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The Optimist

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Identifying therapeutics: The role of COVID-19 Therapeutics Accelerator

What role are you playing in the foundation’s response to COVID-19?

I’m supporting the effort to identify therapeutics that could be used to treat moderate to severe cases of COVID-19. 

What are your priorities right now?

Our first priority is to work with partners to test already approved drugs—drugs that could be available at your local pharmacy—to determine whether any are active against SARS-CoV-2, the virus that causes COVID-19. We’re doing this because the safety profile of these medicines is well known, they’re already being manufactured at scale, and they could be made immediately available to treat coronavirus patients through a simple off-label recommendation. Finding a drug that fits this profile could have a big impact in saving lives, protecting healthcare workers, and ultimately stopping this pandemic.

What are you currently doing to accelerate that work?

For the past two weeks, our focus has been looking closely at approved drugs and screening them for the properties they would need to have. Is there evidence that they’re active against viruses? Is there evidence that they could be delivered to millions of people in the form of a pill? Do we have evidence that the compound is easy to formulate and manufacture at scale? We have used published data from labs and computer modeling as well to explore these questions and narrow down our list to about 75 compounds worth exploring.

What other steps are you taking to accelerate the discovery of potential treatments?

With the launch of the new COVID-19 Therapeutics Accelerator, we are working with an array of pharmaceutical companies and academic researchers to examine their catalogs for potential treatments. One incredibly valuable resource is the ReFRAME catalog of the Scripps Research Institute in La Jolla, CA. ReFRAME is a collection of more than 10,000 small molecules and biologics that have already gone through safety testing in humans and have a well-characterized safety profile.

Researchers also know other important things about these compounds—such as how well they dissolve in water or in fats and how quickly the body processes them. This information is essential to understanding which compounds are likely to work as oral treatments versus which compounds would need to be delivered by injection or infusion.

What is the advantage of creating a treatment that people can take as a pill?

We’re especially interested in compounds that can be delivered orally because that would dramatically expand the number of people who could have access to them, and it would also allow us to treat people who are in the early stages of infection. If someone needs to be hooked up to an IV drip to receive an antiviral, that means you need an in-patient hospital setting and a qualified healthcare provider to administer the treatment. It also means that infusions are likely to be prioritized for people who are critically ill as opposed to people who are just beginning to show symptoms.

If you can develop a pill-based treatment, however, that means you can deliver it to people via a pharmacist or a local clinic dispensary. And if you can treat people in the early stages of infection, you can also reduce the spread of the virus across the community, preventing other people from getting sick.

What other properties are important for the drugs you’re seeking to develop?

Cost of manufacturing is obviously very important to ensure that we can design treatments that are accessible to populations in low- and middle-income countries. And we also need formulations that are stable at ambient temperatures and have a long shelf life.

About the Interviewee

Monalisa Chatterji
Monalisa Chatterji, a senior program officer for the Bill & Melinda Gates Foundation's Discovery & Translational Sciences team, works on the discovery of novel candidate therapeutics.

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