Wednesday, March 04, 2020

Covid-19 and R&D

Previous viral outbreaks have provoked races to find a vaccine, but Big Pharma halts research after pandemics disappear. The unpredictable nature of outbreaks means that work is often shelved if the crisis dies down; and so progress halts until the next time a similar infection flares up. Sars and Mers were also coronaviruses, but after they petered out work on them essentially stalled. Jason Schwartz, a professor at the Yale School of Public Health said as much to the Atlantic earlier this month: “had we not set the Sars vaccine research program aside, we would have had a lot more of this foundational work that we could apply to this new, closely related virus.”

Vaccines remain science’s best – and virtually only – weapon against viruses, and yet the timeline for developing a vaccine, measured in years, seems hopelessly mismatched to a pandemic, which can spread, kill and often disappear in a matter of weeks or months. The modern record doesn’t inspire much confidence. There have been multiple international viral outbreaks over the past two decades – Sars-CoV-1, Mers, Zika, Ebola – that all provoked similar races to produce a vaccine. Yet to date only the efforts on Ebola have been successful, with a vaccine approved last year.

Why is this? 

Vaccines for epidemics have to overcome the same scientific and regulatory hurdles as other promising treatments, but they also suffer from a near-total lack of interest from the markets that drive the pharmaceutical business. Only a few massive companies retain the ability to develop and produce a vaccine from start to finish, partly because of the expense and the timescales involved, and partly because they’ve consolidated the patents on manufacturing processes – a situation analysts openly call an oligopoly. A success for one of these companies is a treatment for a widespread, persistent disease, that they can sell every single year in perpetuity. 

The last industry blockbuster was Merck’s HPV vaccine Gardasil, in development for nearly 20 years, released in 2006, and still bringing in over £1bn annually. There is no way to easily apply their slow-burn research and profit model to an epidemic. As the leader of the UK’s Ebola response, Adrian Hill, told the Independent in 2014, “unless there’s a big market, it’s not worth the while of a mega-company … There was no business case to make an Ebola vaccine for the people who needed it most.”

The current setup is often the worst of both worlds: too slow to pick up research on new threats because the money isn’t there; and quick to drop it if it can’t be sure the money will be there in the future. It’s a highly market-dependent system, and the market usually fails us. Dr Peter Piot, head of the London School of Hygiene and Tropical Medicine previously declared the entire R&D system “not fit for purpose” for epidemics.

After Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, announced it was “very difficult and very frustrating” that no large pharma companies had stepped up to produce vaccines, both Sanofi and Johnson & Johnson announced new partnerships with the US government on potential treatments. However, the health and human services secretary, Alex Azar, gave no guarantee it would be affordable. “We need the private sector to invest,” he said, “price controls won’t get us there.”

https://www.theguardian.com/commentisfree/2020/mar/04/market-coronavirus-vaccine-us-health-virus-pharmaceutical-business

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