Writing in the New York Times, Bill Gates explains the importance of life-saving therapeutic drugs—and offers recommendations on how to accelerate their development—for future pandemics.

Why therapeutics are just as important as vaccines

According to Gates, developing safe, effective Covid-19 vaccines within a year of the pandemic was a "historic feat," but treatments, such as antivirals or other drugs, were "surprisingly slow out of the gate."

How to improve access to Covid-19 treatments

Although scientists had tested numerous existing drugs, including hydroxychloroquine, dexamethasone, remdesivir, and convalescent plasmas, as potential treatments, it wasn't until late 2021 that effective Covid-19 antivirals, such as Merck's molnupiravir and Pfizer's Paxlovid, became available for use.

"These drugs are useful tools for combating the pandemic, but they arrived much later than they should have and, for many, they are still difficult to access," Gates writes. And if these treatments had been developed sooner, Covid-19 "death rates are likely to have been far lower, and it may have been harder for myths and misinformation to spread the way they did."

If another pandemic occurs, it will be important to develop therapeutics more quickly than they were during the Covid-19 pandemic, particularly if a pathogen is deadlier and more transmissible. A therapeutic drug could save tens of thousands of lives as a vaccine is developed and administered to the population.

Even if there is a vaccine, it is not guaranteed that everyone will choose to get vaccinated. Therapeutics, along with non-pharmaceutical interventions, will be an important way to "reduce the strain on hospitals" and "prevent the overcrowding that ultimately means that some patients die who otherwise wouldn't," Gates writes.

According to Gates, "[w]ith good therapeutics, the risk of severe illness and death could drop significantly, and countries could decide to loosen restrictions on schools and businesses, reducing the disruption to education and the economy."

How to develop life-saving drugs more quickly

The process of developing life-saving drugs is complex and labor-intensive, often spanning several years as researchers work their way through clinical trials and to regulatory approval, Gates writes.

To help researchers "speed up and streamline the [drug development] process without sacrificing safety," Gates offers several recommendations.

For example, more research should be done to understand how different pathogens interact with human cells. If scientists could mimic these interactions, they would be able to quickly identify which drugs could be effective in an outbreak.

Additionally, governments and organizations should invest in large libraries of drug compounds that researchers can access to determine whether existing therapies would work against new pathogens. Although some of these libraries already exist, there needs to be more, and they should be expanded to include "pan-family and broad spectrum therapies—either antibodies or drugs that can treat a wide range of viral infections, especially those that are likely to cause a pandemic," Gates writes.

Researchers could also find better way to activate innate immunity, which is "your body's first line of defense" that quickly kicks in after detecting a foreign invader, according to Gates. By boosting innate immunity, a drug could help stop an infection before it progresses in the body.

Currently, advances in artificial intelligence and machine learning have made it possible for computers to identify weaknesses in pathogens that are already known to humans, and they will likely be able to do the same with any new pathogens that emerge. These technologies will also help accelerate the search for new compounds that can effectively target new pathogens.

"With adequate funding, various groups could take the most promising new compounds through Phase 1 studies even before there's an epidemic, or at least have several leads that can be turned into a product quickly once we know what the target looks like," Gates writes.

Overall, speeding up the development process for life-saving drugs "will require substantial investment to bring together academia, industry and the latest software tools," Gates writes. "But if we succeed, the next time the world faces an outbreak, we'll save millions more lives." (Gates, New York Times, 4/15)