A New Era in the Fight Against COVID-19 Pandemic: Forging a “Viral Pandemic Readiness Alliance”
A September 22-23, 2020 Special Meeting of Top Global Experts Launches “Global Virus Network’s Vision for Future Pandemic Preparedness”
We are in the midst of a pandemic that has completely upended the world with major economic, social and psychological impacts. The major threat to public health is not only connected to COVID-19-related mortalities, but also to associated morbidity and, possibly, sequelae; moreover COVID-19 impacts overall population health due to the disorganization of health systems.
We must be very humble, as we cannot predict what the future could hold: seasonal variations? Long term persistence? Or regression? We need to keep in mind that the reason behind the SARS-CoV-1 epidemic’s regression has remained in part mysterious. In fact, eradication of the virus seems impossible, and herd immunity may be very difficult to achieve. Thus, we must learn to live with the virus.
It is increasingly clearer that we are not facing “another health crisis.” We are entering a new era where novel modes of organization must be designed. We cannot wait for the current crisis to conclude to prepare for the next—we must act now!
Despite significant progress in global health following previous epidemics and pandemics (including HIV, Influenza and Ebola), and although we were aware of the potential risk of such new pandemics, we were not sufficiently prepared. There are two immediate consequences for global health policies:
- The importance of infectious diseases, global and “one health” are only further emphasized.
- The divergence between politics and health in many countries has led to disastrous decisions. As such, we need to provide governing leaders with science-driven and independent strategies.
The Global Virus Network (GVN) is poised to be an important partner in achieving these objectives. This is a coalition of the foremost virologists worldwide, representing 57 research centers and 10 affiliates in 33 countries, and growing by the day. The GVN coordinates scientific projects and has organized task forces on specific viruses including Zika, Chikungunya, and HTLV-1, and now SARS-CoV-2. The organization also has a major focus on education, training and mentoring others in the field. Globally, there is a lack of critical mass in scientists, medical doctors and public health professionals working on infectious diseases. The GVN plays a significant role in advocacy and providing statements (in particular through its website https://gvn.org/). Science-driven and independent expertise are key drivers of meaningful public health strategies, and through its network of outstanding virologists worldwide, GVN offers national and international institutions, as well as industrial partners, a unique source of information and recommendations.
In this context, the GVN organized a two-day workshop dedicated to COVID-19 and future pandemic preparedness with the aim to evaluate what has been improperly and properly handled during these first eight months of the COVID-19 pandemic spreading. The workshop looked at precisely identifying the challenges ahead, the actions to take and how the GVN can collaborate with the many institutions to meet these needs. The goal of the workshop was not to revisit in detail all topics and known facts. A video of the full post-meeting press conference, can be found here.
The following summarizes the major issues discussed:
1) Preparedness: We were not prepared, and we need to prepare now; This implies novel organizational modalities.
- Cooperation and coordination, beyond goodwill and fashionable wordings; too many institutions are still working in silos with self-interest strategies.
- Leverage technologic innovation and scientific progress to produce diagnostics, vaccines, and therapeutics.
- Contemplate and implement novel modes of interactions between academics and industrials, and such partnerships have been at the heart of the GVN since its inception.
- Multi- and transdisciplinary collaborations, including social and behavioral sciences, and perception of communication.
- International collaborations: one country alone cannot solve the problem. While this seems obvious, most countries have reacted on an isolated basis. A global collaboration network for pandemic preparedness and prevention needs to be implemented immediately.
2) Prediction: Humans are the best sentinels. Is it feasible to predict future pandemics? How to sufficiently organize surveillance?
- We must recognize that we cannot predict future pandemics, though we can improve our strategies. Yet, we have sufficient technologies and data analysis systems (including artificial intelligence), but we need to establish implementation and global data sharing mechanisms.
- We know that animal viruses are major risk factors for the next epidemics and pandemics. This is even increasingly at stake. During the meeting scientists emphasized that five of the seven human coronaviruses identified (229E, NL63, OC43, HKU1, SARS-CoV-1, MERS-CoV and SARS-CoV-2) in the last 20 years have emerged from bats. Humans are modifying ecosystems and are in fact accelerating transmission events.
- Comprehensive sequencing-based analysis of all viruses worldwide (“animal viromes”) provides useful knowledge but does not predict transmission to humans. GVN scientists point to the importance of focusing surveillance efforts to the human populations who interface with animals.
3) Origin: There is no scientific evidence that SARS-CoV-2 was disseminated by human manipulation.
- GVN scientists all concur on this controversy.
- The mission to find out the origins of the virus was a true international collaboration and transparent process featuring scientists from China, America, Australia, Japan, France, and the Philippines.
- There is a 1,200-nucleotide difference between the closest backbone virus and SARS-CoV-2, representing 4 to the power of 1,200 possible combinations. Even if someone had unlimited research funding and all the best virologists in the world, no one could make this virus.
- An extensive study will be conducted starting in China and through Southeast Asia to identify the origins of the virus and to allow much better surveillance and mitigation for future emerging viruses.
4) Transmission: “Super spreaders” and “super spreading” events are major drivers of pandemics.
- COVID-19 is a highly contagious respiratory disease with very low mortality directly induced by the virus, thus the ideal condition for a virus to spread. The importance of masks, physical distancing and handwashing is well-known. GVN scientists also emphasize the importance of research on disinfectants, an underappreciated protective measure.
- As re-emphasized in this workshop, only a handful of those infected seem highly contagious. Thus, transmission is driven by a limited number of individuals who behave as “super spreaders.” Why do some individuals (a.k.a. “super spreaders”) transmit viruses to so many others? Although we know that such individuals show high viral load and are generally, yet not always, younger, this cannot fully account for this spreading. What are the other factors? Thus far, research focused on such individuals is mandatory. The question remains whether we can identify novel biomarkers, though we would need to fully exclude stigmatization.
- Also, this implies for obvious statistical reasons that large gatherings are major risk factors for being in contact with such rare “super spreaders” and thus contributors to rapid viral wide spreading. Therefore, we should not only speak of “super spreaders” but also of “super spreading” events.
- Aerosol-related transmission is still a controversial issue. Yet, GVN scientists have emphasized that the impact of short-range aerosol-driven transmission contributes to the dissemination of the virus, particularly in the context of “super spreading” events. Masks are very efficient against large droplets but are unfortunately less efficient against such aerosols.
5) Diagnostic: Efficient and rapid diagnostic testing is the key for controlling an infectious disease, and we have not benefited enough from the huge technology progress in this area.
- Nothing is needed more than rapid diagnostic tests. We need to trace and follow infected individuals and their contacts. We need to educate the general public. This is absolutely the foundation, and we cannot do anything without it.
- There is now ample evidence that salivary sampling can be used instead of nasal swabs in both symptomatic and asymptomatic infected individuals. This can overhaul access to testing, in particular but not only in children. Rapid tests, whether molecular or immune-based, are now available at a low cost, and presentations have been made by GVN scientists demonstrating these points. Point-of-care rapid tests should also be available.
- Important progress has been made regarding serological assays, offering major insights not only on the epidemiology but also defining the neutralization capacity of detected antibodies as novel correlates for protection. These are fully necessary for evaluating protective measures, novel therapies and vaccines. As an example, some presentations showed that the nature of the antibodies to SARS-CoV-2 significantly differs when comparing children and elderly, possibly accounting for variations in disease severity. Yet, we need standardized protocols for neutralizing assays. Also, the protective efficacy of antibodies needs to be further substantiated. GVN scientists have emphasized the need to get access to the cellular immune response for delineating such correlates of protection.
- Discussions have been focused on how we should provide novel organizational schemes to favor rapid translation from technology-driven research to routine testing, and partnerships between academic and industrial partners should be reinforced in an international context. Institutions such as the Coalition for Epidemic Preparedness and Innovations created for vaccine development are interesting models to get such novel consortia moving faster.
6) Therapeutics: Despite a huge effort made on drug repurposing so far, we have achieved limited results.
- Drug repurposing must continue to be at the heart of the therapeutic strategy, providing immediate access of well characterized molecules and allowing massive screening for antiviral activities. However, we do not yet have access to drugs that can prevent transmission in high-risk groups or treat early infections. In fact, we are left with combining steroids, Remdesivir (with some but limited efficacy) and anticoagulants for severe infections with pneumonia. Though, several ongoing studies offer hope for novel prophylactic and early treatment molecules.
- In this context, GVN scientists have emphasized the need for research agencies to fund not only drug repurposing but also drug discovery. Drug discovery will take time to lead to novel accessible molecules – this is a long battle and not a single crisis.
- Several presentations demonstrated the potential of novel therapeutic avenues, from immunomodulatory to direct antiviral approaches. Antivirals are only meaningful in the early phase of the infection.
- The trend will be to use drugs targeting multiple pathways and to combine antivirals and immunomodulatory molecules. Additionally, GVN scientist are addressing the possibility of developing broad spectrum antivirals, which could be effective against coronaviruses, influenza and filoviruses (involved in hemorrhagic fevers such as Ebola, Zika etc.).
7) Vaccines: Safety, efficacy and durability are predominant concerns of COVID-19 vaccine development. Nonspecific immunization procedures must be considered along with COVID-19-specific vaccines.
- Enormous parallel efforts are being made worldwide utilizing innovative approaches to shorten the vaccine development time. There is uncertainty as to when vaccines for COVID-19 will be readily available for mass vaccination and which formula will be the most efficient. Importantly, we need to ensure the safety of vaccines by testing proper animal models and complying with regulatory requirements – we simply cannot incur adverse reactions.
- We also need second-generation vaccines that are more focused on the cell immune response.
- Stimulation of the Innate immune response by non-specific immunization, for example: Bacille Calmette-Guérin (BCG), Oral Polio Virus, is extremely important. GVN scientists made important presentations on this topic, illustrating how BCG-based strategies have already allowed in different contexts to decrease the neonates’ overall mortality in Africa and the rate of respiratory infections in elderly. Mechanisms accounting for stimulation of innate immune response in COVID-19 were thoroughly discussed, and ongoing trials on the impact of BCG and Oral Polio Virus-based vaccines on COVID-19 were deliberated. This approach is complementary to specific vaccine development and might offer a bridge before getting an efficient and sufficiently characterized vaccine.
It is not a crisis – it is a new era. We have major challenges ahead. We need a new organization and we need it now. This is where the GVN is very important, and complementary to national and international agencies. This workshop has led GVN to forge a unified and multidisciplinary pandemic response strategy, tentatively named the Viral Pandemic Readiness Alliance (VPRA) by collaborations with university, industry, government and communities to merge the efforts and find solutions together.
- True international collaborations are essential and go beyond good and fashionable wordings. Global, One Health and VPRA strategy can support future pandemic preparedness with distribution of diagnostics, vaccine and therapeutics and other interventional measures.
- In a surge of COVID-19 publications and news releases, we need reliable channels for dissemination of scientific knowledge and information sharing. GVN and VPRA can contribute to this global collaboration effort by assisting the UN, WHO, CEPI, Wellcome Trust, the Bill and Melinda Gates Foundation, and other organizations to serve this purpose.