Time to prepare for the next pandemic
Researchers urging proactive approach
The last thing people will want to think about when this pandemic ends is the next one. It’s human nature to move on, to want to put coronaviruses, vaccines and disease surveillance behind us. But a growing chorus of researchers says now is the time to get ready for what is sure to come.
Some have begun preliminary efforts to develop antivirals and monoclonal antibodies to prevent serious disease and vaccines that could stop a novel virus in its tracks.
“Either we invest now or we pay a lot more later,” said Wayne Koff, chief executive officer of the nonprofit Human Vaccines Project.
Koff, along with Seth Berkley, CEO of Gavi, the Vaccine Alliance, published an editorial Thursday in the journal Science, calling for a global effort to develop a “universal” vaccine against coronaviruses, the family that includes the virus causing COVID-19.
“We don’t know when the next one is going to come, the only thing we know is the next one is going to come,” Koff said. “Whether we have a year or whether we have a decade – given that unknown, we should be looking at this issue really seriously right now.”
The world got lucky that the previous major pandemic, the 1918 flu, was more than a century ago.
In recent years, the pace of so-called zoonotic diseases jumping from animals to humans has sped up: Zika, Ebola, chikungunya and two previous coronaviruses – Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) – have caused major outbreaks since 2003. And there was the H1N1 flu pandemic of 2009.
None of these has been as widespread as SARS-CoV-2, the virus that causes COVID-19, but all have been lethal: MERS killed one-third of its victims and Ebola roughly half.
After each of these outbreaks, initial enthusiasm for prevention was followed by loss of interest and a deep drop in funding.
That can’t be allowed to happen again, said James Crowe, director of the Vanderbilt Vaccine Center and an immunologist at Vanderbilt University Medical Center, both in Nashville, Tennessee.
“How many times is it going to take until we start looking ahead?” Crowe asked. “This has to be the moment, or
“It’s just moving the timeframe up by doing some of the hard work ahead of time.”
James Crowe Director of the Vanderbilt Vaccine Center and an immunologist at Vanderbilt University Medical Center
else it’s never going to happen.”
It’s tough to convince politicians to spend huge sums of money against a future enemy, but Crowe said those investments would be insignificant compared with the current pandemic’s $20 trillion price tag.
“If we were proactive instead of just responding to an outbreak, we could think differently and think about immunity to things that have not yet happened,” he said.
The trick will be figuring out how to develop treatments and prevention tools for viruses that don’t yet exist. Crowe has a few ideas.
For about $2 billion, Crowe said, he and his colleagues could develop monoclonal antibodies that could protect against the 100 most likely human epidemics. The focus would be on “how much of the mat can you cover with your antibodies, rather than picking the virus du jour,” he said.
He envisions making 10,000 doses of antibodies designed to fight each of these 100 potential epidemics and storing them for the day they might be needed. Further research would be required to prove their effectiveness, but that number of doses would be enough for a trial and to create a “ring” of protection around the people first infected and those who come into contact with them.
If such antibodies or early vaccines had been ready in late 2019 when the first signs of SARS-CoV-2 appeared in China, “we could have upscaled and probably cut off about six months of the pandemic,” Crowe said.
“It’s just moving the timeframe up by doing some of the hard work ahead of time,” he said. “It’s a very simple idea.”
Working faster and smarter
Researchers at the government’s Lawrence Livermore National Laboratory in California, among others, are working to combat whatever might emerge next as humans expand contact with wildlife.
Like weather forecasters, they use computer modeling and artificial intelligence to speed drug and vaccine development and predict the next novel virus and its most likely variants.
“Our goal is to be able to develop a new therapeutic in months rather than years,” said Jim Brase, deputy associate director for computing at the lab. “We and other groups are beginning to show that’s possible.”
They need more data to feed into their models, he said.
The stakes couldn’t be higher. “It’s hard to see something that is more of a threat to our security than a pandemic like this – whether manmade or natural,” Brase said.
The solution will have to involve companies and academic scientists in addition to researchers from across government agencies, said his colleague Shivshankar Sundaram, director of the lab’s center for bioengineering.
No person, group or country has enough expertise and information to pull it off alone. In the USA, preparedness will require the kind of broadbased effort devoted to the original moonshot, World War II’s Manhattan Project and the work President Joe Biden helped direct toward fighting cancer when he was vice president, Sundaram said.
Bruce Gellin, president of global immunization for the Sabin Vaccine Institute, which aims to make vaccines more available, agreed that preventing the next pandemic has to involve a widerange of expertise.
“Transformational changes are going to come from fields we don’t know,” said Gellin, a member of the COVID-19 Vaccine Analysis Team, funded by Georgetown University Medical Center, where he is an adjunct professor.
To avoid another SARS-CoV-2 or another 1918 flu, the world needs a vaccine that can prevent all types of coronaviruses and another against all types of influenza. It needs a “dual moonshot,” Gellin said, “to get both of these covered, so we have the solution before it even shows up.”
Antiviral drugs that can help people fight off a wide range of novel viruses will be key, said Dr. Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University.
“Ideally, we would have developed them 10 years ago,” Goodman said Thursday in a media call with members of the COVID-19 Vaccine Analysis Team.
There haven’t been enough economic incentives for companies to develop products to address a once-in-a-decade or once-in-a-century pandemic.
“If ever there were a moment to wake up and invest in biodefense, not just against terrorism but against natural threats and emerging infectious diseases, this is the time,” Goodman said. “The world needs a faster response. It needs broadly acting antiviral drugs.”
Creating better vaccines
Scientists have been working for years – so far without success – to create a vaccine against HIV. But that work is paying off, Crowe said.
“The decades of work we’ve all put in aspiring to cover a virus that’s very diverse has led us to capabilities that allow us to deal with stuff like coronaviruses or the flu,” he said.
Technology has advanced dramatically in recent years.
“There really has been a convergence of advances in biomedicine and engineering and computer science, which puts us in a much different situation than we were a decade ago,” Koff said.
Coronavirus research at the National Institutes of Health after the SARS and MERS outbreaks showed the importance and power of planning ahead, Koff, Crowe and others said.
NIH researchers had already figured out the spike protein on the surface of SARS-CoV-2 should be the target of vaccines, which was a reason COVID-19 vaccine development went quickly.
Developing a vaccine to address all coronaviruses should be easier than making one against either influenza or HIV, because coronaviruses don’t mutate nearly as fast. The new vaccines against SARS-CoV-2 are far more effective than the annual flu shot, Koff said.
Some companies are developing vaccines that can address a few of the emerging variants. Novavax, among others, is developing the capability to address multiple mutations of SARSCoV-2 in the same way its flu vaccine combats multiple strains of influenza.
To neutralize something that doesn’t yet exist “is a high bar,” said Ted Ross, director of the Center for Vaccines and Immunology at the University of Georgia. “But that’s what we’re all shooting for.”
Coronaviruses are quite diverse, he said, ranging from SARS to the common cold, which may make a single vaccine against all of them difficult to develop.
Ross’ research group has been working toward a comprehensive flu vaccine for decades and has turned its attention to SARS-CoV-2. His main worry is that, as with Zika and Ebola, corporate and public interest will wane as soon as COVID-19 no longer grabs daily headlines.
“I’m concerned that corona could go the same way once we get back to ‘normal life,’” he said. “It will take dedication by funding agencies to continue to fund it the way it should be done.”