As countries grapple with the worst global pandemic in a century, it’s hard to think about preparing for the next one. But if we don’t, it could be worse than Covid-19.
Over the last 30 years, infectious disease outbreaks have emerged with alarming regularity. The World Health Organization lists an influenza pandemic and other high-threat viral diseases such as Ebola and dengue among the top 10 biggest threats to public health. The rate of animal-to-human transmission of viruses has been increasing, with the U.S. Centers for Disease Control and Prevention estimating that 75% of new infectious diseases in humans come from animals.
These zoonotic infections can have profound effects on human life. The overall infection fatality rate is around 10% for severe acute respiratory syndrome (SARS), between 40% and 75% for Nipah virus, and as high as 88% for Ebola.
While the infection fatality rate for Covid-19 is lower — likely less than 1% — the overall burden of death has been significantly higher since it has affected so many people, more than 160 million people as I write this.
Luck is not a pandemic strategy
Although the Covid-19 pandemic has been a human and health care disaster, by scientific measures the world was lucky this time. Covid-19 was far less lethal than its predecessors, less contagious than previous pandemic viruses, and we were able to quickly develop a cadre of effective vaccines.
But luck is not a strategy.
The same way the U.S. invests in and prepares for national defense, it must also prepare for another pandemic. Though the next viral outbreak cannot be prevented, the next pandemic can — but only with better preparation.
There is no doubt that the global pharmaceutical industry, governments, nongovernmental organizations, and health care systems should have been better prepared for Covid-19 in part because the coronavirus that causes it, known as SARS-CoV-2, is closely related to other coronaviruses, particularly the one that caused the outbreak of SARS in 2003.
In fact, coronavirus core proteins often share upward of 95% of their nucleic acid or protein sequences due to their close origins. In some cases, their active sites — the pockets to which antiviral therapies bind — are 100% identical. In short, coronaviruses are highly related, and where it counts they share complete or near complete identity.
Had the drug discovery efforts initiated during the 2003 SARS epidemic been continued and come to fruition, antiviral medications to treat Covid-19 would have been on the shelf to help contain the pandemic, or at least better treat Covid-19 patients. Unfortunately, those efforts were abandoned once SARS seemed under control because there was no apparent market and no infrastructure to support ongoing research.
The response to Covid-19 — if it can be sustained — suggests hope for the future and a springboard for preparedness, especially immediate and ongoing collaborations across the biopharmaceutical industry, academia, and government. Walls came down. Collaboration flourished. A tremendous amount of good science was conducted in diagnostics and clinical management, and the world witnessed spectacular efforts in vaccine development.
The urgency of the crisis and the speed of drug development led the biopharmaceutical industry and governmental bodies to work in concert, streamlining regulatory processes in ways that must continue moving forward once the coronavirus crisis ends. Rethinking traditional practices is essential to pandemic preparedness, which must be approached with the same mindset as countries approach defense, with the goal of establishing a unified global bulwark against future disease outbreaks.
Establish and fund infrastructure for collaboration
Global health crises require organized structures and leadership. Governments and the biopharma industry need to create and coordinate a joint pandemic preparedness ecosystem. Such a structure would help governments, industry, academia, and others focus on their respective strengths for greater efficiency, partnerships, and preemptive research.
In March 2020, two dozen R&D leaders from the world’s leading biopharma companies, including my company, Takeda, came together to form the Covid R&D Alliance. It is showing that this type of industry collaboration is possible by rapidly assembling and coordinating therapeutic responses to the pandemic. At the national and international levels, this alliance and others are beginning to undertake early work to get ahead of drug development in advance of the next pandemic. But this effort must quickly be solidified before momentum and motivation are lost.
The massive human suffering and economic impact of Covid-19 underscore the significant investment that must be made for future preparedness. Dedicated public and private funding of such an effort would demonstrate a commitment to global health care and create a defense against future pandemics that is founded on science and independent from political rhetoric.
Identify leading threats and identify therapies for them
The perpetrators of the next pandemic will likely come from the coronavirus or influenza families. Other possible culprits include flaviviruses such as the West Nile virus, filoviruses such as the Ebola virus, and alphaviruses known to associate with a number of human encephalitis diseases.
Using a list like this to guide its work, the biopharmaceutical industry needs to begin creating an arsenal of antiviral molecules. Given the impossibility of predicting the future, it will be important to focus on broadly active compounds where possible, and virus-specific compounds to fill in gaps.
In the coronavirus family, for example, SARS-CoV-2 is similar in structure to the 2003 SARS virus, and the virus that causes Middle East respiratory syndrome is only slightly different. It should be possible to develop a single antiviral molecule to be effective against all three. If a three-fer isn’t possible, then specific therapies should be developed for each potential pathogen. All therapeutic candidates should be evaluated against diverse viral strains as markers of future potential efficacy in future epidemics.
There is no business model for preparing for a future pandemic. Without specific catalysts, interest in preparing for this unknown is likely to wane as Covid-19 comes under control. Whether it’s because businesses are thinking of investors, media, academia, or other audiences, the tendency is to go where the spotlight is shining — which would be a disaster for pandemic preparedness.
What’s needed is a competitive environment to stimulate innovation. But without an established or obvious market, the necessary investment and entrepreneurism won’t materialize. Enabling future pandemic therapeutic preparedness will require establishing a novel, collaborative ecosystem in which biopharma companies, nongovernmental organizations, governments, academia, and other stakeholders are able to share information and coordinate areas of focus to maximize the collective efforts. The success of the whole will depend on the willingness and success of each individual piece.
To prepare for the next viral pandemic, governments and nongovernmental organizations need to focus on preparing health care infrastructure and viral surveillance to predict the next outbreak. At the same time, academia and the pharmaceutical industry must focus on drug discovery, particularly antiviral therapies. These efforts must seamlessly interface.
To enable future preparedness, the biopharmaceutical industry should leverage the ways of working that emerged during Covid-19 that included sharing assays, models, and data while concurrently focusing on competitive innovation. With the right level of coordination, and without massive resources, an arsenal of antiviral molecules can be created and tested on healthy human volunteers so the world has them at the ready for Phase 2 trials when threats emerge.
Pandemic readiness will also require agility and an ability to adapt rapidly to the unknown. Estimates suggest the existence of 500,000 animal viruses with spillover potential to humans, with a small fraction of these (250 or so) having already made the jump. We must be ready for the perpetrators from poorly studied or poorly understood viral families, as well as the entirely new threats that evolution will create. Focusing on known pathogens is a critical first step in therapeutic preparedness, but the industry must also be ready to start entirely new programs with minimal notice.
The biopharmaceutical industry has a moral obligation to step up where it has expertise and capability, and governments must embrace more flexible regulatory processes to prepare and protect its citizens. Working together, they can help ensure that the next viral outbreak the world faces does not reach the level of a global pandemic.
Andy Plump is the president for research and development at Takeda Pharmaceuticals and a cofounder of the Covid R&D Alliance.