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Potential plasma treatments for COVID-19: A conversation with Dr. Toni Hoover

This week, a group of plasma therapy companies announced they had formed the “CovIg Alliance,” an effort to develop plasma treatments for COVID-19. We spoke with Dr. Toni Hoover, who is Director of Strategy, Planning, and Management for Global Health at the Gates Foundation, about what the effort means for the wider fight against the pandemic, and the foundation’s role.

 

Can you start by explaining the basics of this CovIg Alliance? What are its goals, and what literally does it stand for? CovIg is obviously very close to COVID-19.

That’s right. CovIg is a combination of COVID-19 and hyperimmune globulin (that’s where the “Ig” comes from).

This Alliance’s goal is to develop a hyperimmune globulin treatment (or HiG) made using convalescent plasma. (That’s a technical term for the blood of someone who has survived a disease). Convalescent plasma has been known to be effective in treating various types of other viruses, and that’s because the convalescent plasma contains antibodies that can potentially fight the disease.

To put it simply, this Alliance is trying to develop a treatment for people with COVID-19 that’s made from the antibodies of the people who’ve already had the virus. And those antibodies come from plasma, which comes from a blood donation.

The organizations that are part of this Alliance are some of the top plasma-derived therapy companies around the world. They include Takeda, CSL Behring, Biotest, Bio Products Laboratory, Octapharma, and LFB.

Initially, each of these companies had tried to develop these HiG treatments alone. But with a COVID-19 vaccine still being 12–to–18 months away, the companies recognized that there would be a need for some treatment in the meantime—and that they could produce it faster if they worked together. The Alliance is creating one unbranded HiG medicine, and it could be one of the earliest therapeutics for COVID-19.

 

Why is this so much faster to develop than other treatments or a vaccine?

So, convalescent plasma can be used in two ways. One way is you take the plasma and transfuse it directly into the body of a person who is actively infected with COVID-19.

The other way—and this is the way that the Alliance is pursuing—is to create a concentrated antibody treatment. That is the polyclonal hyperimmune globulin—the HiG. Plasma from many survivors is mixed together then processed to remove the antibody portion, which is then put it into a more highly concentrated form. The process also removes infectious agents and other proteins to make the product safer and allow it to be administered to anyone, regardless of their blood type. In the end, the product, unlike the plasma from a single individual, has a highly predictable concentration of antibodies that can be delivered in a smaller volume to a sick patient.

I should also mention: People suffering from COVID-19 might not be the only people to benefit from this treatment. Depending on how the product performs in clinical trials, these HiG treatments could be used for disease prevention. Potentially, you could give them to frontline healthcare workers and other high-risk populations to prevent infection.

What’s the foundation’s role in all of this?

The plasma companies themselves are actually developing the treatments, and they will run the clinical trials to see how effective they are. (The first one will start in the May/June timeframe.)  

Our foundation is playing an advisory role. We’ve helped connect the different plasma therapy companies and linked them, for example, with organizations that could help build their website and communicate with health care professionals about their work.

 

I know this effort is largely a U.S. one right now. Is there any thought about making these treatments available more broadly, particularly to low- and middle-income countries?

Eventually, that would be ideal. Because these HiG treatments are relatively easy to administer—they just require injections—they might be effective in places where there isn’t a lot of hospital infrastructure. (Drugs like Remdesivir, on the other hand, require days hooked up to an IV.)

Compared to convalescent plasma, HiG is also easier to ship and stays active and stable at room temperatures, unlike convalescent plasma that must be kept refrigerated. This means that it could be more effectively distributed and used in low-resource environments in hospitals and clinics in Africa and South Asia. And importantly, HiG does not require the type and crossmatch procedure needed to safely give unprocessed convalescent plasma.

The challenge is that there are only a few facilities worldwide that can produce HiG right now. So, making enough to meet the whole world’s demand would be difficult.

 

Where are the companies getting the convalescent plasma to make this treatment?

From very generous, heroic individuals. The Alliance has built a website—it's called the Plasma Bot—and through that, they’re able to connect with COVID-19 survivors who might be willing to donate their plasma.

About the Interviewee

Dr. Toni Hoover
Dr. Toni Hoover is the Director of Strategy, Planning, and Management for Global Health at the Bill & Melinda Gates Foundation.

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