After three difficult and often tragic years, health officials are saying the COVID-19 pandemic is finally receding to chronic but manageable levels. California, for example, terminated its official COVID state of emergency last month, and the federal government plans to let its public health emergency expire in May. Unfortunately, that doesn’t mean pandemics are over and we can just forget about them. As many scientists have said, reported in Inside Philanthropy and elsewhere, COVID wasn’t the first pandemic, and it won’t be the last.
The good news is that countries and health researchers now have a chance to get ahead of potential future pandemics, to identify candidate viruses and other pathogens — and hopefully, to lay the groundwork for the faster development of life-saving treatments, if and when a new disease threat emerges.
Pandemic Antiviral Discovery (PAD), a collaboration of health funders consisting of the Bill & Melinda Gates Foundation, the Novo Nordisk Foundation and Open Philanthropy, is designed to do just that. PAD launched in 2022 with an initial commitment of $90 million from the three founding partners. (The Novo Nordisk Foundation’s endowment is managed by Denmark-based Novo Holdings, the holding company for the Novo Group, which contains the Novo Nordisk international pharmaceutical company.)
PAD is not a discrete legal entity, but can be more accurately described as a consortium. “PAD is a lean operation,” said Tina Thorslund, senior scientific lead for the Novo Nordisk Foundation’s efforts with the PAD initiative. “The founding partners decided not to create a dedicated organization or structure that would drive administrative costs.” Instead, the three foundations tap into their own resources, expertise and governance. Since it’s not an official entity, PAD’s grants flow out of the three partner organizations.
“As funders, we believe that by combining our resources, knowledge and networks, we are able to fund large-scale projects, avoid redundancies in efforts, and accomplish goals faster and more effectively than any of the individual partners could do on its own,” Thorslund said. “Researchers who receive funding will benefit from a larger network of PAD grantees, for example, in networking activities.”
In addition to the benefits of collaboration, PAD also highlights some of the strengths of grantmakers structured as traditional, staffed foundations. Especially when they’re as hefty as the three involved here, foundations often have a lot of institutional knowledge they can bring to bear on tough problems. In the case of medical research, they can use that expertise to get grants awarded in a leaner way, as Thorslund indicated.
To get a jump on developing antiviral treatments for any potential pandemic disease, the funders drew on that in-house expertise to make a judgment call about which viruses posed the most likely threat. The PAD initiative has chosen to focus first on three viral families: paramyxovirus, orthomyxovirus and coronavirus. These pathogens can lead to serious disease threats, such as Nipah virus infection, influenza and Middle East respiratory syndrome (MERS).
“These virus families are widely considered to have the highest potential to generate a pandemic threat,” Thorslund said. One key reason is that these viruses have the ability to pass to humans from small mammals like fruit bats and cause serious illnesses. Nipah virus, for example, can cause respiratory disease accompanied by severe neurological complications, and has an estimated fatality rate of 40 to 70%. On top of that, evidence of person-to-person transmission of Nipah elevates it as a possible pandemic danger.
The COVID pandemic revealed many weaknesses in healthcare across the board, but it made global inequalities in healthcare especially clear, including inequitable access to certain medicines. Some COVID vaccines, for example, require cold-chain transport and storage that isn’t readily available in many lower- and middle-income countries. And looking ahead, some of the potentially dangerous viruses of the future are likely to impact those regions disproportionately. “Many of the diseases they cause primarily affect people in low- and middle-income countries and lack market incentives for the research and development of effective drugs to treat them,” Thorslund said.
For this reason, the PAD partners have made equitable access to any future treatments a core principle of the initiative. This will impact the science that PAD funds: To ensure the world is prepared to quickly develop and equitably deploy effective, accessible antiviral treatments next time a pandemic threat emerges, PAD has opted to focus on so-called small-molecule drugs that can be delivered orally, are relatively cheap to produce, and generally ease widespread patient access.
In what amounted to its first major round of grants, PAD recently announced $26 million in awards to support 14 research projects focusing on the henipavirus subgroup. The projects aim to develop new drugs to address diseases related to that subgroup. (PAD partners had previously made three grants focused on influenza and coronavirus.)
It’s not yet clear how long the PAD partners will continue the collaboration. “It depends on how the state of pandemic preparedness evolves over the coming years, as well as on the experience we gain and progress we make over the coming years,” Thorslund said. “We will continue to assess the landscape and determine where our resources can have the most impact.”
When COVID-19 was recognized as a pandemic, many health funders diverted grant money toward research that addressed COVID specifically. As the COVID threat loses urgency, health research funders may find it tempting to return to funding their traditional areas of interest. But after the lessons of COVID — the sickness and death that it caused and the slowdown of the global economy — it would be a mistake for funders to stay out of the pandemic business entirely.
It would similarly be a mistake for public, government-led funders of research to let pandemic research fade into the background. Pandemics are a global challenge, as Thorslund quite correctly points out, and they demand global commitment, partnerships and coordination. Now, private and public funders around the world need to keep the lessons of COVID foremost in their planning to protect health and avoid, or at least minimize, the economic harms and disruption a future pandemic could cause. “The PAD initiative is, in the global context, a rather small and very focused initiative that should never stand alone,” Thorslund said. “We intend to collaborate and coordinate with existing or new initiatives whenever we can.”