Preparation Preconditions: What measures are needed to combat another pandemic?

pharmafile | March 29, 2022 | Feature | |   

Could we have foreseen the damage caused by the COVID-19 pandemic? This is a central question that has plagued biopharma companies, healthcare systems, and governments alike in the last two years. A recent peer-reviewed study published in the Lancet suggests that the global number of fatalities may stand at a staggering number in excess of 18 million, although many of these could have gone unreported. How could we have braced ourselves for the COVID-19 pandemic, and what measures could have been taken to prevent it?


Taken by storm


March 2020 saw the introduction of the first lockdown in the UK, and the beginning of mass restrictions that have become all too familiar in our social landscape. Since then, questions have been raised surrounding failures in the country’s leadership, and how the NHS can be better funded to prevent mass chaos and better support its staff.

The 100 Days Mission to Respond to Future Pandemic Threats is an initiative kickstarted by the government, building on the target set by the Coalition for Epidemic Preparedness Innovations (CEPI) to have effective vaccines within 100 days of a pathogen being sequenced. The government has pledged £160 million towards this cause, but what more is needed to make this a reality?


Measure up: What steps are pharma companies taking to prevent future pandemics?

COVID-19 has evidently driven growth for pharma, and has prompted greater funding into pandemic-related research. However, the strain it has placed on healthcare systems and pharma companies cannot be understated.  

The past two years has seen as a drastic surge in demand for personal protective equipment (PPE) and over-the-counter (OTC) medications, which has led to worldwide shortages. China and India, the two main global suppliers of active pharmaceutical ingredients (APIs) and generics, implemented export bans at the beginning of the pandemic, which caused shortages of both products in most countries. This in turn slowed the manufacture of finished products, causing certain medicines to become scarce, with a knock-on impact on patients’ quality of life.2 Pharmaceutical retailers have also experienced fewer walk-ins, causing a loss in profit and greater redundancies. The magnitude of the economic damage caused is undeniable.

As mentioned previously, the 100 Day Mission has potential to stave off the threat of another pandemic. Pharmafocus spoke to RD Therapeutics CEO, Ailene Thiel, who shared with us: “CEPI’s mission to cut vaccine development to 100 days is a truly momentous goal. COVID-19 will not be the last pandemic. It is critical for the world to come together to develop and distribute vaccines, diagnostics and therapeutics. CEPI’s plan will reduce the risk posed by epidemics and pandemics by developing a library of vaccines for known disease threats, such as Lassa fever, MERS and Nipah virus, and build on the scientific advances made during COVID-19 to prepare in advance for ‘Disease X’- the threat of an unknown pathogen with pandemic potential. CEPI is also working to develop the next generation of globally accessible COVID-19 vaccines, including ‘variant-proof’ COVID-19 vaccines, as well as vaccines that provide broad protection against all Betacoronaviruses.

“If we can work with CEPI to speed up vaccine distribution and ensure broader geographic reach, we can significantly reduce the spread and impact of future viruses, potentially saving millions of lives and reducing the economic impact on communities around the world. The 100 Days Mission has recognised the need to compress vaccine development timelines in an effort to save lives and prevent trillions of dollars of economic damage.”

Needle-free vaccines are also currently being explored as a tool to combat against future pandemics. Ailene Thiel enlightened Pharmafocus on the potential of this: “Innovation is needed in efficient vaccine platforms that can be manufactured in regional hubs and easily and quickly distributed to every corner of the globe. A very large part of the world is still currently struggling to obtain and distribute needle-based therapies. In Africa alone, 83% of the population has not received their first dose of a COVID vaccine. How can we, as a society that claims to be working to address inequalities, let this happen? An alternative that provides huge advantages is oral vaccination. Oral vaccination via the sublingual route can be achieved through self-administration, is non-invasive, and avoids the requirements for cold-chain transportation and storage. Moreover, it does not require administration by healthcare professionals, individuals who are in short supply during a pandemic.”


Clean code: How can technology aid in preventing future pandemics?


Clinical trials are instrumental in mitigating the risk of future pandemics. In a 2021 article in EBR January, titled Amplified Needs Accelerate Innovation During a Pandemic, Dr Patrick Schneider, PhD, shared: “The clinical trial process and pharmaceutical value chain as a whole are notoriously slow and expensive – that is, they were until COVID-19’s impact and unprecedented need for speed created an opportunity. Randomised clinical trials, while a classic approach and important for collecting data broadly across vaccine candidates, can be coupled with newer approaches like real-world trials or Bayesian statistics to accelerate vaccine development.3 This monumental shift has the potential to revolutionise a process that can drastically improve how critical vaccines and therapies successfully reach patients.”

Pharmafocus also spoke to Dr Gerald Pfeifer from SUSE, who articulated the increasingly instrumental role that open-source technologies play in driving research: “Open source technology is a very collaborative way of developing software and driving innovation together. It’s very similar to academia; you share the base, you jointly cooperate on base research on base components. In the pandemic, companies conducted research and shared the samples with others. You sequence the virus, you share the study results for everyone to benefit from it, so you combine forces. The open source approach is about collaborating on something and making the blueprint readily available. You make the code available, and then people can build and distribute it.”

Artificial intelligence supported the response to COVID-19, and will play an increasingly pivotal role in preparing against future pandemics. Ailene Thiel shared: “The COVID-19 pandemic has propelled the adoption of technologies that are improving the clinical trial process. Artificial Intelligence (AI) and Machine Learning (ML) will play an increasing role in improving the efficacy and reducing the costs of clinical trials. Patients will also benefit, as AI/ML will enable learning from trials which can lead to improved patient satisfaction rates. AI algorithms, combined with wearable technology, will facilitate monitoring of patients real-time, providing continuous monitoring of safety and efficacy which will help retain patients in clinical trials. Shared analytics platforms will improve predictions and support collaboration. Innovative data visualisation tools are changing the level of insights that can be shared with users and facilitate decision making. Natural Language Processing (NLP) adds a new dimension and can capture clinical trial feedback which previously was often lost. All these more recent technologies will help tremendously with the 100 Days Mission aims – to reduce the impact of future pandemics by making diagnostics, therapeutics and vaccines available within 100 days.”


Feeling free: How do we ensure equitable access to vaccines across the world?


Preventing another pandemic means guaranteeing access to vaccines not only in wealthier countries, but also low and middle-income regions. Over the past two years, global health authorities have consistently raised the issue of unfair access to vaccines, as well as other tools to help combat the pandemic. However, the first shipment of vaccines – 600,000 doses of the Oxford-AstraZeneca jab – delivered by Covax, the WHO-backed access programme, only arrived in the Ghanaian capital, Accra, in late February 2021. More than three-quarters of people in low-income countries aged 12 and over are yet to receive a single-dose, compared with 10% in high-income countries, according to the research group, Our World in Data.4

Dr Pfeifer offered his perspective on how this can be combatted: “Companies such as Biotech, Pfizer, and Moderna can make the code or the instructions readily available. It’s a political question, a business question. It doesn’t have to be completely free. Open source can be applied to hardware, or medicine, and there are many skilled developers that can contribute to collaboration online, despite being on the other side of the globe.”

Open-source vaccines are also notable tools that offer potential to bridge the inequality gap. Afrigen Biologics and Vaccines, a South African start-up, has successfully formulated a replica of Moderna’s COVID-19 vaccine, and the first human trials of the copycat drug could commence in November. Researchers have embraced the concept of ‘open-source pharma’, which is an idea modelled on the free software movement that encourages collaboration and sharing to improve coding for software.4 The aim of the initiative is to make this technology accessible to poorer nations, and also to train qualified staff to produce vaccines locally, without breaking any intellectual property rules.

Ailene shared how vaccines can be distributed equally across borders: “In spite of the spectacular success to date in developing vaccines at record speed to address the current pandemic, the response to date has demonstrated clear inequities, as seen by the significant proportion of the world that continues to be under-vaccinated against COVID-19, most notably low- and lower-middle income countries. There are multiple factors at play that perpetuate the inequity of global vaccination, and success is significantly constrained by challenges in the governmental and health systems of many developing countries. Within the health systems themselves, challenges include a lack of trained medical personnel, inadequate health infrastructure, such as vaccine storage facilities, and limited tracking mechanisms.

“The only way to address this issue is to deliver vaccines equitably to all corners of the world by removing current barriers to global vaccination. There is a clear opportunity for new vaccine delivery technologies to help facilitate more equitable access to vaccines. Oral vaccination can remove most of the existing barriers and can be easily delivered to remote populations. It can be delivered in schools, places of worship and town halls, without trained medical professionals in attendance. As such, it is well positioned to address unmet medical needs in developing countries – a critical element in increasing equitable access to vaccines and hereby controlling or preventing a global pandemic.” 


Moving forward

The COVID-19 pandemic have steered pharma companies in the right direction, as the industry as a whole now has a clearer idea of what went wrong, and where to go from here. Global access to vaccines can be achieved by taking advantage of tools such as open-source pharma, and through exploring alternative options to needle-vaccines that can be distributed broadly with more ease.    

Although the past two years have had a detrimental impact on healthcare systems, they have also certainly illuminated areas ripe for reform and improvement. Looking to the future, pharma companies will need to ensure that they use opportunities for collaboration and innovation to their advantage, to mitigate against the risk of great economic damage and loss of life in the event of another pandemic.  


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Lina Adams

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