Addressing the global antiviral deficit

By Jeremy Carver and Michel Chrétien

Canada has welcomed antivirals as a new weapon in the fight to contain the COVID-19 pandemic and alleviate the overcrowding of our hospitals and intensive-care units (ICU). Health Canada’s approval of Pfizer’s antiviral, Paxlovid, has evoked an enthusiastic response from many politicians, physicians and journalists. This endorsement of the key role for antivirals is long overdue.

In the rush to acquire vaccines, Canada overlooked the need to simultaneously create an antiviral development strategy. We need to make up for lost time.

It’s imperative that our federal government create a robust, sustainable, organization dedicated to delivering more antivirals as part of our commitment to improving the global response to pandemics.

Antivirals are essential to ending this pandemic and getting Canada back on a path of new normalcy. To avoid the emergence of drug-resistant SARS-CoV-2, many more antivirals will be needed.

When AZT was first approved in 1987 as a treatment for HIV, it was the only drug available. Now, thirty-five years later, there are more than 30 treatments available, and in the right combinations, drug resistance can be avoided, and symptoms managed.

Another public health benefit of antivirals is that the treatment of infected individuals at the time of diagnosis can lower their viral load and reduce transmission to immediate contacts. This has been shown with triple therapy for HIV and Tamiflu for influenza. Antiviral treatment also reduces the severity of symptoms, benefiting the patient, reducing time in hospital or ICUs, and saving the health care system added costs.

We also need treatments for the surviving patients who are experiencing long-COVID symptoms, such as chronic fatigue and fibromyalgia, cardio-pulmonary sequelae, renal failure, anxiety or depression.

What form should Canada’s antiviral initiative take?

To discover and develop more antivirals will require funding on the same aggressive scale that was used for the acquisition of vaccines.

As a start, Canada has recently committed $18.5 million annually to create a “Centre for Research on Pandemic Preparedness and Health Emergencies.” The Research Centre’s mission is broad, and while it includes developing and mobilizing research for pandemic response, it will not be able to deliver the antiviral therapies essential to a robust pandemic response.

How could this be expanded to be successful?

We believe, that in addition to this Centre, Canada should create a highly focused new entity – a global collaboration for antiviral discovery and development. The mission of the new collaboration should be to establish a not-for-profit antiviral drug development pathway for academic discoveries — all the way to patients.

We suggest that such a collaboration be made up of two parts: a focused research organization (FRO) dedicated to antiviral development, embedded in a new academic Network of Centres of Excellence (NCE) focused on antiviral discovery. Canada should urgently launch a competition for the new NCE that could bring together the medicinal chemists, structural biologists, pharmacologists and virologists that will be needed to discover new antiviral drug candidates.

The new collaboration would work in partnership with existing Canadian facilities, such as the pre-clinical testing capability at the National Microbiology Laboratory level 3 and 4 biosafety labs or the new National Research Council manufacturing facilities in Montreal. Any collaboration agreements between these entities, or others, should follow open-science protocols.

Canadian scientists and institutions would then be able to participate meaningfully in the billion-dollar philanthropic efforts represented by the World Health Organization’s therapeutics pillar of ACT-A. Such a collaboration with low-and-middle income countries, would foster global efforts for better pandemic preparedness and response.

One illustrative attempt to discover new COVID treatments has been nicknamed the “COVID Moonshot.” It is an international collaborative effort to discover potential therapeutics that was kick-started through Twitter.

Even though this collaboration has rapidly succeeded in finding drug candidates, the “Moonshot” founders note that they are now at the “hard slog” stage – the need for capital to conduct numerous regulated trials, and the subsequent manufacturing and distribution of antivirals globally once they are approved by the regulatory authorities.

For too long the global community has assumed that the pharmaceutical industry will do the “hard slog” and has resigned itself to paying the exorbitant prices that follow. The experience of the Moonshot group emphasizes the need for a not-for-profit pathway for the development of treatments derived from academic collaborations.

A global collaboration for antiviral discovery and development would be a pioneering initiative that Canada is well positioned to lead.

Jeremy Carver PhD is an Emeritus Professor in the Faculty of Medicine, University of Toronto, and President, CEO and co-founder of the not-for-profit International Consortium on Anti-Virals/Consortium International sur les Thérapies Antivirals

Michel Chrétien, FRS, MD is Professeur Émérite de recherche, Institut de recherches cliniques de Montréal and a co-founder of the not-for-profit International Consortium on Anti-Virals/ Consortium International sur les Thérapies Antivirals.