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That was the key finding of a virtual panel on Fair Treatment – the place of therapeutics in future pandemics hosted on Wednesday, 22 May by the Cumming Global Centre for Pandemic Therapeutics at the Peter Doherty Institute for Infection and Immunity (Doherty Institute).

The conversation was a fascinating pre-cursor to the 77th World Health Assembly (WHA) to be held in Geneva, Switzerland, 27 May – 1 June. Pandemic preparedness, prevention and response will be a key focus at the WHA as the World Health Organization (WHO) has set a deadline for negotiations to succeed around an inaugural Pandemic Accord.

Moderated by the Health and Social Care Editor at London’s Channel 4, Victoria McDonald, the panel comprised global experts from diverse disciplines: Michel Kazatchkine, former member of the Independent Panel for Pandemic Preparedness; Eloise Todd, Executive Director of the Pandemic Action Network; Harjyot Khosa, Regional External Relations Director, International Planned Parenthood Foundation; Shingai Machingaidze, Co-Chair, The Science and Technology Expert Group, International Pandemic Preparedness Secretariat; and Sharon Lewin, Director of the Cumming Global Centre for Pandemic Therapeutics.

This line-up was reflective of the global and coordinated approach critical to future pandemic response.

The Pandemic Accord is needed, but will not deliver a silver bullet solution

All eyes remain on Geneva as eleventh-hour negotiations for the Inaugural Pandemic Accord continue on the eve of next week’s WHA.

The consensus from the panel was that an Accord would not deliver the breadth of reforms needed to prevent future pandemics, but was an important foundational first step.

“We need to make sure that the Pandemic Accord is a floor and not a ceiling. Whatever comes out of next week should be viewed as a foundation and not limit future ambition,” said Eloise Todd.

“For truly transformative change to be made to the international preparedness and response ecosystem, we must see equal weighting given to therapeutics, vaccines and diagnostics – and these must be managed collectively for global common good,” said Michel Kazatchkine.

“The Pandemic Accord currently under negotiation in Geneva, as it stands today, will not deliver on such reforms.”

Countermeasures must work in collaboration, not competition

Looking to the learnings from the COVID-19 pandemic, panellists reflected on the approach taken by the Access to COVID-19 Tools Accelerator set up by the WHO at the beginning of the outbreak to optimise a coordinated global response effort.

The discussion focused on the fundraising approach, which opted to raise funds for countermeasures individually rather than an approach guided by a holistic epidemiological strategy. By September 2021, the vaccine pillar had achieved 95 per cent of its fundraising target, while the therapeutics pillar just 19 per cent.

“This approach essentially set up a competition between these forces. We saw a vaccine gold rush and the management of COVID-19 was lost in that approach,” said Eloise Todd.

“Even if you get a vaccine quickly it might not stop transmission. You still must find where people are ill and treat them to save lives. This narrative was lost during the COVID-19 pandemic.

“The key learning for future pandemics is to take an absolutely bird’s eye view on saving lives from day one.”

When looking at best use of funding for therapeutics specifically, there is risk that significant investment can be made in pathogens that may never reach pandemic status.

“Platform technologies become so important so we can adapt and respond no matter what the pathogen is. It needs to be plug and play,” said Sharon Lewin.

Access remains a challenge for under-represented communities

Equity and access to pandemic countermeasures was a focal point of the discussion, particularly among Low and Middle-Income Countries and under-represented communities.

This is reflective of some of the sticking points as part of the Pandemic Accord negotiations.

“If we look at countries in South-East Asia like Bangladesh, they didn’t receive COVID-19 vaccinations for some larger communities until July 2022. There are also people from fragile humanitarian settings, like Taliban-occupied Afghanistan, who still didn’t have access to testing deep into the pandemic – so vaccines were a far-flung thought,” said Harjyot Khosa.

“We failed so many communities when it came to COVID-19 therapeutics. Are we ready for another pandemic? Are we ready to get vaccines and therapeutics in the hands of communities? I don’t think so.”

A global and coordinated approach is required for therapeutic advancement

Efficient and equitable preparation for future pandemics is paramount, optimising all countermeasures – vaccines, diagnostics and therapeutics. However, when examining the current state, there is significant underinvestment in therapeutics.

“We need to see an end-to-end coalition established to bring the entire value chain together and revitalise the global therapeutics pipeline,” said Shingai Machingaidze.

“This coalition would bring together key existing stakeholders to identify synergies and leverage current efforts to sustain research and development funding and develop technology platforms that can speed up the availability of new and existing therapeutics.”

Looking to the HIV response as a best-practice use of therapeutics

While much of the conversation around the inaugural Pandemic Accord has focused on equitable access, it has been primarily attached to vaccines and overlooked therapeutics.

This largely mirrors the scientific response to the COVID-19 pandemic. For example, during the first 12 months of the pandemic, USD$91 billion was publicly invested globally in vaccines compared to just USD$4.6 billion in therapeutics.

Panellists cited the role therapeutics have played in the HIV response as a best practice example that could be broadly replicated.  

“We could see pandemics where a vaccine isn’t readily available. Therapeutics such as direct acting antivirals can fill the gap and offer a second layer of protection,” said Sharon Lewin.

“The HIV response epitomises this. After 40 years of research, there is still no HIV vaccine, but therapeutics mean it’s no longer a death sentence and have helped to reduce the rate of new infections.”

The goal of the Cumming Global Centre for Pandemic Therapeutics is to develop new platform technologies to develop therapeutics at speed for pathogens of pandemic potential. Treatment solutions can be adapted to a new pathogen within much shorter timeframes than currently possible through greater investment in new science and ideas.

Learn more about the Cumming Global Centre for Pandemic Therapeutics by visiting cgcpt.edu.au