Pandemic Treaty Must Treat Therapeutics As Equal To Vaccines

Experts say a pandemic treaty, currently discussed at the World Health Assembly, must prioritise medicines as much as vaccines. In the first 12 months of Covid, US$91 billion was allocated globally for vaccines, far exceeding $4.6 billion for therapeutics.

KUALA LUMPUR, May 31 — A global panel of experts has called for equal access to both vaccines and therapeutics in the event of a new pandemic, after the late and expensive development of medications during Covid-19.

The 77th World Health Assembly (WHA) in Geneva, Switzerland, is currently discussing proposed amendments to the International Health Regulations (IHR) 2005 and to conclude a global pandemic treaty.

“We learned from Covid that we need therapeutics because the vaccines we developed weren’t perfect. The therapeutics came too late. They were too expensive. They weren’t widely available, and they weren’t great drugs. We need therapeutics, even if we have an effective vaccine, as we learned from Covid.

“But I think the most important thing that we must contemplate is a pandemic where we don’t have a vaccine at speed,” said infectious disease expert Dr Sharon Lewin, director of The Peter Doherty Institute for Infection and Immunity and the Cumming Global Centre for Pandemic Therapeutics, during the “Fair Treatment – the place of therapeutics in future pandemics” virtual panel last May 22.

“That vaccine could take 10 years or we never have a vaccine and I feel therapeutics in that situation play a really important second layer of protection that can reduce people getting sick, reduce transmission, and potentially protect people from becoming infected.”

Dr Lewin, who is also president of the International AIDS Society (IAS), cited the role of therapeutics in the HIV response as a model for future pandemics.

“As an example, after 40 years of research for HIV, there is still no HIV vaccine. However, therapeutics or what I mean here is direct-acting antivirals or drugs that stop HIV from replicating, have turned HIV from a death sentence to a chronic manageable disease. 

“And because these drugs also block transmission, it results in dramatic decreases in new infections. So, direct-acting antivirals can fill a gap. They can be a second layer of protection or they can be the only intervention we have,” Dr Lewin said.

Eloise Todd, executive director of the Pandemic Action Network, questioned the fundraising strategy of the Access to Covid-19 Tools Accelerator, established by the World Health Organization (WHO) at the start of the Covid outbreak. 

She argued that instead of a coordinated global response, the approach focused on raising funds for individual countermeasures, lacking a comprehensive epidemiological strategy. 

The panel highlighted the vast disparity in investment between vaccines and therapeutics, with US$91 billion (RM428 billion) allocated globally for vaccines compared to just $4.6 billion for therapeutics during the first 12 months of the Covid-19 pandemic.

By September 2021, when the Delta variant fueled new outbreaks, the vaccine pillar had achieved 95 per cent of its fundraising target, while the therapeutics pillar only reached 19 per cent.

“There were attempts to work through the Medicines Patent Pool (MPP), but the fact that these partnerships came in January and March 2022 to produce generic versions of molnupiravir and nirmatrelvir, which is part of the Paxlovid family, came really quite too late in the process to have an impact in lower middle-income countries. 

“I do think as well there was a communications spotlight and juggernaut that was the vaccine gold rush, and we saw leaders trying to invest in this solution. And really, the whole management of Covid was lost in that gold rush approach. 

“So, rather than understanding that even if we get to a vaccine solution quickly, even if a vaccine would come in six months or a year, it might not actually stop transmission completely, which is what happened, but it does mean that you have several months or years in which you have to find where people are ill and treat them to save lives – and that whole narrative was lost. 

“I do think there’s actually a very important story to tell and the reason why we’re here today, there is a powerful reset that we can deploy when the next crisis strikes – when the next pandemic threat comes around – and say one thing we learned is that the epidemiological approach we need to take means that we have to have an absolutely bird’s eye focused view on saving lives from day one. 

“By all means, let’s have R&D (research and development) in vaccines, but we actually need to have R&D in therapeutics and we also have to look at how to repurpose existing therapeutics,” Todd said.

While the panel agreed that a pandemic accord wouldn’t deliver all the reforms needed to prevent future pandemics, they saw it as an important foundational 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,” Todd said.

Michel Kazatchkine, former member of The Independent Panel for Pandemic Preparedness and Response, stressed the need for equal weighting of therapeutics, vaccines, and diagnostics, managed collectively for global common good.

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

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