Jennifer Kahn: How to stop the next pandemic before it starts

Researchers believe they could pre-emptively create vaccines and drugs to fight a range of viral threats — if they can get sufficient funding, writes Jennifer Kahn
Jennifer Kahn: How to stop the next pandemic before it starts

Researchers believe they could pre-emptively create vaccines and drugs to fight a range of viral threats — if they can get sufficient funding, writes Jennifer Kahn

Coronavirus COVID-19 molecule getting injection
Coronavirus COVID-19 molecule getting injection

ON a cold morning in February 2018, a group of 30 microbiologists, zoologists, and public-health experts from around the world met at the headquarters of the World Health Organisation in Geneva.

The group was established by the WHO in 2015 to create a priority list of dangerous viruses — specifically, those for which no vaccines or drugs were already in development.

The consensus, at least among those in the room, was that as populations and global travel continued to grow and development increasingly pushed into wild areas, it was almost inevitable that once-containable local outbreaks, like Sars or ebola, could become global disasters.

“The meeting was in a big room, with all the tables arranged around the edge, facing each other,” one of the group’s members, Peter Daszak, recalled recently.

“It was a very formal process. Each person was asked to present the case for including a particular disease on the list of top threats. And everything you say is being taken down, and checked factually, and recorded.”

Daszak, who directs the pandemic-prevention group EcoHealth Alliance and is also chairman of the Forum on Microbial Threats at the National Academy of Sciences, Engineering and Medicine, had been given the task of presenting on Sars, a lethal coronavirus that killed roughly 800 people after it emerged in 2002. (Sars stands for severe acute respiratory syndrome and is officially known as SARS-CoV-1.)

“We’d done a lot of research on coronaviruses, so we knew they were a clear and present danger,” he told me.

“High mortality, no drugs or vaccines in the pipeline, with new variants that could still be emerging.”

The discussion, he said, was intense. “Everyone else in the room knows the facts already — they’ve read all the research,” Daszak said.

But for each pathogen, the speaker had to convince the room that it presented a significant threat — “that this disease really could take off, and that we should concentrate on it rather than on Lassa fever or something else.

A laboratory technician wearing a biohazard overall performs coronavirus detection tests inside an isolation chamber at a laboratory in the Torlak Institute of Virology in Belgrade, Serbia, on Wednesday, March 4, 2020. Photographer: Oliver Bunic/Bloomberg
A laboratory technician wearing a biohazard overall performs coronavirus detection tests inside an isolation chamber at a laboratory in the Torlak Institute of Virology in Belgrade, Serbia, on Wednesday, March 4, 2020. Photographer: Oliver Bunic/Bloomberg

BUT for years, Racaniello notes, the real obstacle to making panviral drugs or vaccines has been that no one was willing to pay for their development. For pharmaceutical companies, he points out, panviral vaccines are simply a terrible business proposition: Companies have to spend hundreds of millions of dollars to develop a shot that people will get once a year at most — and not at all in years when no particular disease is ascendant.

Panviral drug treatments are unprofitable for similar reasons. For one, the course of treatment is short, usually just a few weeks; for chronic diseases -diabetes, high blood pressure-, patients take regimens of pills daily, often for years. (One person noted that Gilead’s stock price actually dropped after the company produced a revolutionary hepatitis C drug. Because the treatment completely cured patients, the market for it started to shrink, undermining the company’s bottom line.)

The other problem is that there’s currently no way to quickly test for most viruses, which is essential if a doctor wants to establish a diagnosis and prescribe the right drug. Governments, meanwhile, have been reluctant to fund panviral development —

both because it’s expensive and because the rewards can feel remote, especially as many diseases originate in other countries.

“We don’t prevent well; we respond well,” Daszak notes.

Bill Gates, Co-Chair, Bill & Melinda Gates Foundation speaks onstage at 2019 New York Times Dealbook on November 06, 2019 in New York City. (Photo by Mike Cohen/Getty Images for The New York Times)
Bill Gates, Co-Chair, Bill & Melinda Gates Foundation speaks onstage at 2019 New York Times Dealbook on November 06, 2019 in New York City. (Photo by Mike Cohen/Getty Images for The New York Times)

The foundation has supported GAVI, an international alliance that helps vaccinate children in poor countries and spearheaded a fund to fight HIV, tuberculosis, and malaria worldwide.

Mark Suzman, chief executive of the Gates Foundation, says that when governments and companies do pull together, the focus is often on projects like these rather than “forward-looking” issues like pandemics or climate change.

One exception, he says, has been the Coalition for Epidemic Preparedness Innovations (Cepi), an NGO that was founded in 2017 to co-ordinate and finance the development of new vaccines for diseases that might lead to a pandemic.

When it started, Suzman told me, Cepi was a low-profile project: “It was really a response to the ebola epidemic of 2014 and 2015. Now, of course, it looks incredibly farsighted.”

Cepi works by identifying the most promising research, and then connecting it to industry and government resources, in order to bring multiple sets of “candidate” vaccines through initial clinical trials.

The goal is to create a stockpile of potential treatments for known coronaviruses, haemorrhagic fevers, and other global threats that could quickly go into production in the event of an epidemic.

Cepi isn’t the only group trying to find solutions to the drug and vaccine problems.

In the US, a federally funded university collective called the Antiviral Drug Discovery and Development Center (AD3C) was created in 2014, with the goal of developing drugs for influenza, flaviviruses (including West Nile), coronaviruses, and alphaviruses.

Like Cepi, AD3C partners with pharmaceutical companies but focuses on salvaging and reformulating promising drugs that might be valuable but that the company isn’t interested in pursuing.

Amesh Adalja, a senior scholar who specializes in infectious-disease and pandemic preparedness at the Johns Hopkins University Centre for Health Security, told me that approaches like these are going to be “instrumental” in preventing whatever comes after Covid-19.

“In the wake of this pandemic, people are going to realise that spending money on organisations like Cepi is a good investment — especially when you realise how much having a vaccine against the coronavirus would have offset the damage and destruction and disruption that we’ve seen.”

The screening, done by the Rega Institute in Belgium, will scan and test 14,000 compounds in a Scripps Research Institute library, as well as the proprietary libraries of 15 pharmaceutical companies, including Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, and Pfizer, for possible crossover treatments.

Because most of the drugs have already been tested for safety, they need to be tested only for efficacy, speeding up the process.

The willingness to share proprietary compounds, says Suzman of the Gates Foundation, is “pretty unprecedented”.

And while that collaboration is currently focused on Covid-19, the hope is that, after the current crisis has passed, that same collection could be screened for more ambitious projects — like a broad-spectrum anti-coronavirus drug.

The big question, according to nearly everyone I spoke with, is whether we’ll manage to maintain this political and financial will over time. Racaniello and Daszak both remember being sure that after Sars and ebola, pandemic prevention would be a priority; instead, each outbreak was quickly forgotten. And while it’s hard to imagine forgetting the current disaster, researchers worry that funding and attention will once again fade in the face of competing pressures.

As Racaniello observed, the combined 2019 budgets for the US National Institutes of Health and the National Science Foundation was $47bn — less than 7% of the $686bn allocated to defence. “I would argue that viruses are just as much a threat as a bad nation would be to the military,” Racaniello said.

Or as Daszak put it: “We don’t think twice about the cost of protecting against terrorism.

“We go out there, we listen to the whispers, we send out the drones — we have a whole array of approaches. We need to start thinking about pandemics the same way.”

Adapted from an article that originally appeared in The New York Times Magazine.

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