so, it became pretty clear they were.”

That was encouraging. “But anybody who’s done a lot of vaccine development will tell you, ‘Well, yeah, but there’re all these other things that are going to go wrong.’ Because they usually do.”

From there, scientists needed to administer the vaccines in a large-scale trial of volunteers, diverse in background, medical status, race, and age.

“We all held our breath,” Collins recalled, “first of all wondering, Will there be some mysterious, unexpected, dangerous side effects now with more than 30,000 people? Will you start to see that? And we did not with the mRNA vaccines. Neither the Pfizer nor the Moderna has had that issue.”

“And then you hold your breath until the day that you know there’s a sufficient safety record, which means half of the people in the trial have to have been followed for at least two months.”

In December 2020 came the phone call with the good news.

Despite this unprecedented breakthrough, the work was hardly done. Collins credits President Donald Trump’s secretary of health and human services, Alex Azar, with moving forward in the spring of 2020 with “at-risk manufacturing,” beginning mass production of the vaccines while clinical trials were still under way. If the vaccines had failed, they would have had to have been thrown out; the money would have been wasted. But instead, the moment the trials were completed, millions of doses were ready to be administered. The Department of Defense was pulled in to assist with distribution. Collins also co-chaired a public-private partnership called ACTIV, or Accelerating COVID-19 Therapeutic Interventions and Vaccines, which developed a coordinated research strategy for prioritizing and speeding up development of the most promising treatments and vaccines.

Today, Collins told me, the challenges are different. “We are no longer limited by supply,” he said. “And it’s time to really try to figure out how, for the folks who are still movable on this, how do we move them into the yes category.” The pace of vaccinations is slowing in the United States; providers are administering about 1.7 million doses a day on average, roughly half as many as the peak of 3.38 million a day reported in mid-April.

“We need to get to 70 to 85 percent, which is the rough guess about when the virus starts to lose,” Collins said. “We still have to work really hard on people who haven’t signed up yet.” As of today, 62 percent of people 18 or older have received at least one dose of a vaccine; 51 percent are fully vaccinated. A few weeks ago, President Joe Biden declared that his administration’s goal is to at least partly vaccinate 70 percent of adults by July 4. Achieving that objective will require making vaccines more convenient for people to obtain, especially those living in rural or hard-to-reach locations, and having trusted authority figures appeal to vaccine-hesitant populations.

Collins acknowledged that he worries about what comes next. Is a variant out there that’s so different from the original strain that the vaccines fall below the threshold of efficacy? India and South America are experiencing a terrible surge of cases; every one of those newly infected people presents an opportunity for the virus to make itself even more dangerous.

“So far, the vaccines that are currently approved in the U.S. do work against the most worrisome emerging variants,” Collins told me. “That includes the B.1.1.7, which was the one that spread rapidly through the U.K. and is now 74 percent of the isolates in the U.S.” He also said that the mRNA vaccines work against the South Africa variant, although the response they generate is not quite as strong, which is why the NIH is already working with Moderna to design and test a follow-up vaccine in case we need it.

I asked Collins whether a booster vaccine for a COVID-19 variant would require a relatively simple recalibration or restarting the entire vaccine process from scratch.

“The FDA fortunately has already thought this through, and with the mRNA approach, all you’re doing is changing some letters in that mRNA code,” he said. “Otherwise, it’s exactly the same vaccine—the packaging and the lipid envelope and all that are all the same—so the FDA would be inclined in that situation to let you do a very rapid trial. You don’t have to do another 30,000 trials and take six months to get the answer.”

The past year has brought many unexpected twists, even for experienced researchers. I asked Collins what had most surprised him about the virus since we spoke last March.

“That it is so readily transmitted by people who have no symptoms,” he told me, pointing to the role that presymptomatic individuals have played in spreading the virus. “That’s unprecedented. That made our public-health measures infinitely more difficult.” With SARS and MERS, which are also coronaviruses, people who were infectious were generally quite sick, and so they were in bed or in a hospital. “With SARS-CoV-2, they were walking around feeling fine until maybe three days later. And the actual peak of infectivity is about two days before symptoms come on. The peak. I mean, it’s diabolical.”

When we first spoke, Collins expressed his hope that we would discover a highly effective therapeutic agent that could be given to people right after they got infected and that would “basically knock the thing out before you ever really got very sick.” But that hasn’t happened. 

The big push right now, Collins told me, is “to pull out all the stops like we did for HIV 25 years ago, and come up with really effective, highly targeted antiviral drugs”—for example, a safe, cheap pill that could be given at urgent-care facilities to people who have been exposed to or tested positive for COVID-19—“that will knock this virus out and others like it that may be emerging in the future.”

I asked Collins whether any collateral good might come from this horrible pandemic. “We certainly have learned that this mRNA-vaccine strategy is a winner, and that will be applicable now to virtually any pathogen that we need to make a vaccine against,” he said. “Our vaccines for tuberculosis are going to be revamped as a result of this.” He added that vaccine strategies for cancer are “going to get a big push because mRNA is a much more efficient way to produce what you might be looking for there.” He also mentioned a borderline obsession of his: diagnostic testing.

“By basically turning NIH into a venture-capital organization, we have brought forward no less than 34 really dramatic new technologies for doing testing at the point of care to discover who’s got the virus and who doesn’t. That includes home tests that are now out there that would not have been out there without our having invested all of this in the technology development. So that’s pretty much a game changer. That’s going to change the way we think about doing testing for lots of things.” We will, he said, “move away from the big-box laboratory, where you have to go to deliver a blood sample, to basically doing testing at home.”

For all the progress America has made in vaccine development and distribution—several states in the Midwest and Northeast have reported seeing new cases decline by more than 50 percent over the past two weeks—I wanted to hear Collins’s perspective on what has most unsettled him about America’s response to the pandemic. After all, well over half a million of our fellow citizens died in less than a year because of COVID-19. What is it about our country and our politics that explains the epic mishandling of the COVID-19 crisis?

“You can certainly look at other countries across the world as models of various types of behavior, and ours doesn’t come across as looking admirable for most of the first year of this pandemic,” he told me. “Look at the way in which Taiwan or New Zealand or Australia or South Korea addressed this.” In America, he said, we value our individual liberties and our unwillingness to submit readily to authority. The nature of our society and our individualist, atomized culture meant that the pandemic was going to be less than optimally managed.

“But oh my goodness, it could have been managed better than it was!” Collins said. “The mixing of messages about exactly how serious this was, and about exactly what measures individuals could and should take to try to limit the harms, left many people with a sense of confusion. People were given the chance to pick the option that they liked best and go with that. And oftentimes that was an option that led to more disease. The consequences of that are just absolutely devastating for our country. So, as a national effort to adopt reasonable public-health measures, we failed.”

There are all kinds of reasons for that. We don’t have a national message generator that can always be consistent. We place a lot of the decision making in the hands of local and state leaders; they have not been equally competent during the pandemic. Even as the data began to be more accurately collected, we failed to react to them appropriately. It certainly didn’t help that the most important voice in American life, the president’s, was dismissive of masks one week, promoting hydroxychloroquine as a cure for COVID-19 the next. Trump even suggested using a disinfectant like bleach as a potential treatment, as Deborah Birx, his coronavirus-task-force coordinator, looked on in horror.

Collins described his frustrations this way:

It all got so tangled up in politics, where your political party was the strongest predictor of whether you were going to wear a mask or not, which scientifically makes absolutely zero sense. If you were an alien and you landed on the planet in the midst of a pandemic and you looked around and you saw some people wearing masks and some not wearing masks and you said, “I wonder what that’s about?” and it turned out it was their political party, you would just shake your head and get back on your spaceship and say this planet doesn’t have a future and head off somewhere else, because it’s just bizarre.

“It is both the wonderful way in which our nation has been so creative and so successful by not submitting to authority, but in this instance, when it’s a pandemic, it hurt us a lot. People died,” Collins said. “Surely hundreds of thousands of people lost their lives that didn’t need to.”

As I talked to Collins, I found it difficult to simultaneously hold the conflicting emotions—great sorrow and great gratitude—evoked by two realizations: A single disease has caused carnage and grief unmatched in any of our lifetimes, but because of the work of countless heroes in the world of medicine, many millions survived. Collins and his colleagues have been givers of life in a year of death.

Congratulations, tennis. You’ve won neither the battle nor the war with Naomi Osaka, but you have just bullied one of the biggest stars in your sport into quitting a major tournament that could use the publicity she would have brought to it.

Osaka, the second-ranked woman in international tennis and the highest-paid female athlete in the world, withdrew from the French Open after a power struggle with tournament officials over whether she would attend obligatory press conferences. Osaka has had trouble in that tournament in the past, having never advanced out of the third round. Last week, Osaka announced on social media that she was skipping all news conferences during the event to protect her mental health. “I’ve often felt that people have no regard for athletes’ mental health and this rings very true whenever I see a press conference or partake in one,” she wrote last week. “We’re often sat there and asked questions that we’ve been asked multiple times before or asked questions that bring doubt into our minds, and I’m just not going to subject myself to people that doubt me.”

Critics quickly portrayed Osaka as shirking one of her fundamental duties: communicating with the public. In reality, the episode laid bare some of the deeper tensions in big-money athletics. Who controls a sport—the leagues that organize the competition, or the athletes who actually play? When athletes have direct access to fans via social-media platforms, what role should traditional sports media play? And when athletes, particularly athletes of color, feel mistreated by tournaments, sports leagues, and media outlets alike, what recourse do they have?

As a sportswriter for more than 20 years, I have attended many of the postgame news conferences that so unsettle Osaka. These sessions help journalists and fans understand what we’ve just witnessed and why individual athletes defied expectations or failed to rise to the occasion. They also help humanize athletes whose personalities might not always come through in game footage alone. But even for seasoned journalists, the experience can be awkward. Most of us would prefer to conduct private interviews with athletes, but logistically that’s not feasible. Even if athletes could spend one-on-one time with several different news outlets, they would be subjected to a lot of the same questions. Still, the reliance on press conferences means that journalists often have to ask intrusive questions in front of a crowd.

Press conferences are more crucial for journalists who report on tennis than those who report on other sports. In the NBA, the NFL, the WNBA, Major League Baseball, and the NHL, players speak with the press almost daily during their respective seasons. Tennis players, by contrast, are generally unavailable outside of tournaments. The game, although popular in America, is covered with greater intensity overseas. These factors can result in aggressive questioning of athletes during press conferences. (Although press conferences have a function in the news-gathering process, leagues have also been able to turn access to players into an additional source of revenue. Notice how many different brands and companies are on the banners behind professional athletes when they speak with the press. That placement isn’t free.)

Rather than figure out a way to support Osaka or come to a workable compromise, French Open officials fined her $15,000 after she didn’t participate in the mandatory news conference following her first-round win on Sunday. The fine was not a surprise. In the past, other tennis stars have skipped news conferences and received the same treatment.

But tournament leaders weren’t satisfied with a fine. Officials from across the tennis world felt the need to put Osaka in her place. In a statement signed by the heads of all four Grand Slam tournaments—Wimbledon, the Australian Open, the U.S. Open, and the French Open—Osaka was warned that she could face suspension from future Grand Slam tournaments and harsher penalties if she did not fulfill her media obligations.

“We want to underline that rules are in place to ensure all players are treated exactly the same, no matter their stature, beliefs or achievement,” the statement said. “As a sport there is nothing more important than ensuring no player has an unfair advantage over another, which unfortunately is the case in this situation if one player refuses to dedicate time to participate in media commitments while the others all honour their commitments.”

The end result—Osaka completely out of the tournament—benefited no one. Osaka’s subsequent explanation for her decision made tennis officials look all the more callous. “I never wanted to be a distraction and I accept that my timing was not ideal and my message could have been clearer,” she wrote. “The truth is that I have suffered long bouts of depression since the US Open in 2018 and I have had a really hard time coping with that.” If the Grand Slam officials’ goal was to show Osaka who’s in charge, this was an enormous misstep. The sport has only further demonstrated that such tactics with today’s athletes are ineffective, outdated, and likely to backfire at a time when athletes have more leverage than they’ve ever had.

Across all sports, top athletes are no longer willing to stay silent about anything—their own personal struggles or the social and political issues they care about. They want the full scope of their humanity considered, and they are willing to confront prejudice not only in sports but throughout society. Last year’s U.S. Open took place amid nationwide protests against racial injustice. Osaka, a 23-year-old of Japanese and Haitian ancestry, showed that her goal isn’t to make other people comfortable. She wore a succession of face masks bearing the names of Black people who’d been killed by police and other would-be law enforcers. After she claimed her third Grand Slam title, a reporter asked her what message she wanted to send. Osaka responded, “Well, what was the message that you got? [That] was more the question. I feel like the point is to make people start talking.”

Osaka has received largely favorable coverage because of her performance on the court for the past two years. But she has witnessed the way two other tennis champions of color—Serena and Venus Williams—have been portrayed throughout their careers. In fact, in her Instagram post announcing that she was skipping out on media sessions at the French Open, Osaka included a clip from an interview Venus Williams did with ABC News in 1995, in which Williams’s father, Richard, chastised the interviewer for continually questioning his daughter about her seemingly high confidence.“You have to understand you’re dealing with the image of a 14-year-old child,” he told the interviewer. “And this child is going to be out there playing when your old ass and me gonna be in the grave … You’re dealing with a little Black kid, and let her be a kid.”

Such scrutiny became part of an exhausting pattern for the Williams sisters. The New York Times once published an article about how other women in tennis don’t want the kind of body Serena Williams has.

During the U.S. Open final against Osaka in 2018, Serena Williams lost her composure after being cited for multiple rule violations during the match. Williams got into a heated argument with an umpire after he accused her of receiving coaching from the stands. The episode culminated in Williams slamming her racquet against the ground. Following her loss, an Australian newspaper published an editorial cartoon that deployed racist imagery reminiscent of the Jim Crow era to depict Williams as a poor sport. Williams’s lips were overexaggerated, and her body was drawn ludicrously big.

Osaka’s first major tournament victory should have been a celebratory moment, at least for her. But U.S. Open spectators booed her for beating Williams, the favorite, under acrimonious circumstances.

Notably, Osaka has cited the U.S. Open final against Williams as the starting point of her own depression and anxiety. Osaka was just as direct about her mental-health struggles when she withdrew from the French Open, drawing support from a wide array of athletes, many of whom have experienced the same anxiety about public speaking. At the French Open this week, Serena Williams told reporters: “The only thing I feel is that I feel for Naomi. I feel like I wish I could give her a hug, because I know what it’s like. Like I said, I’ve been in those positions.” The Golden State Warriors star Stephen Curry tweeted, “You shouldn’t ever have to make a decision like this—but so damn impressive taking the high road when the powers that be don’t protect their own. Major respect @naomiosaka.”

That sports media in the U.S. are still overwhelmingly white and male contributes to the skepticism that many top athletes of color feel. According to the University of Central Florida’s Institute for Diversity and Ethics in Sports’ most recent report card for gender and racial diversity in U.S. sports media, 85 percent of sports editors are white, as are 80 percent of columnists and 82 percent of reporters. When I was a sports columnist at the Orlando Sentinel in 2005, a survey found that I was the only Black female sports columnist at a daily newspaper in North America. The lack of representation remains stunning—and embarrassing.

Most of the reporters I know—but not all—tread delicately when any player is having a difficult moment. But few of us dwell much on the mental health of the players we cover, the impact of nonstop scrutiny, and the emotional toll of having to explain tough losses, bad decisions, and subpar performances, as well as extraordinary success. And the possibility that people capable of athletic miracles might be in genuine emotional distress strikes many of us as incongruous.

Because of Osaka, I couldn’t help but think of the former NFL player Ricky Williams. In 2004, Williams briefly retired from the NFL at 27, after testing positive for marijuana for the third time—which would have triggered a four-game suspension and a $650,000 fine. He later returned to the NFL, but he was suspended for a year after a fourth positive test. His career, which was also interrupted by a series of injuries, eventually ended with the Baltimore Ravens after the 2011 season. Williams was routinely characterized as a misfit and someone who cared more about smoking marijuana than about football. He used to do postgame interviews with a helmet on because he hated dealing with the media.

But during the third year of his pro career, Williams was diagnosed with social-anxiety disorder. He had turned to marijuana to help cope with his struggles and to help heal his body. That put Williams’s entire career in a much different context. He has since become a strong advocate for cannabis use, and even started his own marijuana company. “The story was ‘football player retires to go smoke pot,’” Williams told CNBC in 2018. “And part of that was true, but it was much bigger than that. I was really redefining myself and figuring out what I want to do with my life.”

Many would look at intense media scrutiny and conflict with league officials as simply the price of being a successful professional athlete. But today’s athletes aren’t willing to put a happy face on their trauma just so the rest of us can be blissfully entertained.

The Brooklyn Nets star guard Kyrie Irving was fined twice this season for refusing to speak to the media, including last month. The first time was during training camp, when Irving issued a statement that read in part: “Instead of speaking to the media today, I am issuing this statement to ensure that my message is properly conveyed. I am committed to show up to work every day, ready to have fun, compete, perform, and win championships alongside my teammates and colleagues in the Nets organization. My goal this season is to let my work on and off the court speak for itself. Life hit differently this year and it requires us, it requires me, to move differently. So, this is the beginning of that change.”

After being fined $25,000 by the NBA, Irving posted his response in an Instagram Story. “I pray we utilize the ‘fine money’ for the marginalized communities in need, especially seeing where our world is presently,” he wrote. “[I am] here for Peace, Love and Greatness. So stop distracting me and my team, and appreciate the Art. We move different over here. I do not talk to Pawns. My attention is worth more.”

When Irving did finally talk to the media, he insisted that the “pawn” comment wasn’t an attack on journalists. “It’s really just about how I felt about the mistreatment of certain artists when we get to a certain platform of when we make decisions within our lives to have full control and ownership … We want to perform in a secure and protected space.”

The nagging suspicion that leagues and reporters alike fundamentally misunderstand athletes of color makes these athletes still more determined to cultivate their own image with fans. That’s why so many prominent athletes—including the NBA stars Russell WestbrookLeBron James, Stephen Curry, and Kevin Durant—have opted to launch their own media companies. With their massive social-media followings, they can take their message directly to the public. Many of them don’t need press conferences to promote or build their brands, and the establishment is having trouble adjusting to the new normal, in which it can’t make players do what it wants simply because that’s the way things have always been done.

The issues that Osaka has raised aren’t going away. These days athletes would much rather tell their own stories than let reporters do it for them. Not long ago, players couldn’t win any power struggles against the media, much less their own league. Now they can.

This story was originally published by The Atlantic. Sign up for their newsletter.