Experts call for greater emphasis of therapeutics in pandemic response

During the COVID-19 pandemic the global discourse was heavily skewed toward vaccines and therapeutics were an afterthought, according to experts. But therapeutics play a crucial role in a pandemic, Sharon Lewin, director of the Cumming Global Centre for Pandemic Therapeutics, said. The world was lucky that vaccines were developed quickly for COVID-19, but that not might not be the case during the next pandemic. Instead, therapeutics — treatments such as drugs that can alleviate symptoms and prevent disease progression — could be a critical tool in managing the crisis. Lewin gave the example of HIV, which after decades of research still doesn’t have a vaccine. However, antivirals have turned the infection from a death sentence into a chronic manageable disease — and the drugs also block transmission. She was part of a panel discussion on Wednesday where experts spoke about the urgency of elevating the role of therapeutics in pandemic preparedness and response. Member states of the World Health Organizations are in the thick of negotiations in the lead-up to the World Health Assembly next week in Geneva. But these conversations fall short of the reforms needed to ensure equitable access to medical countermeasures such as therapeutics in the next pandemic, the speakers said. “A considerable portion of the “access” discussion has been attached to vaccines, with the need for therapeutics far less prominent,” the Cumming Global Centre for Pandemic Therapeutics wrote in a press release. And this is all too familiar. During the first year of the COVID-19 pandemic, $91 billion was publicly invested on vaccines worldwide compared to just $4.6 billion in therapeutics. At that time, the Access to COVID Tools Accelerator, or ACT-A, was set up to ensure that low- and middle-income countries received treatments, vaccines, and other health supplies. But it didn’t deliver them quickly, and it was particularly poorly set up for therapeutics, said Eloise Todd, executive director of the Pandemic Action Network. ACT-A was loosely governed, she said. It also had a fundraising approach, which raised money for individual types of products, such as vaccines and medicines. But what that did was pit different heath supplies against one another and create a situation where vaccines were heavily prioritized. By September 2021, the vaccines pillar of ACT-A had achieved 95% of its fundraising target, whereas the therapeutics pillar received only 19%, she said. Fundraising should have instead raised money for a holistic strategy to tackle the spread of the disease, Todd said. The fundraising also didn’t approach the funding of therapeutics in a way that followed the full lifeline of their development. It focused on funding for procurement but other aspects such as research and development of new products, and last-mile delivery to ensure that the therapeutics made it to the people in need were lacking. And generic medicines came too late, she added. There were some attempts to work through the Medicines Patent Pool — a United Nations-backed organization that signs agreements with patent holders to sublicense products to generic manufacturers. But these partnerships came late in the pandemic — agreements were announced in January 2022, and March 2022. “They came too late, they weren't fantastic drugs, and they weren't equitably available across the world,” Lewin said. But there are concerns that the lessons learned during COVID-19 won’t translate into the text of the pandemic treaty, participants said. The language in the current draft is “quite far” from ideal in terms of equitable access to medical countermeasures, which includes therapeutics, Todd said. But she hopes the ongoing negotiations serve as a floor, not a ceiling of what’s possible in the future — and that whatever comes out next week at the World Health Assembly doesn't limit future ambitions to create greater access to therapeutics. Currently, she said the tone of the discussions is very much framed around charity — donations to lower-middle income countries from high-income countries — as opposed to structural changes. The pandemic treaty negotiations and process to amend the International Health Regulations have also put on hold the creation of a new medical countermeasures coordination platform — an effort to create a global platform for the speedy development and equitable access to pandemic control tools. This new platform would serve as a “connective tissue” that would bring together the important players such as governments, manufacturers, and suppliers so that they can work together to create an environment where there will be equitable access to medical countermeasures, Todd said. There’s been some “political hedging” in regards to the future medical countermeasures coordination platform, with people not wanting to get ahead or be at odds with the ongoing pandemic treaty negotiations, she said. “I think the work on that will ramp up again, when there is more of a basis to build on,” she said. The International Pandemic Preparedness Secretariat is also working to establish a global therapeutics coalition, said Shingai Machingaidze, co-chair of the science and technology expert group at the secretariat. It would aim to prevent the duplication of efforts and wasted resources, and create a pipeline of drugs that work to cover a wide range of potential pandemic risks. "The intention is not to create a new entity. It's really to bring together the existing entities,” Machingaidze said. And there is a need for political leadership, said Michel Kazatchkine, former member of the Independent Panel for Pandemic Preparedness and Response. During the HIV crisis, leaders such as U.N. Secretary-General Kofi Annan, South African President Nelson Madela, and U.S. President George W. Bush warned that we cannot have a world where the patients exist in the global south and the medicines exist in the north, he said. “That is not the case now. We need to revive that political leadership,” Kazatchkine said.