Midway through college, Michael Mina set off for the coastal Sri Lankan town of Chilaw to teach English. Within months, he had moved to the grassy mountains and been ordained as a monk, spending most of his days in relative silence. But a tsunami soon shattered the nation, and Mina’s Buddhist resolve with it.
Today, Mina, an immunologist and epidemiologist entering the third year of a global pandemic, can’t stop talking. He wants to. But the frustration and zeal welling up inside him inevitably spills onto his Twitter feed, resulting in upwards of 20 posts a day. If he doesn’t have the ear of some reporter, he’s on the phone with an executive at Swiss diagnostics giant Roche, or the White House, or a former colleague at Harvard, forever plugging his now 19-month-old pitch: COVID testing needs to be fast, frequent, and accessible. In the beginning, those three words were scribbled on a Post-It note pasted to his computer screen. Now they’re just seared into his brain.
The 38-year-old believes — no, is absolutely certain — the answer to blunting the pandemic lies in rapid antigen tests.
But the United States has not made rapid testing a priority, instead leaning hard into the shaky promise of vaccines as the panacea. Mina knows this is the moment such tests are needed the most, with the holidays here and people unwilling to relinquish their hard-won social lives. Yet, even amid a blizzard-like surge of COVID cases that threatens to overwhelm the nation’s hospitals once again, such tests remain elusive and unaffordable.
No one is as unflinching, as exasperated, as demoralized and still as persistent as Mina is in this crusade. His biting demeanor — “It’s like, what the f*** are we even doing here?” — is outweighed only by a Sisyphean dedication to the cause — “I don’t know why I keep at this, but I do.” This winter, he resigned from his roles as a professor of epidemiology and immunology at Harvard T.H. Chan School of Public Health and director of molecular virology diagnostics at Brigham and Women’s Hospital to join eMed, a Miami-based diagnostic company that virtually guides users through rapid tests. Mina said his move into the more lucrative private sector was fueled by a frustration with academia, as well as by a belief that more corporate support is needed to make rapid tests widely available and affordable.
While Mina was not the first — nor the only — rapid antigen test advocate, most everyone agrees he is by far the most “Let’s say, passionate,” according to Melissa Miller, director of the clinical molecular microbiology lab at the University of North Carolina. His advocacy borders on indignation. Some of his peers admitted to either blocking or unfollowing him on Twitter.
Using a narrow lens, there are signs that his campaign may finally be paying off. President Biden announced Tuesday the federal government will purchase 500 million rapid tests and ship them free to Americans starting in January. Massachusetts is handing out 2.1 million at-home rapid tests to 102 communities. Colorado already offers a free at-home test mail-delivery program. But these isolated and limited efforts will likely do little to stave off the tidal wave of cases sparked by the arrival of Omicron. These tests may be fast, but they still aren’t frequent or accessible.
“Even now that we’re trying to promote these tests, we’re still screwing it up,” said Mina, as he sat outside a Jamaica Plain cafe with his three-month-old daughter sleeping in a stroller nearby. He is one of the rare viral personalities whose online demeanor mirrors that of his everyday persona. For two hours, he spoke nonstop — taking just one bite of his avocado toast — with vexation and bewilderment about the country’s inability to recognize the value of the rapid test.
That afternoon he was back on Twitter. “I feel we’ve learned so little despite so much pain,” he wrote.
Why does the man care so much? First, because as an engineer-turned-epidemiologist, he truly believes these pocket-sized tests can save lives and livelihoods. Second, because for all the spectacular advances American science has made over the past century, the pandemic has spotlighted its many shortcomings. To Mina, the tortuous journey of rapid at-home COVID tests is a microcosm of the failure of science and public health in America.
“I really do feel like the story of antigen tests is just the story of how America deals with public health; inefficiently, paternalistically, and without any collective unity. The rapid test is just a microcosm of all that is flawed,” said Mina.
When the pandemic hit, Mina joined forces with Deborah Hung to establish the groundbreaking testing lab at the Broad Institute, the powerhouse Cambridge diagnostics lab that now processes some 150,000 PCR tests a day and sequences as many as 10,000 samples per week. But soon he worried that even that relatively fast clip wasn’t going to cut it to curb COVID transmission on a grand scale.
Someone reached out to Mina about the possibility of creating a new kind of test, one that people could do at home, to catch an infection before heading into work or to a concert or out to dinner with friends. The only snag: the tests wouldn’t be as sensitive as the venerated PCR, which can correctly pinpoint 98 percent of positive results.
“It dawned on me that of course there was still a role for it,” Mina said. “It doesn’t need to be quite as sensitive as a PCR, it just needs to be fast enough to catch cases in real time.”
Rapid tests typically detect viral antigens when someone has enough of them to be able to spread the disease, but are far less able to identify cases in earlier or later stages of infection, when viral loads are lower.
The sensitivity question has been a thorn in the side of the rapid test from the start. If the “gold standard” PCR test was the teacher’s pet in the eyes of infectious disease experts, then the rapid test was its mediocre, B-minus classmate. That stigma traces back to the 2009 swine flu epidemic, when experts saw rapid tests regularly fail, and it persisted as COVID-19 began sweeping the globe a decade later.
“We had the bias of how poorly rapid antigen tests worked for influenza. There was the thought that this was not a tool that we could use during a pandemic,” said Miller, the UNC microbiologist.
“We need the best means of detecting and containing the virus, not a perfect test that no one can use,” read the piece.
When Kristian Andersen, director of Infectious Disease Genomics at Scripps College in California, finished reading the essay that summer, he recalls turning to his wife and saying, “Finally, somebody who can put it into easy to understand language. Bravo.”
From that summer on, Mina spread the gospel of the rapid antigen test from a coffee-table-turned-standing desk in the living room of his Jamaica Plain apartment. He pestered the White House to invest in the technology. Reference a rapid test in an interview with an epidemiologist last fall and they’d inevitably inquire: “You’ve been talking to Mike, haven’t you?”
Mina’s an indefatigable optimist disguised as a despairing pessimist. To him, the federal government’s failure to embrace the rapid antigen test has been a massive disservice to its people and a metaphor for how undervalued public health remains in America.
“We take medicine very seriously in this country,” he said. “But we treat public health as this froofy thing that doesn’t deserve funding. The FDA refuses to acknowledge that this test is a vital public health tool. It’s really bizarre and I think it’s responsible for hundreds of thousands of additional deaths.”
Earlier this month, the Biden administration announced private health insurers must reimburse for the purchase of rapid tests. Even if consumers with coverage are able to navigate the reimbursement process, the initiative could drive prices up. Meanwhile, over 28 million Americans remain without health insurance. (Halfway through an interview for this story, Mina realized he was among them, his new employer’s plan had not yet begun.)
A recent briefing room tiff between NPR’s Mara Liasson and White House press secretary Jen Psaki haunts Mina’s dreams.
“That’s kind of complicated,” said Liasson of the reimbursement scheme. “Why not just make them free and give them out to — and have them available everywhere?”
Psaki shot back sarcastically: “Should we just send one to every American?”
Mina, who for months called on both the Trump and Biden administrations to distribute rapid tests to all its citizens by mail, called the exchange a “Saturday Night Live” skit crafted to satirize his last 18 months of advocacy.
Though the government has now committed to widely distributing tests by mail through January, the supply does not currently exist to fuel both that campaign and fill the shelves of pharmacies. Nothing has highlighted the glacial pace at which the FDA authorizes potentially life-saving treatments quite like a fast-moving, novel pandemic.
“The FDA is used to a system where it’s better to do nothing than act with any uncertainty,” said Mina.
Rapid antigen tests, in particular, appear to wait behind a giant tangle of red tape and velvet ropes that some experts see as disproportionate to the test’s potential risks. In November, ProPublica reported that companies trying to get approval for rapid tests were subjected to an arbitrary, opaque process that crawled on, often long after their products had been approved in other countries that prioritize accessibility and affordability over perfect accuracy.
Today, there are only 13 authorized over-the-counter rapid antigen tests in the U.S., a far cry from Europe’s 100-plus available offerings. Mina calls the disparity “American exceptionalism at its worst.” U.S. employers tasked with testing their entire workforces have found themselves in bidding wars to secure adequate supply. A mid-November decision by the FDA to prioritize reviews of at-home tests has not yet made rapid tests easier or cheaper to obtain, as empty shelves at pharmacies and out-of-stock messages online show.
So did Biden’s plan announced Tuesday to distribute 500 million free tests across America next month inject any holiday cheer into Mina? It’s complicated.
“I mean, it’s a great start. I do feel some bit of achievement here,” he texted. But a man does not scream into the void for 19 months only to abandon his creed when a politician makes a promise. He noted that the tests won’t start arriving until January. And even then, further action is needed.
“I’m worried it will be mostly or materially a PR stunt which this Admin and FDA have gotten good at doing around tests,” he continued. “They have an opportunity to do better here but it’ll likely amount to <1 test per person.”
Fast? Yes. Accessible? Maybe. Frequent? Not exactly. And so the crusade — as outlined on a Post-It note a-year-and-a-half ago — marches on.