ANTIVIRAL PANDEMIC PREPAREDNESS COULD AVOID $28 TRILLION IN GLOBAL LOSSES
As German Government Agency SPRIND Launches AMC Initiative
As the 5th anniversary of the outbreak of the COVID-19 pandemic approaches, SPRIND, supported by University of Chicago economists, proposes new funding models to stimulate global development of pandemic-preparedness antivirals.
LEIPZIG: 2pm CEST, Wednesday 21st August 2024. New research by Germany’s Federal Agency for Breakthrough Innovation SPRIND indicates that the immense financial and social costs of a future Covid-like pandemic could largely be mitigated: the early availability of antiviral therapeutics could prevent $28.2 trillion of global losses in the event of a Covid-like pandemic, including through the millions of lives saved.
The findings are from SPRIND’s latest research into global pandemic preparedness, as part of its work to create solutions for the development of broad-spectrum antivirals that can rapidly be deployed in future pandemic scenarios. To this end, SPRIND aims to implement an international advance market commitment (AMC), i.e. a commitment from industrial-scale buyers to purchase these drugs in the future if they can be successfully developed and produced.
Researchers at SPRIND modelled 135 scenarios, calibrated using the number of infections and rates of mortality observed over the COVID-19 pandemic according to the World Health Organisation and Our World in Data. The reference scenario is that antivirals become available after 100 days from the first infection, offering 50% protection against transmission and 50% efficacy against mortality. Versus COVID-19 infections and losses, SPRIND's research has found that the early availability of broad-spectrum antivirals for a comparable future pandemic would:
Create effective PREVENTION OF A WIDESPREAD PANDEMIC taking place, with mortality and cases reduced to less than 1% of the COVID-19 pandemic
SAVE APPROXIMATELY 6 MILLION LIVES, with benefits from averted deaths in monetary terms totalling $7.8 trillion
Avert 91% of ECONOMIC LOSSES, totalling $11.8 trillion
Avert LEARNING LOSSES (from education disruption) totalling $8.6 trillion
SPRIND’s work in developing a market commitment for platform-based broad-spectrum antivirals is in collaboration with the Market Shaping Accelerator’s (MSA) Innovation Challenge from the University of Chicago (UChicago) (UChicago). The team at MSA, including Nobel Laureate Michael Kremer, Rachel Glennerster, Christopher Snyder and Christopher Avery, have contributed to building an implemented market-shaping mechanism, and addressing challenges around payouts, the regulatory pathway, and current commercial market uses of these antivirals.
With the COVID-19 pandemic estimated to have been responsible for over 27 million deaths globally, and costing close to $14 trillion in reduced economic output, pre-planning for subsequent viral outbreaks could mitigate vast human and financial losses. Yet, despite indications that future pandemics will be recurrent 30- to 50-year event, with an estimated annual average death toll of 2.5 million according to the Centre for Global Development, there is a clear need for more robust pandemic preparedness strategies. Global vulnerabilities in pandemic preparedness were exposed with COVID-19, as the development and regulatory approval of antiviral pills in response to the new pathogen, such as Paxlovid, took almost two years from its onset. These novel therapeutics thus played a limited role in fighting the pandemic. With future outbreaks still a significant risk, quickly available antiviral drugs that can combat a wide range of pathogens, both known and yet to be identified, will be fundamental to a swift pandemic response that saves lives.
Previously well-established antiviral methods and drug classes were unable to make a significant impact on pandemic progression, since they were slow to arrive or were susceptible to mutations. In contrast, platform-based broad-spectrum antivirals have the potential to act broadly and be quickly adaptable to new or evolved viruses with the efficacy of more specific drugs. In the case of future outbreaks, building upon platform technologies can accelerate the effective rollout of therapeutics, which has been illustrated in the success of the mRNA vaccine platform. The need for novel antiviral therapeutics that can be available early on after a new outbreak is stressed by the US Biomedical Advanced Research and Development Authority (BARDA), responsible for the procurement and development of medical countermeasures, the Health Emergency Preparedness and Response Authority (HERA) committed to enhancing preparedness to respond to serious cross-border health threats through a continued effort to provide funding to support the development and further characterization of medical countermeasures, and the German Center for Pandemic Vaccines & Therapeutics (ZEPAI). Equally, enabling new technologies for antiviral drugs is high on the priority list of the International Pandemic Preparedness Secretariat, tasked with implementing the 100 days mission. The primary barrier to the development of this transformative technology is cost. Pharmaceutical markets lack the commercial incentives to invest in novel research that may not be reimbursed down the line as the arrival of pandemics is uncertain. Closing that gap between the public health benefits and the financial attractiveness of pandemic preparedness will be key to the funding and development of this technology.
Since existing commercial funding models are unfit for pandemic preparedness drugs, alternative approaches are needed. One such example is an advance market commitment (AMC), an agreement to buy or subsidise a product if a company can successfully develop and produce it. This guarantees enough ensuing demand to incentivize suppliers and investors to take on the costs and risks of innovation. A government-sponsored AMC enables a new form of risk sharing between taxpayers and investors. When new technologies are developed through government grants, taxpayers pay for the inevitable failures on the way towards new drugs. As the AMC only pays for successfully developed drugs, investors take on part of the risk of failed attempts to develop these new drugs. This allows governments to pursue ambitious goals of great benefit to society while sharing part of the technology risk with private investors. SPRIND’s preclinical broad-spectrum antiviral challenge funded a number of distinct approaches that yield promising results, with additional approaches from other therapeutic areas, or even those that do not yet exist, still to be tested. An AMC would therefore enable this research field to progress organically, rewarding whichever methodology proves successful without curtailing the scope of possibilities. By aligning incentives with broader public health policy objectives, such as regulatory approval and manufacturing capability, AMCs can effectively incentivise the timely availability of antiviral treatments during outbreaks.
Jano Costard, Head of Challenges at SPRIND, comments: The findings of this research illustrate the game-changing potential of novel therapeutics in pandemic response. Importantly, these new technologies have transformative potentials outside of pandemics, in tackling respiratory viruses that lack proper medication. Yet, the importance is really in how we enable technologies that could save lives, which pre-emptive spending can do. Thanks to the teams at SPRIND, MSA, and UChicago for their dedication to this groundbreaking piece of work.
Michael Kremer, Faculty Director at the Market Shaping Accelerator at the University of Chicago, and 2019 Economics Nobel Laureate, comments: Pandemics threaten tremendous damage to our economies and society. Innovation can help protect us from future pandemics, as demonstrated by the impact of novel mRNA vaccine technologies during COVID-19. Unfortunately, the existing set of incentives for investing in pandemic preparedness innovation fall far short of the social need. By guaranteeing demand for successful products, the AMC being designed by SPRIND with support from MSA can harness the energy and creativity of the private sector to invest in developing broad-spectrum antivirals, which would be hugely valuable tools in combating future pandemics.
Thomas Kalil, CEO of Renaissance Philanthropy and Former Deputy Director at the White House Office of Science and Technology Policy, says Governments can and should do more to reduce the threat of future pandemics, especially given the tragic loss of life associated with the COVID-19 pandemic, and the enormous costs to the global economy. The work by SPRIND and MSA has identified a key role for market-shaping in the development of broad-spectrum antivirals, given that they could have high social returns and uncertain private returns. I hope that governments and other funders join forces to support this proposal. Millions of lives may depend on it.
Rachel Glennerster, Faculty Director at the Market Shaping Accelerator at the University of Chicago and incoming President of the Center for Global Development, adds The development of innovative broad spectrum antivirals would save lives and generate an expected present value of hundreds of billions of dollars worth of benefits. Unfortunately, we can't rely on markets to generate these innovations on their own. An Advance Market Commitment for broad-spectrum antivirals has the potential to generate groundbreaking new technologies to counter infectious diseases in pandemics and current viral threats. SPRIND’s proposed policy could yield immense social value and should be a priority of international governments.
Jeremy Farrar, Chief Scientist at the World Health Organization, comments: The world needs novel antiviral therapeutics to address existing endemic and epidemic viral infections (Dengue, Chikungunya, Influenza, Nipah and many others) as well as quickly react to future pandemics. However, readily available therapeutics are missing for most acute viral infections. Therefore, enabling science and technologies for accelerated development of broad-spectrum antiviral drugs must be a priority of governments, the private sector and philanthropy.
More about the AMC-initiative: Broad-spectrum Antivirals Blog Post
