Investment in AMR, vaccines and infectious disease preparedness research are proving extremely valuable in the current pandemic, as are the relationships and networks we’ve built around the globe.
As the world battles COVID-19, it’s useful to reflect on where IMI has been active over the past decade in fighting infectious diseases.
It is easy to forget that infectious diseases were accountable for the majority of mortalities in the first part of the 20th century, even in developed countries, when the average life expectancy in the US and Europe was around 45-48 years. Two innovations, antibiotics and vaccines, changed that. Both were implemented at scale in developed countries in the decades 1950-1970, and life expectancy surged past 70 years.
Making highly competitive companies highly collaborative
Infectious diseases never go away (the only viruses to be declared eradicated from the planet remain smallpox and rinderpest), and today we have new challenges. The world desperately needs new antibiotics or other interventions to counter antimicrobial resistance (AMR) and we know too well now that we need to be better prepared for pandemics like COVID-19.
With these massive challenges, it’s no surprise that IMI has mobilised considerable resources in order to address these public health needs. About 30% of IMI’s portfolio is dedicated to infectious diseases, representing a combined budget from public and private sources of over €1.5 billion (roughly at 50-50 contribution levels).
Topics like AMR and pandemic preparedness lend themselves to PPPs like IMI. They are both considered market failures - though for very different reasons. In the case of antibiotics, it is acknowledged that once new antibiotics are approved for use by regulators, they will be used sparingly and so there will not be the usual volume play that would allow the private sector to make a profit. In the case of pandemics, companies often offer newly-developed treatments or vaccines at cost and, as a result, profit margins are essentially non-existent. These factors incentivise governments to join forces with industry partners and indeed, the usually-competitive industry players are often willing to join PPPs where their own investment risk is lowered and a collective proposition can benefit all.
What IMI built was built to last
For over a decade now IMI has been heavily involved on AMR R&D at many levels. Large clinical and laboratory networks have been built across Europe so that new antibiotics can be tested clinically and efficiently wherever outbreaks occur. This is epitomised in one of IMIs largest projects called COMBACTE-NET. Other projects like ENABLE and COMBACTE-CARE are providing new molecules that can enter the pipeline at different stages of development (through the AMR Accelerator). IMI is also now aggressively attacking multidrug-resistant tuberculosis (MDR TB) which is creating havoc in a highly mobile world where susceptible and infected populations mix at scale.
IMI has also been very active in preparing for pandemics caused by viruses. The largest programme related to this targeted Ebola, following the epidemics of 2014 and 2016. Just a few weeks ago, this work, which brought the private sector and public bodies together at scale, culminated in the European Commission granting marketing authorisation to Janssen Pharmaceuticals for the Ebola vaccine that was developed in the family of IMI projects called EBOVAC. This success was not only enabled by the PPP concept, but probably would not have been implemented so quickly without it. Indeed the speed with which this project was implemented was extraordinary. It was also done under hugely challenging geopolitical and epidemiological conditions.
We have a number of other projects in infectious diseases that don’t fall under AMR or pandemics, but that address important aspects on vaccines. The toolbox generated by FLUCOP, for example, could be used to define correlates of protection of SARS-CoV-2 vaccines, i.e. assessing how effective a vaccine is by measuring the proportion of people who generate a particular immune response. In addition, Vac2Vac is developing and validating non-animal tests for checking batch quality, safety and efficacy of vaccines. This quality control might be applicable to SARS-CoV-2 vaccines.
What happens next
So what have we learned from this decade of work, and how can these kinds of projects now be leveraged to cope with the next pandemics? And how can these efforts be connected to global initiatives? The COVID-19 pandemic is the best example of how these past investments can indeed be leveraged to speed up responses. A few examples:
In 2015, IMI launched a project called ZAPI (zoonotic anticipation and preparedness initiative). This was led by the animal health industry and the Erasmus University. The project has developed technology platforms to speed up vaccine and antibody identification and production, irrespective of what pathogen emerging as the next global threat. Of course, the project needed test pathogens in order to prove concepts, and the team chose Schmallenberg virus, Rift Valley fever virus and … Middle East Respiratory Syndrome coronavirus (MERS), a coronavirus that jumped from camels to humans in 2003.
The work on MERS was immediately applicable to COVID-19. As I write, plans are afoot to test human monoclonal antibodies that were made to fight MERS but cross-neutralise SARS-CoV-2.
Cross-project leverage does not end there. The Ebola vaccine project used a new technology based on a prime boost vaccine strategy – and as this platform has now been now accepted by EMA for the Ebola vaccine – then the regulatory hurdles to approve such a vaccine adapted to contain the relevant antigens from SARS CoV-2 will be much lower.
Finally, what about the clinical and laboratory networks created for AMR within IMI? Well, as it happens, these can indeed be used for COVID-19, but more than that. Other European infrastructures and projects are now being linked together by the European Commission to create a preparedness clinical research platform at the scale and dimensions the planet needs to react now and in the future. The European Clinical Research Infrastructure Network (ECRIN), the EC-funded project PREPARE, and the IMI project COMBACTE-NET are now getting together to harmonise approaches. Building efficiencies and connecting globally will increase responsiveness to the next wave of COVID-19 or, indeed, the next pandemic.
IMI can do these kind of things at the scale that is required. The €1.5 billion that has been mobilised for infectious disease research within this PPP has not only delivered on the initial objectives of each project, but is now being leveraged and adapted to respond to COVID-19.
More can and needs to be done. More project-to-project cross-fertilisation needs to be integrated from the beginning of each project. More connectivity with global initiatives is required, and this is now built in as a prerequisite of each project in the new IMI COVID-19 programme, which was launched on 4 March.
I will be bringing more news on each of the new projects in this programme over the next few weeks.
IMI coronavirus projects
DECISION - Widespread testing will pave the road to recovery - as long as we can trust the results
MAD-COV-2 - ACE2 and COVID-19: studying the Achilles’ heel of the coronavirus
RAPID-COVID - SARS… or something else?
IMPENTRI - Could this cancer drug fight fluid build-up in the lungs of COVID patients?
CARE - CARE is preparing for the new normal
KRONO - A rapid diagnostic test 'pipeline’ for current and future pathogens
COVID-RED - A fertility tracker could be repurposed to spot early COVID-19 cases
DRAGON - Could artificial intelligence help to diagnose COVID-19? IMI’s DRAGON project thinks so
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“This is like a real-life experiment for us” ZAPI lays the groundwork for responding to zoonotic disease outbreaks like COVID-19