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Preparing for next pandemic

By Chukwuma Muanya
07 July 2022   |   4:15 am
Pandemics and large-scale outbreaks can claim millions of lives, disrupt societies and devastate economies. The devastating human, economic, and social cost of COVID-19 has highlighted the urgent need for coordinated action to build stronger health systems...

Photo by Vincenzo PINTO / AFP

•World Bank Board approves new fund for Pandemic Prevention, Preparedness and Response
•Contributions will accelerate efforts to get vaccines into arms, facilitate access to new treatments
•Researchers investigate therapy against monkeypox infection, associate disease with HIV
•Broadly protective Betacoronavirus vaccine with potential applications against Disease X developed

Pandemics and large-scale outbreaks can claim millions of lives, disrupt societies and devastate economies. The devastating human, economic, and social cost of COVID-19 has highlighted the urgent need for coordinated action to build stronger health systems and mobilise additional resources for pandemic prevention, preparedness, and response (PPR).

Since 2015, the shortlist of less than 10 Emerging Infectious Diseases (EIDs) has been updated yearly and has consistently included widely known names such as Ebola, Zika and Severe Acute Respiratory Syndrome/SARS (example, cause of large-scale infections), and more geographically specific names such as Lassa fever, Marburg virus, Rift Valley fever, and Nipah virus.

In February 2018, after the “2018 R&D Blueprint” meeting in Geneva, the WHO added Disease X to the shortlist as a placeholder for a “knowable unknown” pathogen. The Disease X placeholder acknowledged the potential for a future epidemic that could be caused by an unknown pathogen, and by its inclusion, challenged the WHO to ensure their planning and capabilities were flexible enough to adapt to such an event.

According to a document produced by the World Bank and the WHO, preparedness starts at country level and comprises many elements. First and foremost, it requires strong and resilient health systems, in particular primary care, to facilitate detection of disease outbreaks, provide essential care, and support deployment of vaccines and other medical countermeasures. Second, it requires surveillance systems and laboratory capacity to detect both human and zoonotic disease outbreaks. Third, mechanisms are needed for coordination across sectors for prevention and preparedness. Fourth, preparedness requires legal frameworks and regulatory instruments to support both outbreak prevention and the deployment of countermeasures. Fifth, there is a need for well-functioning supply-chains as well as adequate stockpiles of essential goods and equipment.

The World Bank’s Board of Executive Directors, last week, approved the establishment of a financial intermediary fund (FIF) that will finance critical investments to strengthen pandemic PPR capacities at national, regional, and global levels, with a focus on low- and middle-income countries. The fund will bring additional, dedicated resources for PPR, incentivize countries to increase investments, enhance coordination among partners, and serve as a platform for advocacy. The FIF will complement the financing and technical support provided by the World Bank, leverage the strong technical expertise of WHO, and engage other key organisations.

Developed with leadership from the United States, and from Italy and Indonesia as part of their G20 Presidencies, and with broad support from the G20 and beyond, over US$1 billion in financial commitments have already been announced for the FIF, including contributions from the United States, the European Union, Indonesia, Germany, the United Kingdom, Singapore, the Gates Foundation and the Wellcome Trust.

Also, the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, has welcomed contributions from Norway and Sweden to the ACT-Accelerator, which have taken both countries over their ‘fair share’ allocation.

Contributions of $340 million from Norway and $300 million from Sweden will accelerate efforts to get vaccines into arms, facilitate access to new treatments and ensure health systems can meet the challenges of the COVID-19 pandemic.

Norway and Sweden join Germany in having exceeded their fair share for ACT-A’s 2021/22 budget, with Canada pledging to do the same. ‘Fair share’ calculations are based on the size of a country’s national economy and what they would gain from a faster recovery of the global economy and trade.

In February 2022, President Ramaphosa of South Africa and Prime Minister Støre of Norway – in their roles as co-chairs of the ACT-Accelerator Facilitation Council – made a call to 55 countries to jointly support global efforts to end the COVID-19 crisis and contribute their ‘fair share’ to the ACT-Accelerator agencies’ urgent needs.

These contributions from Norway and Sweden reinforce the strong support that both countries have provided to the ACT-Accelerator since its inception in 2020.

The ACT-Accelerator now faces a funding gap of $ 11.2 billion, having received contributions totaling $ 5.6 billion for the 2021/22 budget.

Meanwhile, in a recent study published in the journal Drugs, researchers reviewed preventive and therapeutic measures against monkeypox.

The researchers concluded: “The study findings showed that while several monkeypox-infected individuals exhibit mild and self-limiting symptoms even without any medical interference, the prognosis of the infection may depend on various factors including initial health status, previous vaccination status, and concurrent comorbidities. Hence, the researchers believe that the development of personalised treatments according to the individual risk of experiencing severe infection symptoms is the most reasonable approach.”

Also, in a recently published article in the International Journal of Infectious Diseases, scientists have described the importance of smallpox vaccination as a preventive measure in controlling recent outbreaks of monkeypox infection.

In recent outbreaks, a high prevalence of human immunodeficiency virus (HIV) infection has been observed in a considerable proportion of people who have contracted monkeypox infection. This observation highlights the need for strict surveillance of emerging monkeypox cases to control recent outbreaks’ uprising trajectories.

Regarding pre-exposure preventive measures, anti-retroviral treatments have shown high efficacy in reducing monkeypox transmission by 50 per cent in real-world conditions. Vaccination against the already eradicated smallpox virus has also provided 85 per cent cross-protection against monkeypox infection.

As a pre-exposure preventive measure, vaccination is particularly recommended for at-risk healthcare workers and laboratory staff that handles clinical samples for monkeypox diagnosis or work with orthopoxviruses (monkeypox, cowpox, and variola).

Also, CEPI, the Coalition for Epidemic Preparedness Innovations, and Codiak BioSciences (NASDAQ GS: CDAK) on Tuesday announced the latest funding award under CEPI’s US$200m programme to advance the development of vaccines that provide broad protection against SARS-CoV-2 (including its variants) and other Betacoronaviruses. CEPI will provide seed funding of up to US$2.5 million to Codiak BioSciences—a clinical-stage biopharmaceutical company based in Cambridge, MA, USA—to continue the advancement of vaccine candidates from its pan Betacoronavirus program through preclinical studies.

Codiak’s proprietary exoVACC TM platform leverages engineered exosomes—naturally occurring, extracellular nanoparticle vesicles—to precisely control antigen display on the surface or in the lumen, in order to deliver antigens, adjuvants and immunomodulators selectively to antigen-presenting cells to maximize immune response. Codiak’s pan Betacoronavirus vaccine construct carries the receptor-binding domain (RBD) protein of both SARS-CoV-1 and SARS-CoV-2 at high density on the surface of the exosome, combined with structurally constrained, highly conserved T-cell antigens expressed in the lumen, and stable loading of a STING agonist. This design closely resembles the natural viral structures, and these engineered exosomes stimulate a broad immune response comprising both antibody and T-cell-mediated immunity.

Codiak has previously presented preclinical data showing its vaccine candidate stimulates a comprehensive and durable immune response against multiple SARS-CoV-2 variants and the ability to produce antigen-specific T-cell responses against known coronavirus variants of concern. CEPI’s funding will enable Codiak to further validate its program in preclinical studies, assessing the immune response against known Betacoronaviruses that already pose a significant epidemic or pandemic risk, such as SARS-CoV-1, SARS-CoV-2, and MERS-CoV, and the potential of the immune response to protect against infection and disease caused by these viruses.

If this innovative approach is proven to be successful, it could also be applicable for developing vaccines against other pathogens in the CEPI portfolio, including ‘Disease X’—unknown pathogens with pandemic potential that have yet to emerge.