The target builds on a similar goal set out by the Coalition for Epidemic Preparedness Innovations (CEPI) earlier this year.
The 100 day mission for diagnostics, therapeutics and vaccines (DTVs) “may seem far-fetched, but it is possible,” notes the report.
From 307 days to 100 days
Presented to the G7 summit in Cornwall, UK, over the weekend, the Pandemic Preparedness Partnership sets out a the scenario where a pandemic hits – but the world is ready.
The COVID-19 pandemic saw the first vaccines ready for clincial trials in under a month; with vaccines available for distribution after 307 days. While this represented ‘an incredible achievement' (particularly given novel vaccines often take up to 15 years to develop, if at all), even quicker development times could have changed the course of the year.
The WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. That means the 100 day mark came on 9 May, 2020. If the world could have deployed safe and effective DTVs at that moment, ‘hundreds of thousands of lives would have been saved; lockdowns would have been shortened, and trillions of dollars of lost economic output saved’, according to the report.
And the COVID-19 response did have ‘challenges and failings’ that will have to be overcome in order to reach the 100 day goal: such as the lack of existing DTVs; low manufacturing capacity; systemic inefficiencies and inequities; and a lack of preparedness and coordination that meant there were unclear demand commitments, insufficient funding, inconsistent rules and regulations, delays and inequitable access to DTVs.
“The first 100 days when faced with a pandemic or epidemic threat are crucial to changing its course and, ideally, preventing it from becoming a pandemic," notes the report.
"In those 100 days, non-medical public health interventions like social distancing, isolation, contact tracing and personal protective equipment (PPE) are essential, but the three best weapons we have to defeat a pathogen threat are diagnostics, therapeutics and vaccines. Together, they can save millions of lives.
“Building on the target set by the Coalition for Epidemic Preparedness Innovations (CEPI) - to have effective vaccines within 100 days of a pathogen being sequenced - we propose an Apollo Mission for the modern age to galvanise the international community.
“In the first 100 days from a pandemic threat being identified (defined by when WHO declares a PHEIC) we should aim for the following interventions to be available, safe, effective and affordable: accurate and approved rapid point of care diagnostic tests; an initial regimen of therapeutics; and vaccines ready to be produced at scale for global deployment.
“The 100 Days Mission is a rightly ambitious goal to aim for. That said, we accept the reality that for some pathogens there will be many years of work to get us to this position, but for others we could achieve the goal more quickly. A lot will depend on whether we know our enemy or if we are met with a surprise attack: whether it is a pathogen we are prepared to fight or a completely novel “Disease X” threat. And it will depend on how quickly the pathogen spreads and the severity of the disease it causes. The timing and nature of such threats is uncertain.”
What does better pandemic preparedness look like? Lessons from COVID-19
Drawing on the experience gained from COVID-19, the report outlines a series of measures that could improve the speed of vaccine and wider DTV development. These include:
Prioritising R&D: "The initial focus should be on the respiratory viruses (such as coronaviruses and influenza viruses) most likely to cause a future pandemic, and thereafter on Lassa, Nipah, Rift Valley, Chikungaya and Ebola, to fill the gaps in our arsenal. This can be achieved through a concerted focus on developing prototype DTV libraries targeting the critical viral families most likely to be the source of a future pandemic. We should make the most of technologies such as advanced structural biology, antigen mapping and viral phenotyping to define likely common surface protein vaccine targets and enzyme antiviral targets to develop these prototype vaccines and therapeutics."
Knowing the enemy: "We recommend building prototype vaccine and diagnostic libraries applicable to representative pathogens of pandemic potential. This should be informed by analysis of which priority pathogens would benefit from prototype vaccines, particularly respiratory viruses."
Modernise vaccine tech: "We recommend that industry, working with biotechnology companies, research institutions, CEPI, governments and foundations, invest in modernising vaccine technology by targeting vaccine preventable diseases. The objective, alongside treating preventable diseases, is to have improved vaccine platforms ready to respond to an unknown “Disease X”. The more high-quality vaccines available and approved by regulators, the more options for repurposing or reprogramming when a Disease X threat emerges."
Manufacturing network: "Industry, governments and international organisations, should explore how a vaccine manufacturing network, utilising the latest technology, could be rapidly activated in a pandemic. Governments and international organisations should also consider expanding mass adult vaccination campaigns for common diseases - both to respond to very real and pressing public health needs and to create regular demand for expanded capacity. An expanded vaccination programme would have widespread health benefits and would help address the need to ‘keep warm’ manufacturing and stimulate innovation in business as usual, while avoiding the trap of public money paying for empty facilities that soon become outdated."
Clincial trials network: "WHO should work with governments and stakeholders to scope an international clinical trials network to enable a coordinated and efficient approach to testing of new DTVs and existing therapeutics. The network should bring together national clinical trials infrastructure, interlinked regionally in a way that can be rapidly commandeered as a global resource in a pandemic."
Harmonise regulatory processes: "SRAs [Stringent Regulatory Authorities], working with WHO and other relevant organisations, should streamline, harmonise and simplify regulatory processes in business as usual, and agree a faster and joined-up approach in pandemics. This should include a new look at existing rules such as the Good Clinical Practice clinical trials guidance and consider whether they are still fit for purpose"