Britain Moves On to the Next Big Covid Problem: Treatment
(Bloomberg Opinion) -- Britain’s Vaccine Task Force was the country’s biggest triumph since the 2012 Olympics — and it was a lot more consequential. It gave the U.K., which has one of the world’s highest pandemic death tolls, early access to a suite of effective vaccines and a jumpstart on immunizing the population. It saved countless lives.
Can the government replicate that success to find a drug that can treat Covid-19 at home?
That, at least, is the plan. A new antivirus task force is being set up to find two drugs that can treat Covid-19 at home before the end of the year, and establish a further pipeline of drugs for next year. It’s one part of the government’s three-pronged approach for tackling a potential third wave of infections, alongside readying booster shots to fight against new variants and continued mass testing.
There are good arguments for pushing ahead with therapeutics. Even with the country’s vaccine drive, some community transmission of the virus will still happen. A small number of people will likely get the virus after being vaccinated, while others won’t be vaccinated either because of hesitancy or a medical reason. Younger people are a bit less likely to get the vaccine but just as likely to get Long Covid, which can leave debilitating symptoms for long after the virus has left the system.
Finding a pill that will “stop Covid-19 in its tracks,” as Boris Johnson put it, would prove cost-effective — in terms of quality of life years and other measures — says Dalia Dawoud, a health economist who recently co-authored a study on the economic impact of antivirals.
And yet, this is a totally different ballgame from vaccine procurement. The options are more limited by what drugs already exist, and there is still a need for longer-term investment in therapeutics.
The biomedical challenge of developing antiviral drugs is very different from that of finding vaccines. Viruses aren’t easily druggable because they colonize human cells, have a high rate of replication and are mutable — the ultimate moving target. Out of 220 viruses known to infect humans, antiviral drug development is currently present for only 10 of these pathogens (and nearly half are used to treat retroviruses such as HIV).
The new U.K. task force will largely be choosing from repurposed existing drugs and a few in late-stage trials to find candidates. “It’s somewhat easier said than done, because there aren’t many of the solutions available today,” says John Bamforth, director of the Eshelman Institute for Innovation at the University of North Carolina and interim executive director of the Rapidly Emerging Antiviral Drug Development Initiative, a public-private partnership focused on identifying antiviral candidates to use in future pandemics. Bamforth argues that while the current search — and investment — is helpful, the sooner governments pivot from fire-fighting to pandemic preparedness, the better.
Up to now, the big obstacle in developing drugs to fight viruses has been financial. It takes 10 to 15 years for a new medicine to come to market and can cost over $1 billion on average — and often up to $2.6 billion. The period between discovery and proof of concept is known as the “valley of death” as so many projects die there. And even promising efforts in response to a disease can peter out when the virus fades because drug companies want to ensure there’s an active market for their product.
But crises tend to push the normal obstacles aside. There are currently hundreds of therapeutic projects and trials underway around the world.
The National Institutes of Health in the U.S. has announced $155 million in funding for a public-private partnership to explore a pool of FDA-approved drugs for repurposing against Covid-19. Europe has its own R&D accelerator, funded with 75.8 million euros ($91.2 million) over five years. The World Health Organization’s Solidarity trial program has some 500 hospitals as sites to test new and repurposed drugs. There is also the Covid R&D Alliance formed by some 20 life-science companies and venture capital firms to fast-track drug candidates.
The new U.K. task force will want to ensure high efficacy and safety, with robust data to back up the claims and the ability to secure adequate supply, including with domestic manufacturing. One closely watched candidate is molnupiravir — a collaboration between Merck & Co. and Ridgeback Biotherapeutics — currently in phase 3 clinical trials. Merck just entered into a non-exclusive voluntary licensing agreement with generic manufacturers in India to accelerate molnupiravir’s availability there, pending regulatory approval. The U.K.’s Telegraph newspaper reported that Pfizer Inc. (whose vaccine has apparently been dubbed the coolest) is starting clinical trials for a new orally administered antiviral for Covid-19 codenamed PF-07321332.
Existing repurposed drugs, such as Gilead Science’s remdesivir, may offer the quickest route. A trial in Canada in January suggested that Colchicine, a gout medication that is cheap and widely available as a tablet, can help reduce serious illness from Covid-19 if taken soon after a positive test. The U.K.’s Principle trial is currently testing the drug favipiravir, which has been licensed in Japan since 2014 to treat influenza.
Will the new effort reproduce the vaccines success? That’s asking a lot. No head has yet been appointed and success in that short time frame will depend on the qualities of the drugs that meet the criteria. We’re also at a different stage of the crisis, so things may move more slowly, with more bureaucracy involved. There may be more price sensitivity too.
The government will need to be transparent about the data they are relying on. Some will recall the hype around tamiflu during the H1N1 virus and even some of the controversy during Covid around the efficacy of existing drugs, such as remdesivir and hydroxychloroquine, both of which were endorsed by Donald Trump.
Still, a pill to treat Covid-19 is a worthy short-term goal. Longer term, the U.K. and other governments need to be thinking about the next time a virus comes to town.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Therese Raphael is a columnist for Bloomberg Opinion. She was editorial page editor of the Wall Street Journal Europe.
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