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The Optimist

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Developing COVID-19 therapeutics: An investment that needs to happen

Why is developing treatments and vaccines for novel pathogens like COVID-19 a high-risk endeavor for pharmaceutical companies?

One of the biggest challenges is that it takes many days or weeks to understand exactly what path a novel pathogen like COVID-19 is going to take. Earlier in this century, two other coronaviruses epidemics—SARS and MERS—demonstrated pandemic potential, but both were ultimately stopped. With COVID-19, there were worrisome indications early on about its pandemic potential—given the fact that it is highly transmissible.

Many pharmaceutical companies immediately swung into action to develop candidate vaccines and identify potential treatments. But no pharmaceutical company in the world has the capacity to work at risk to take the next steps required to launch large-scale clinical trials or produce hundreds of millions of doses without knowing if there is going to be a need or demand for their product. Just the cost of building or refitting a single manufacturing facility for vaccines could run up to $100 million.

So, while pharmas are quite capable of producing candidate products in short order, they need strong funding from governments or philanthropies to de-risk the next steps in the product development process. They aren’t going to be able take the next step without partners. 

But pharmas make speculative, high-risk investments all the time. It’s a high-risk business to begin with. What’s different in this case?

It is a high-risk business, but pharmas normally mitigate those risks by developing products for which they know there will be high future demand and ability to pay. Take, for example, treatments for diabetes or cancer or Alzheimer’s. There is reliable data on the global burden of those diseases to guide their investment strategies. For a completely novel pathogen like COVID-19, there are no reliable data. Will COVID-19 be stopped? Will it become seasonal like influenza? We just don’t know. And that’s what makes government funding so critical to removing roadblocks and accelerating product development.

Have there been public-private initiatives like COVID-19 Therapeutics Accelerator before?

Yes, there are comparable examples going back to the Second World War. Pharmas worked with governments to accelerate the identification and development of antibiotics based on Alexander Fleming’s initial discoveries from the late 1920s. This collaboration played a critical role in saving the lives of wounded soldiers. The Allies also invested in the development of novel treatments for malaria to save the lives of soldiers fighting on the Pacific front and in North Africa and Italy, where malaria was still endemic. When governments commit to removing financial constraints on product development, there are amazing opportunities to achieve breakthroughs. 

The biggest public-private consortium right now is the TB Drug Accelerator, which pulls in government funding and pharma expertise to accelerate the development of new curative treatments for tuberculosis. So, there is a strong, recent precedent for the work we are catalyzing together with Wellcome and Mastercard to accelerate the development of broad-spectrum antivirals for COVID-19 and other novel viral pathogens.

Are you getting strong engagement from the pharma sector with the launch of CoTA?

Absolutely. There has already been tremendous energy and excitement with companies eager to assist in identifying and optimizing potential therapies, open their small molecule libraries to investigators, and lend their best minds and technologies to the effort. The key now—once strong candidates have been identified—will be securing funding from governments to launch clinical trials and fund the production of any products that prove safe and effective at scale.

What are your long-term hopes for this effort?

First and foremost, we want to accelerate the development of new, broad-spectrum antivirals that can not only be deployed to treat COVID-19 but will also be available to fight future novel viruses. That’s our immediate objective, and we are fully focused on it.

I do hope as well that COVID-19 will help transform the public-private partnership model for investing in global health. This outbreak reminds us that a health crisis anywhere can quickly become a crisis for everyone. It also reminds us that if we aren’t tackling the greatest burdens of disease around the world—both fast-moving diseases like COVID-19 and slow-moving epidemics like TB and HIV—we are doing so at the cost of millions of lives and untold billions in economic productivity. There is no reason why we can’t tackle these issues. As Bill Gates said in his New England Journal of Medicine essay last week, our leaders just need the will to do so.

About the Interviewee

Trevor Mundel
Trevor Mundel leads the foundation’s efforts to develop high-impact interventions against the leading causes of death and disability in developing countries.

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