The problem is painful and obvious: while epic sums are being spent, every day more people are dying, and we are all living with fewer freedoms. We would not choose to begin the design of our weapons after declaring war. Why did we choose to start developing life-saving medicines against infectious diseases only after the pandemic started?
Seventy years ago, humanity was recovering from World War II. The Soviets raised the Iron Curtain, NATO was formed, Mao Zedong proclaimed the People’s Republic of China, and a new pathogen was discovered in mammals. Twenty years later, this pathogen would be christened “coronavirus.” The magnitude of the events of 1949 remains profound.
The West mobilized to face the threat of the Cold War, working tirelessly and engaging in preparedness exercises. Indeed, the preparations themselves allowed us to avoid World War III. We were vigilant, focused, and pro-active in avoiding another war.
Today, humanity is engaged in a different but equally threatening struggle against a deadly enemy, an invisible enemy; one trillionth the size of a flea. SARS-CoV-2, the coronavirus that causes COVID-19, has in six months killed more Americans than all the wars since World War II combined. We are fighting an enemy that is invisible, unthinking, and doesn’t know borders. But this enemy is known. We’ve known it for seventy years.
The SARS-CoV-1 outbreak in 2003 should have been a wake-up call. It alerted us to the pandemic threat and forced a response which enabled us to gain insights into the virus and our immune responses to it. The 2003 outbreak even gave us antibodies, isolated from survivors’ blood plasma, that could have been developed into anti-COVID-19 therapeutics and prophylactics. Tragically, the work was never completed. We are now paying a heavy price for the lack of foresight and lack of will.
Why did we prepare so well to avoid another global war but so poorly for a pandemic? The number of scientific publications on coronavirus during the Cold War is one-tenth of what has been published in 2020 alone. It was not until after the war against coronavirus began that we asked ourselves, “How could we have been better prepared to prevent this human and economic loss?”
Today, the National Institute of Allergy and Infectious Disease funds $6 billion per year in world-class research intramurally and across our nation’s university systems. This funding yields tens of thousands of scientific papers and hundreds of patents each year, many of which describe promising drug candidates. To turn those inventions into medicines, however, an investment of hundreds of millions of dollars and 5-15 years is needed.
In oncology, for example, the process works efficiently. A thriving ecosystem of investors and biotech and pharma companies invest in possible therapeutic candidates. Cancer is also a deadly disease, and crucially, if we invest in trials today, we can reasonably expect there will be patients in need five years from now when the investigational drug may be approved. Advances in oncology are announced daily.
For pandemic threats, however, the environment is entirely different. There is no commercial market to treat diseases without incidence. The standard pharma industry model is not functional for infectious diseases – especially sporadic ones. The costs of development are similar between oncology and infectious disease, but we simply don’t know which pathogen will strike, nor when. But of course, there is also no market for fighter jets… unless we wish to be prepared for war.
Today, over 2,400 clinical trials are underway at staggering expense. Unfortunately, most drugs being tested were not designed to treat COVID-19. They are “repurposed,” i.e. they were designed and developed for another disease, and we hope they might happen to work against coronavirus. Historically, success in repurposing has been rare, a shot in the dark.
Contemporaneously, many vaccines that were designed for coronavirus are in various stages of vaccines, the pace of progress has been both impressive and unprecedented, and yet anything less than “commercially available in January 2020” is too slow, as evidenced by the lives lost and the historic global societal and economic disruption. Farther behind, a variety of therapeutics and point of care tests that would help contain a pandemic (i.e. both of which could have been developed in 2003 after SARS-CoV-1), are also still lacking.
We must prepare now to avoid the next pandemic. We know the pathogens most likely to cause the next pandemic. Many are deadlier than coronavirus. We know how to turn scientific innovation into diagnostics, vaccines, and therapies to equip ourselves. We know there will be future pandemics. We know that we must act now.
We must fund research into repurposing, rapid response, and innovative new medicines. We must create and test broad-spectrum medicines, pathogen-prioritized diagnostics, therapeutics, and vaccines, and immune and inflammation modulators. If we do not, we will repeat the COVID-19 experience with swine flu, or Ebola, or a pox, or a resistant microbe, or any of a range of “most likely” pathogens.
We won the Cold War. We organized, we forecast, we learned, we prepared, and we evolved. American ingenuity prevailed, and it will again… if we put it to work. To achieve security from pandemic threats, we need to integrate the best of our nation’s ground-breaking science, entrepreneurial innovation, public sector investment, and private sector efficiency. We need to fill our defensive arsenal today, so that we’re fully prepared for the next outbreak.
We know what to do and how to do it. If COVID-19 has given us anything, it is the will to ensure this never happens again.
Jake Reder, Ph.D. co-founded Celdara Medical in 2008 and currently serves as its president and CEO. Benjamin tenOever, Ph.D. is the Fishberg Professor of Medicine, an Icahn Professor of Microbiology, and the Director of the Virus Engineering Center for Therapeutic and Research at Mount Sinai.