Preparing for the next pandemic: Scientists discuss drugs, discovery and direction at La Jolla symposium

Preparing for the next pandemic comes down to blending science and strategy, scientists said at an inaugural pandemic preparedness symposium March 8 at the Scripps Seaside Forum in La Jolla.

The all-day forum, called “Antiviral Medicines for the Next Big Threat,” was sponsored by La Jolla-based Scripps Research and brought together leading medical and science authorities to discuss the preemptive groundwork for creating readily available drugs for the viruses most likely to drive the next global pandemic.

The event included keynote speakers, panel discussions and opportunities for scientists and others to connect.

“There’s a high likelihood that the next pandemic will be a virus or from a viral family we know,” said Sumit Chanda, a professor in the Scripps Research department of immunology and microbiology who co-leads the institute’s Center for Antiviral Medicines & Pandemic Preparedness.

CAMPP was established at Scripps last year following a $67 million award from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

The three-year grant, with the potential for a two-year extension, is part of the U.S. government’s response to COVID-19. CAMPP is one of nine Antiviral Drug Discovery Centers for Pathogens of Pandemic Concern established nationwide, funded by a total of $577 million to develop antivirals for COVID and other viral families with high potential to cause a future pandemic.

Chanda said preparation involves global scientific cooperation, development and stockpiling of antivirals and vaccines, better scientific communication to the public and coordinated pandemic preparedness programs.

Global cooperation

To effectively mitigate a future pandemic, global surveillance and coordinated response strategies are needed that include “scientific cooperation that transcends political boundaries” to share information, Chanda said.

Dr. Trevor Mundel, president of global health for the Bill & Melinda Gates Foundation, said “surveillance is a prerequisite … to have any kind of rational pandemic response.”

Coordination currently is lacking, he said, as “we live in a fractured world.”

Antivirals and vaccines

“It takes time to make a bespoke antiviral, [but] having something at the ready that isn’t perfect but can mitigate death and illness is going to be key” to quickly weakening a future pandemic, Chanda said. That also requires development of novel vaccines, he added.

Carl Dieffenbach, director of the AIDS division for the National Institute of Allergy and Infectious Diseases, said he’s frustrated by the propensity of those involved in funding COVID-19 therapeutics to “want instant success. … They don’t want to hear that some things just take time.”

“The biggest thing we can do right now,” Mundel said, “is make not just effective antivirals but antivirals that have the right properties that lack side effects, drug interactions and rebound types of issues.”

Increased scientific literacy

Dr. Trevor Mundel, president of global health for the Bill & Melinda Gates Foundation, speaks in La Jolla about the need for diagnostic manufacturing in pandemic response.

(Elisabeth Frausto)

“You can make the best vaccine in the world, you can make the best drugs in the world, but if people don’t take them, they’re useless,” Chanda said.

“We have a job as scientists ... to do better in educating the public about what we do and what the real threats are.”

The challenge in the United States, Mundel said, is the need for community testing to “get people rapidly tested within the … time frame for the antiviral to be actually useful.”

He said diagnostics in the current pandemic struggle with “incentivization inertia,” as those without a compelling reason to be tested for the COVID-19 coronavirus — such as to travel or go to work — stop testing, leading to a wider spread of the disease since most people don’t know to take an antiviral.

“Asymptomatic humans do not like to be tested,” Mundel said. “That’s a huge challenge for us. … How do we address that sort of social phenomenon?”

Another, more surprising, barrier to getting antivirals to infected people comes from medical professionals, Mundel said. Data from December indicates that “only about 20 percent of diagnosed COVID cases in the risk categories that should get [COVID-19 antiviral] Paxlovid actually get prescribed [the medicine] by their health care professional” due to a fear of disease rebound, he said.

“The only way we overcome this challenge [is] to make diagnostics pervasively available,” Mundel said, such as by making it easy to pick up a test while in line at a local store or sending tests to members of an infected person’s extended family.

The path forward also includes innovative manufacturing, he said. “We’ve been investing in some technology … that can print 16 million diagnostic tests per day, [which] lends itself to a very low cost.”

Preparedness programs

Carl Dieffenbach, director of the AIDS division for the National Institute of Allergy and Infectious Diseases, says a pandemic preparedness plan should have collaboration between academic and commercial enterprises.

(Elisabeth Frausto)

Developing pandemic preparedness programs to minimize worldwide negative economic impact is another key, Chanda said.

A lot of the programs for the current pandemic “were done in an uncoordinated way,” he said. A plan for the next one needs to be put in place “without really scrambling and coming up with piecemeal, ad-hoc decisions,” he added.

Dieffenbach acknowledged that “if you ask just about anybody on the street, they’re done with COVID. … The challenge we face is to maintain the energy and the pressure moving forward so we can actually continue with pandemic response and in the meantime really accelerate the pandemic preparedness part of these programs.”

An integrated plan for pandemic response would address key research gaps in the top viral families, accelerate the development of vaccines, therapeutics and diagnostics for pathogens, and coordinate global players in medicine, academics and industry, Dieffenbach said.

Chanda said CAMPP is working to bring together the best virologists, structural biologists, immunologists, biochemists and more to develop treatments for coronaviruses, flaviviruses (such as Zika and West Nile), paramyxoviruses (such as measles, mumps and some respiratory infections), bunyaviruses (that cause fevers and are borne by insects or rodents), togaviruses (such as equine encephalitis and rubella) and filoviruses (Ebola and Marburg), the families most likely to cause the next pandemic.

He added that researchers are furthering CAMPP’s two missions: to bring about new therapeutics and innovate discovery of antiviral drugs. ◆