The U.S. government’s announcement that it is investing $3 billion into research on antiviral medicines for Covid-19 is a step in the right direction and comes at a critical moment in the pandemic — though earlier, of course, would have been better.
But based on my experience with drug development, in particular with antivirals, in both government and the private sector, I know that the process takes longer and is more expensive than anyone ever anticipates. I believe that $3 billion in federal funds is not nearly enough, and that at least $10 billion in clinical research funding is needed to discover and develop the new antiviral medicines that patients desperately need and that physicians have been asking for since the start of the pandemic.
One reason we need new antivirals is that these medicines are efficient and cost-effective ways to limit the spread and severity of respiratory infections like Covid-19.
A second reason is that the pandemic is still raging in about half of the U.S. and in many countries around the world. At this point, about 40% of Americans haven’t received even a single dose of a Covid-19 vaccine, which has allowed the Delta variant to spread rapidly, driving up the rate of infections, hospitalizations, and deaths.
For people with Covid-19 who end up in the hospital, there are few recommended treatments. These include dexamethasone (a steroid), remdesivir (an antiviral), baricitinib (an anti-inflammatory), and tocilizumab (a monoclonal antibody). Convalescent plasma has not shown a great deal of success and in many cases is not recommended. Monoclonal antibodies, which are delivered via transfusion, are now recommended only for those who are infected and not yet hospitalized but are at risk of hospitalization due to the presence of one or more specific medical conditions. In short, clinicians treating patients in the outpatient setting have few options for people with mild to moderate Covid-19.
The situation is the same around the world. The United Kingdom continues to report hundreds of thousands of cases per week even though more than 60% of the population is fully vaccinated. Australia has reimposed restrictions. Japan declared a state of emergency, banned spectators at the Tokyo Olympics, and sent athletes home who tested positive. Brazil is poised to surpass the U.S. as the country with the highest number of Covid-19-related deaths in the world.
And the global death toll has soared past the grim milestone of 4 million as the Delta variant, which is highly contagious, deadly, and potentially more dangerous to younger people, continues to spread.
In short, the virus is doing what viruses do — mutating and infecting vulnerable individuals without regard to state or international boundaries or our collective desire to return to pre-pandemic times.
Antiviral medicines can’t stop the spread of Covid-19. But they can help treat it and prevent it from killing people.
While I applaud the U.S. government’s commitment to support antiviral research, much more than $3 billion in funding will be required to develop multiple classes of safe and effective drugs to treat this virus and stay ahead of any variants.
What’s needed is a more robust public-private partnership with an expanded scope, much like what was created for vaccine development, with at least $10 billion in seed money from the government. The partnership should invest in and fast track the most promising experimental antiviral medicines, including combination therapies, with a goal of finding at least two or three that are safe, effective, easy to manufacture, and affordable.
By itself, $10 billion sounds like a lot of money. But it isn’t when compared to the trillions of dollars the pandemic has cost so far. According to the International Monetary Fund, the projected loss of global economic output between 2020 and 2025 as a consequence of the pandemic will total $28 trillion.
A third reason for investing in research to find new treatments for Covid-19 is the Strategic National Stockpile. Federal agencies have been consulting with the private sector on how much and what to put in a national stockpile. If Covid-19 continues to mutate into more dangerous, contagious, deadly versions of itself, it is vital for national security and health that the U.S. build a large stockpile of personal protective equipment, ventilators, masks, diagnostic tests, and effective antiviral medicines.
The evidence is clear: Now is the time for the public health community, the medical community, and the policymakers in Washington D.C. to join in partnerships much like the ones that successfully developed Covid-19 vaccines. As the current wave of infections is demonstrating, we need treatment options delivered at home — orally if possible — that will reduce mild-to-moderate symptoms, shorten the length of illness and, most importantly, prevent hospitalization. Only with a full complement of vaccines, treatments including antivirals, and public health mitigation strategies will we be able to end the pandemic.
Armand Balboni is a physician-scientist; CEO of Appili Therapeutics, a public company working to develop anti-infectives including a broad-spectrum antiviral for use against Covid-19; and former deputy director of clinical and regulatory affairs for the U.S. Army. The views and opinions expressed here are his alone and do not necessarily represent those of any entities with which he is or has been affiliated.
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