Medical research is always trying to get better at dealing with diseases that threaten human health. The diseases themselves, however, are a constantly moving target. Not only do pathogens like the SARS-CoV-2 keep changing their stripes, evolving to evade vaccines or spread more efficiently, but new pathogen threats emerge from time to time — and any one could potentially trigger yet another epidemic or even pandemic. While support for disease research has long been a staple of philanthropy, funders are now seeking to address the threat of newly emerging pathogens that present pandemic threats.
The Howard Hughes Medical Institute (HHMI) — one of the nation's largest private funders of biomedical and science research, with annual grantmaking of about $825 million — recently launched a new program to support studies to address the threat of new pathogens. Now, HHMI has committed $100 million to its new Emerging Pathogens Initiative, with funding going out to 13 research teams. It's a measure that grew out of the experience of seeing the COVID pandemic rise so suddenly with such serious global consequences, according to Dennis McKearin, senior scientific officer at HHMI.
"Early on, we made a few awards to individual programs at universities that were studying coronavirus in response to the pandemic," McKearin told me. "And that led to the recognition that this is a space we could be more active in and have some impact." At the center of the new initiative is HHMI's aim to move beyond the coronavirus and to create a broadly systematic approach to research into emerging pathogen threats, as opposed to study of individual pathogens in isolation.
It's a tough task, especially because pathogens come in so many guises. Some are viruses like HIV, measles, flu or SARS-CoV-2. Others are bacterial, like tuberculosis or tetanus. Malaria is caused by single-celled organisms called protozoa. Other pathogens are fungi or worms. Throughout human history, deadly pandemics have arisen from each of these types of pathogens.
It's simply impossible to predict whether the next epidemic will be viral, bacterial, whatever. It could also be a combination of pathogens, as seen in South Africa, where tuberculosis began to rise dramatically in people with HIV to become one of the leading causes of death for those infected.
"Given all that, we wanted to challenge our investigators to put their minds to this broad question of what's important to know about emerging pathogenicity," McKearin said. And as the COVID pandemic showed, just as important as the pathogens are the responses of the human immune system to the infections; therefore, researchers studying immunology are also being funded under the HHMI Emerging Pathogens Initiative. HHMI has long experience with immunology: For years, it funded the work of James Allison, whose Nobel Prize-winning research led to the development of treatments for cancer by directing the immune system to attack and kill tumors.
A few funders, but not many, are investing substantially in research around emerging pathogen threats. The federal government's NIH is funding some basic science research on the topic, as well as relevant public health efforts such as training sufficient numbers of healthcare workers, or quickly ramping up hospital response to a new, pandemic-level infectious disease danger. Philanthropy, which is already in the business of helping to build workforces, should also focus on ensuring that we have sufficient clinical professionals trained to respond to infectious disease epidemics.
In related philanthropic giving, the Stavros Niarchos Foundation, a top global health funder powered by some $12 billion from the estate of the Greek shipping tycoon, has stepped up backing for the study of infectious disease, including evolving and emerging pathogens. This past fall, Rockefeller University launched the Stavros Niarchos Foundation Institute for Global Infectious Disease Research, enabled by a $75 million grant from the foundation, to speed the development of therapies to address emerging pathogens. Like HHMI, the new institute will study novel coronaviruses as well as other pathogens that threaten global health. Inside Philanthropy's Liz Longley has written about Stavros Niarchos Foundation's partnership with Rockefeller University and other institutions to address infectious disease.
And last year, I wrote about the Gates Foundation's efforts to build out virus surveillance labs and programs around the world to monitor the emergence of potential new variants of the SARS-CoV-2 bug that has driven the COVID pandemic. In a very real sense, the constant evolution of the coronavirus means it's always potentially a fresh threat.
HHMI's aim is that better broad and systematic understanding of pathogens and the human immune system's response can lead to development of a swifter, more effective response to an emerging disease threat. We saw how quickly COVID spread around the globe before healthcare providers and public health professionals really knew how best to respond.
"We want to understand the basic principles that make the infectious agent infectious and that give the potential to become an epidemic or pandemic," McKearin said.
Pandemics are caused by individual diseases, but as HHMI argues, the need to address epidemics and pandemics presents an additional and different set of questions for research. There’s a big opportunity here for other science funders to back research into the factors that can lead to pandemic, rather than traditional, disease-specific study.