I can tell that the current events are getting a bit overwhelming by the difficulty of writing about other topics here! I’m not specifically on a coronavirus topic today, but rather on what some of the news coverage is saying about our expectations for medical research.
One of the things people have noted about my two recent posts on potential therapies is that I have not been too optimistic about something helping us out in the near term. I don’t want that to be interpreted as “We’re All Doomed”, because we aren’t. This epidemic will pass, as they all do, but the question is of course how much damage it will cause as it peaks. And unfortunately, I don’t see much of that damage being mitigated by what I do for a living, which is early-stage drug research. That’s frustrating; in fact, I think it’s a contributing factor to my mood in general. Here I am, a person who’s made a career out of trying to develop new therapies for sick patients, and what do I have to offer?
I’ve seen a number of things in the last week or two from other folks in the drug discovery world, looking at possible new targets, new screens of chemical matter, and so on. There are several ways to look at this sort of thing. One is that efforts to find new drugs for such conditions have to start somewhere, and the things I’ve seen have been perfectly reasonable approaches to doing that. The counterpoint, though, is that a screen against a new target today might, if everything works really well, lead to a new drug in about the year 2029 (and a lot of things will have to go right for even that to happen). If you look at past respiratory viral outbreaks, a recurring feature is that drug discovery starts up, makes a bit of progress, and then the disease goes away and things go back on the shelf (H1N1, SARS, MERS, and more). Now, there’s a counterargument to that as well, and I don’t want to minimize it: the SARS work (for example) definitely informs the efforts on the current outbreak, because they’re rather similar viruses.
But if I were going to pile a lot of funding into this field right now, I would concentrate on the possibilities of repurposing existing drugs (and of getting manufacturing and distribution ramped up should something work), and on vaccine development should we have to deal with this virus again. As mentioned yesterday, we’re not going to have a vaccine in time to deal with the wave that’s hitting us now, but we can be ready if it comes back around. This seems to be just what the recently announced COVID-19 Therapeutics Accelerator effort is aiming at, and it’s good to see.
While driving this morning, I heard an NPR segment with someone warning that vaccine development was going to take longer than people thought, that the talk of taking one into trials meant that just the very first smallest steps were underway, that a year to 18 months was about the quickest imaginable timeline and that was if things went perfectly. It turned out to be Anthony Fauci being interviewed, and good for him. These don’t seem to be politically popular things to say in some parts of the administration, but we need the truth here. I worry that there’s a good-sized segment of the population that is still not realizing how bad things could get, and another good-sized one that expects biomedical research to come to the rescue shortly with a drug or vaccine that will stop things in their tracks.
Well, I am very eager to see the remdesivir trial results (we should get the first ones shortly), because I still think that’s the best shot for a repurposed drug that could have a real effect. After that, though. . .no, I don’t think there’s a lot that’s going to help out. And even remdesivir, should it have some efficacy, will be a major challenge to deploy in time. I would like to be wrong about this, believe me.
I think a lot of people have been watching a lot of TV shows that require the plot lines to be wrapped up quickly and neatly – that’s always been a particular problem with anything involving R&D, because “quickly” and “neatly” are often not very good descriptors of what we do. I shouldn’t blame TV, of course – you can go back to earlier in the 20th century and see plenty of examples from pulp science fiction and adventure stories of that peculiarly American form, the “Edisoniade”, where a competent, wisecracking team of inventors crank out one amazing new plot-resolving device after another. From the Frank Reade and Tom Swift stories through E. E. Smith, John W. Campbell, and George O. Smith (just to name a few) there’s always been a market for that genre, and the police and medical procedural shows are just another manifestation.
The good part is, we really do crank out a lot of amazing things. The bad part is that we can’t always pull that off on the tight schedules that people imagine, and this is probably going to be one of those times. It’s the low-tech stuff that’s important right now: soap and water, staying out of big crowds, etc. Keeps a person humble, it does.