To effectively manage current and future variants, we need a three-pronged response that goes beyond the focus on current vaccines.
First, we need substantially more genomic surveillance. We don’t know how many variants are in the United States or how widespread they are, and we don’t have a rapid-response system to evaluate the effectiveness of the available vaccines and treatments against them. To fix this, the United States must sequence the genome of about 3 to 5 percent of cases — currently as many as 50,000 viruses a week — especially in cases of those who get covid-19 after being infected or vaccinated. Fortunately, President Biden’s administration is hard at work on these urgent responses, including adding sufficient resources in its rescue plan.
Second, we must develop multivalent vaccines — that is, vaccines that can immunize against more than one strain of the same disease. The annual flu vaccine is multivalent against three or four different influenza viruses. We will need the same for covid-19, which the administration is also working on.
Finally, and most importantly, we need greater focus on developing scalable treatments to prevent severe covid-19, shorten the duration of the disease and reduce deaths. At every turn, we have underestimated this virus. The current vaccines are effective — for now. But we should not assume that will remain the case as the virus mutates.
Plus, having vaccines is not a silver bullet, as we’ve already seen. It will take months to vaccinate every adult in the United States — much less globally — who wants to be vaccinated, and we must expect significant pockets of people to go unvaccinated and remain susceptible to serious infection. Trials for children — who can become seriously ill with covid-19, although it’s rare — have also not been completed. And if an updated vaccine booster becomes necessary to tackle these new variants, it will take yet more time for it to reach people.
The Trump administration’s efforts to develop therapeutics were slow and too limited. The program in charge of these efforts — the National Institutes of Health’s ACTIV program — only began pursuing therapeutics in the summer and largely focused on small trials of expensive, targeted monoclonal antibodies, convalescent plasma and other advanced therapeutics. But these will never be game changers. Viral strains are developing resistance to the currently authorized monoclonal antibodies. The Eli Lilly monoclonal, bamlanivimab, does not work against the variant first identified in South Africa. Same goes for one of the two monoclonals in the Regeneron cocktail. We do not yet know how effective these monoclonal antibodies will be against other variants. They are also expensive intravenous infusions for nonhospitalized patients that must be administered within a few days of developing symptoms by already overstretched medical personnel.
The Biden administration proposes an investment of billions in covid-19 therapeutics over the next five years. This is an important commitment, but if the money isn’t to be squandered, we need a different approach to develop a wider range of therapies — especially drugs to treat late-stage, potentially fatal inflammatory diseases that can be administered orally or through the nose and reach people more quickly.
To do this, the NIH must identify the most promising existing drugs to enter human trials. For example, Canadian researchers reported last month that the generic drug colchicine reduced hospitalizations by 25 percent among high-risk covid-19 positive patients. The jury is still out, as the study was stopped early, but the drug potentially has great advantages. If proved effective, it is unlikely to be rendered ineffective by new variants. It is also administered orally, widely available and cheap. That is not the only potential therapeutic. Other existing drugs, such as inhaled interferon, fluvoxamine and fenofibrate, merit careful consideration.
Prior experience has shown that most drugs, even promising ones, don’t stand up to scrutiny in carefully designed trials. Hence, we need to be studying many more new drug candidates in human trials if we are to find some that work against covid-19. Operation Warp Speed helped overcome market failures and spur the development of multiple new vaccines. We need a similar effort for new anti-viral and anti-inflammatory agents.
Most importantly, we need to rapidly create a network of academic centers, health systems, managed-care organizations and clinical research organizations so that every American who tests positive for covid-19 has easy and rapid access to therapeutic drug trials. With more than 100,000 new cases a day, enrolling just 1 percent in trials would mean 1,000 people joining studies daily. Such large numbers would enable researchers to rapidly assess which drugs work and which don’t.
The coronavirus has one goal: to multiply and spread. It is doing this quite well and gaining strength as it goes. We humans may be done with the virus, but it will not let us rest. If we want to get back to a normal life, we must implement this three-pronged strategy as soon as possible.