While the United States has thus far played defense in the battle against the coronavirus, a potent offensive weapon is quietly being honed for deployment: our biopharmaceutical industry. This industry, one of our nation’s jewels, attracts some of the world’s best, brightest, and most creative scientists and entrepreneurs, motivated by a desire to make a positive impact on the world. Many are now working to prepare a counterattack against the COVID-19 pandemic. Thus, we are cautiously optimistic.
Biotechnology was born in the 1970s and, in the subsequent half-century, a new ecosystem for discovering lifesaving drugs has sprouted and flourished. The industry today creates over 60 percent of all new medicines in the world. Millions of patients have benefited; lives have been spared. America today has over 1,000 companies working to address the diseases that afflict us all.
Our optimism over the near term is fueled in particular by therapeutics. While vaccines are probably the optimal long-term solution, they have historically had one disadvantage: They take longer to develop and manufacture. This is because the target population for an effective vaccine is the entire population of the planet. Establishing safety, before injecting a vaccine into billions of arms, is a critical step that will take time.
Drugs to treat severely ill patients benefit from the inverse proposition. These medicines, which attack the virus directly or mitigate the virus's secondary effects, can be identified and developed quickly. Clinical trials of these drugs can be small, fast, and definitive; testing many drug candidates simultaneously is both feasible and warranted in this unprecedented situation. In critically ill patients, the potential benefits of such drugs are likely to outweigh their potential risks (like chemotherapy for cancer patients).
Relative to other diseases, for which the underlying biology is not yet clear, COVID-19 and the secondary damage it causes are fairly well understood. Consequently, discovering effective drugs should be doable. We have been given a big head start thanks to our scientists’ earlier effort and success with HIV and other viruses. Additionally, the biopharmaceutical industry possesses an armamentarium of repurposed medicines for autoimmune diseases, many of which are currently being evaluated in treating the damaging consequences to those who survived COVID-19. We are fortunate that we are not starting from square one.
One of the most important ingredients in drug discovery is serendipity. Just as “shots on goal” in soccer or hockey correlates to the probability of scoring a goal, serendipity in drug discovery is often a function of the number of drugs (and independent biological mechanisms) being tested. Good news: There are already approximately 100 unique drugs in clinical trials to treat COVID-19 (according to both clinicaltrials.gov and Evercore ISI), and it has been only four months since the disease is believed to have originated. The majority of these drug candidates were previously designed for related viruses and secondary pathologies; many have already been shown to be effective against COVID-19 in vitro. With so many shots on goal, if each of these candidates has even a 5 percent chance of success, the probability that at least one impactful drug emerges is over 99 percent.
We have all come to know Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, as a cautious, thoughtful, and rigorous scientist, not prone to hyperbole. Here is what Fauci said at the press conference of the coronavirus task force on March 26:
"You are going to be hearing over the next month or more about different drugs that are going to go into these randomized controlled trials. And I feel confident, knowing about what this virus is and what we can do with it, that we will have some sort of therapy that gives at least a partial if not a very good protection in preventing progression of disease. And we will be back here talking about that a lot, I’m sure.”
While there are of course no guarantees, we are cautiously optimistic and hopeful that one day soon, with the help of the US biopharmaceutical industry, the world will celebrate the discovery of one or more drugs to treat COVID-19.
Mark Lampert is founder and CEO of BVF Partners. Jeremy Levin is chairman of BIO and chairman and CEO of Ovid Therapeutic. Michel Vounatsos is CEO of Biogen. John Maraganore is CEO of Alnylam Pharmaceuticals.