Study: Neglecting development of therapeutics may repeat history and replicate vaccine inequality

A new policy report released today by the global non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) highlights how the development of therapeutics has been relatively neglected in the global response to COVID-19 and warns that with the few treatment innovations available principally in high-income countries, we risk repeating history and replicating the vaccine inequality that has become a defining characteristic of this global pandemic.

To avoid another crisis of access and innovation, the authors offer a series of recommendations for immediate course correction in the COVID-19 response. This includes increasing attention on the need for therapeutics; transforming the governance structure of the Access to COVID-19 Tools Accelerator (ACT-A) to provide equal representation from low- and middle-income countries, and securing policies such as a temporary waiver on intellectual property to ensure transfer of technology to ensure access for all.

Great strides have been made in the development of new tools for COVID-19, especially vaccines, but the past year has made it painfully clear that access is the unfinished business of global health. We now have the opportunity to course correct with treatments and make the response to COVID-19 a model for equity, collaboration, and knowledge- sharing."

Dr Bernard Pécoul, Executive Director, Drugs for Neglected Diseases Initiative

One area that has been particularly neglected in early therapeutic interventions that could prevent disease progression and the need for hospitalization, intensive care, or worse. The report calls for more support for open drug discovery and development of novel antivirals, host-targeted interventions, and repurposed compounds, as well as for robust testing of these options in comparable adaptive platform trials.

In addition to calling for more equal representation on the ACT-A, the authors argue that ACT-A should make addressing intellectual property barriers a key transversal workstream across all pillars of its mandate and explicitly support the TRIPS waiver and licensing initiatives that would facilitate the sharing of technology, data, and know-how. The report also urges ACT-A to take explicit steps to improve transparency with respect to the development, production, and supply of COVID-19 medicines, diagnostics, and vaccines.

Given the massive amount of public funding that has gone into the development of COVID-19 technologies, the report urges government funders to use their leverage to negotiate clear and transparent terms and conditions that ensure sharing of research data, knowledge, and technology on a non-exclusive basis in order to enable adequate production scale-up and ensure sufficient supply, equitable allocation, and affordability.

As decision-makers around the world assess options for the future of global health and pandemic preparedness, the report also offers timely policy recommendations. It argues that more urgent steps need to be taken to reorientate to a more decentralized, distributed, and democratic approach to access and innovation that ensures greater parity between rich and poor and delivers new health technologies as global public goods.

'With the rapid spread of variants of concern, the international community cannot afford to wait to respond to the needs of those at highest risk of infection and death,' said Dr Pécoul. 'But we also need to act now if we are serious about building a safer world from existing and future epidemics and pandemics – now is the time to build an international system that will guarantee equal access to life-saving biomedical innovations.'