Based on a situation report by the World Health Organization (WHO) on 29 March 2020, the number of confirmed cases has reached a staggering 634,835, globally. With the death rate soaring to reach above 30,000 it is no wonder that the WHO risk assessment ranks the COVID-19 outbreak at very high.<1 As countries scramble to contain the spread with lockdowns and stricter social distancing measures, the scientific community is also doing its part to search for a vaccine or treatment for the fatal disease.

A quick search on www.clincialtrials.gov displays 192 clinical trials currently focusing on studying the effectiveness of various therapeutic options against COVID-19.a Some of these trials include studying the use of patient plasma, traditional Chinese medicine, or even repurposing of previously approved drugs for other viruses.

To help us consolidate the current lessons and priorities of the scientific community as well and governments of countries both affected and unaffected is Dr William A. Haseltine. He has granted APBN his exclusive comment on the matter and provided insight to better prepare for future infectious disease outbreaks.

1. With COVID-19 now spread to over 100 countries, what in your opinion should governments and healthcare organizations prioritize to contain the disease?

Universal testing should be their first and foremost priority. Everybody who has either been exposed or exhibits symptoms must be tested. Everybody administering the tests must be protected with adequate training and gear. Contract tracing, both primary and secondary, must be implemented. All who test positive must be quarantined.

The second priority is to ramp up emergency preparedness in hospitals. We need extensive isolation wards staffed by trained personnel and stocked with equipment. If and when drugs are brought to market, our hospitals must have them immediately. In the meantime, healthcare workers must be prepped to administer the prophylactic and therapeutic drugs to come.

Last but not least, clear public health communications and public awareness. Most governments need a single authoritative voice — a trusted channel of communication — that can guide the actions and fend off the fears of a listening public.

2. What three lessons in relation to the response by the scientific community towards the COVID-19 outbreak can be applied to preventing or handling future outbreaks?

The first lesson is that the coronavirus will return, again and again. We cannot repeat the mistakes we made this time around — waiting to act until it’s too late. We need to be prepared.

That brings us to the second lesson: only combination antiviral drugs can beat back the incoming tide of coronaviruses. A COVID-19 vaccine may or may not be effective against future strains. Just like we did for HIV, we need to develop broad-spectrum drugs that will treat and prevent against the coronavirus family, not just one strain.

The third lesson is to keep watch for other viruses, as well as changes in our capacity to resist infection, that may cause even more deaths in the future. One danger we’re all familiar with is the flu. Another is the possibility of antimicrobial resistance. Current trends prevailing, two million people are expected to die due to antimicrobial resistance in India by 2050. Drug resistant tuberculosis is yet another danger in many parts of the world. In 2017, India had 2.8 million cases of tuberculosis and 423,000 deaths. Nearly one third of the cases were drug resistant tuberculosis.

3. In finding a “quick-fix” to treating COVID-19 currently approved drugs are tested for treating the novel coronavirus, in comparison to developing a drug from scratch which would be the more sustainable approach and why?

The most efficient approach would be to repurpose drugs that are already approved, since it is the approval process that prolongs the drug development pipeline. Another way to circumvent the many months – typically years – needed to develop a drug and bring it to market is to use federal agencies like the Biomedical Advanced Research and Development Authority (BARDA) and emergency funding mechanisms like Project BioShield to fast track clinical safety trials. The advantage of this approach is that the drugs would be more numerous, more specific, and more likely to be effective at lower doses.

Either way, we need combinations of drugs to avoid problems with resistance, which we know occur. My recommendation is a broad spectrum, anti-coronavirus drug. In fact, we should be doing the same thing to treat and prevent the flu, which is already alarming enough to be on the BioShield list.

4. What can be done to ensure that there is a business incentive for pharmaceutical and biotechnology companies to continue to develop drugs and vaccines against viruses to prevent future outbreaks?

What’s the difference between an antiviral drug for coronaviruses and antiviral drugs for measles and chickenpox? Predictability and seasonality. If you are dealing with a virus like measles, which has a character that is predictable and relatively static and unchanging, then it makes economic sense to combat it with a vaccine. Coronaviruses, on the other hand, attack us in the form of specific strains that appear almost erratically – and, unfortunately for vaccine developers, on a timescale unbeholden to market forces. That’s why the search for a coronavirus vaccine has, despite the two major outbreaks (SARS and MERS) that preceded COVID-19, proven futile until now. Any money invested in drug development simply dries up once the worst of the outbreak is over. Hence the need for a broad-spectrum anti-coronavirus drug that never goes out of fashion – a major investment in the short term, but the most economically viable option in the long term.

Absent a normal market incentive, you will need a government incentive for a drug to be produced at a large scale – which is precisely what BioShield and BARDA create. They provide money not only for buying up mass quantities of the drug, but also for much of the research and development it takes to get there. Suddenly, a market is guaranteed.

5. In relation to healthcare system preparedness, what more could have been done to minimize the spread and number of deaths from COVID-19?

Testing, testing, testing. Look at what happened in the United States. Shortly after the outbreak began, the World Health Organization produced a diagnostic testing kit that most countries have since replicated. Our Centers for Disease Control and Prevention decided to deviate from established guidelines and produce their own. Weeks passed before they reached a handful of designated labs — who promptly discovered that the kits were flawed. No surprise is it then that even today, when cases are approaching the thousands, the United States remains an untested nation.

If a reliable, standardized test had been made immediately available to all, that would have slowed the spread of the disease considerably. So, would stockpiles of emergency equipment and procedural training for the medical personnel we lean on for protection in these kinds of emergencies.

The COVID-19 pandemic has shown us that health systems worldwide aren’t equipped to handle a global health crisis of this magnitude. So long as our health systems remain hospital centric, and so long as our hospitals remain overburdened even on an average day, they will be unable to mount an adequate defence against the disease. We must forge a new path toward a health system of integrated and distributed care, where patients receive care where they need it most — in the home and community.