By Karen Taylor, Director, Centre for Health Solutions
Our previous reports have highlighted the increasing number of innovations that have led to life-saving and life-enhancing clinical treatments and how, over the past 30 or so years, healthcare has moved from treating infectious or communicable diseases to managing a ‘tidal wave’ of complex age and behaviour related, non-communicable, diseases.1 This transition was made possible by the development and widespread use of vaccines and antibiotics which dramatically reduced the prevalence and improved outcomes for most infectious diseases. Today, this scenario has been turned on its head as people across the world face the unrelenting human and economic impact from a novel, infectious, coronavirus SARS-CoV-2 (named COVID-19 disease). On 11th March the World Health Organisation (WHO) declared COVID-19 a pandemic, and the biopharma industry is now in a race to develop both preventive and therapeutic interventions.
What we know about COVID-19
Most people now know that coronaviruses comprise a large family of viruses that can cause respiratory tract infections in both animals and humans. Moreover, that while multiple strains of these viruses circulate within animals, only seven known types of coronavirus cause infections in humans. These include those responsible for the ‘common cold’, along with Severe Acute Respiratory Syndrome (SARs-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) and now, SARS-CoV-2.2
The humanitarian costs of the COVID-19 outbreak continue to escalate, and by 26th March over half a million people had been infected globally, with the number of people confirmed to have died in Europe doubling every two to three days.3
In search of effective treatments
Currently there are no COVID-19 vaccines or other treatments, and the race is on across the world to identify suitable therapeutics, including antivirals, anti-interleukins and vaccines, with much of the early effort focussed on repurposing clinically-approved drugs and mining chemical libraries for lead compounds.
In November 2019, our research report Intelligent drug discovery: Powered by AI, identified the role that AI could play in speeding up drug discovery by analysing research data more effectively, screening chemical libraries, de-novo drug design, drug repurposing and pre-clinical testing.4 In response to the pandemic, several academic and industry groups are now using deep learning to identify candidates to fight coronavirus. As a result there are now around eight potential treatments at pre-clinical phase that were identified using AI. AI for drug discovery companies that have proposed potential treatments and which featured as case studies in our research report include BenevolentAI and Insilico Medicine.5,6
One notable feature of the contestants in the race to find a treatment is that much of the research is based on collaborations between both private and public research organisations. Moreover, biopharma companies with vaccine and/or infectious disease experiences are partnering with more innovative companies such as AI for drug discovery companies.7
As the coronavirus threat continues to escalate, increasing numbers of biopharma and biotech companies have joined the fight, and, despite some hype surrounding some of the claims, there are now over 70, novel small molecule antivirals and re-purposed therapies in the biopharma pipeline.8 Indeed, two dozen new treatments were made public in just the past two weeks.9 The Milken Institute’s treatment and vaccine tracker for COVID-19 uses an aggregation of publicly-available information from validated sources, and believes it is important to make this data accessible to the public. Its latest update (24 March), identifies seven categories and 73 potential treatments and vaccines (Figure 1).10
How long before an effective treatment is found?
The nearest solutions on the horizon are antivirals, with the earliest available likely to be three to four months. Earlier this month, the Director of the National Institute of Allergy and Infectious Diseases told a US congressional panel that he hoped the first clinical trial patient would receive a vaccine ‘in a few weeks’. Indeed a week later the first trial patient received a dose in a Phase 1 clinical trial.11 To date there is one treatment in Phase 3, one other in Phase 1 and two vaccines also in Phase 1 of a clinical trial. Consequently, it will take some time before any vaccines or treatments reach patients who desperately need them. Our report, Intelligent clinical trials: Transforming through AI-enabled engagement, demonstrates quite clearly the reasons for this and the requirement to meet regulatory hurdles, which, even if fast tracked, will still take time.12
Indeed, scientists believe it will take at least a year to 18 months for an effective vaccine to be found, but it could take longer, as apart from the two above, most other potential vaccines for COVID-19 are only in the animal testing stages.13 While this may feel like a long time when facing the peak of the pandemic, industry watchers agree that the efforts we are seeing are unprecedented and would not have been possible in the past – for example, during the last SARS outbreak.
To date, the race to find targeted therapeutics for COVID-19 has developed at a scale and pace never seen before. However for those requiring hospital treatment who may already have a severe disease, including pneumonia, repurposed drugs as well as novel drugs will be needed in the fight against COVID-19.
Given that it could take at least 12, if not 18 months or more to develop a vaccine, more hope is resting on repurposing drugs and some other antiviral treatments that could be developed quicker. As researchers and biotech companies work on these, there is every reason to believe that completion of a first treatment could be in a few months. With confirmed cases over now over half a million and billions around the world whose lives have been disrupted by the pandemic, we must all hope that the desired outcome will be sooner rather than later. I personally believe that AI applied across the pharma value chain will expedite a solution.