COVID-19 LESSONS FOR DISEASE X

Science, Tech and The Shape of Things To Come

25 February 2021

Fuelled by global collaboration, rapid deployment of discoveries from the fields of science and technology have accelerated recovery efforts in the battle against COVID‑19. How can we ensure that these collaborations aren’t exceptions specific to this pandemic?

The first edition of Temasek Shophouse Conversations held on 20 January 2021 brought together leaders from the public, private and community sectors together to forge multi-sector collaborations to achieve common good – including four experts who invented solutions for diagnostics and therapeutics in response to the global health emergency.

Together, they offered insights on rethinking systems, policies and mindsets for holistic change so that we may better prepare for future pandemics.

From Science to Market

Important discoveries in science and innovative uses of technology have advanced recovery efforts during the COVID‑19 pandemic. This includes cPassTM, the first US FDA-approved rapid test kit that measures neutralising antibodies responsible for clearing the viral infection in COVID‑19 patients.

The test kit was jointly developed by the team led by Professor Wang Linfa at Duke-NUS Medical School, A*STAR’s Diagnostics Development Hub and US biotech company GenScript. It provides results within the hour – a significant improvement from lab-based kits that currently take days1. This data can then be used to support COVID‑19 investigations to see if vaccines have worked, determine infection rates, contact tracing and more2.

The rapid development and commercialisation of the test kit shows the strengths of international collaboration. Beyond the scientific community, key players including businesses and regulatory bodies, are crucial to extend scientific discoveries to a wider audience.

In February 2020, BenevolentAI used their artificial intelligence programme to identify existing drugs that could be repurposed to treat patients with COVID‑19. In just four days, they determined that baricitinib, a drug traditionally used to treat rheumatoid arthritis, could effectively reduce a patient’s extreme immune response to the virus. “We were fortunate to get the attention of the medical journal, The Lancet, early on. But beyond that original article, we faced a lot of naysayers. For two months, we released more data and spoke to Eli Lilly, the company that owns the drug, baricitinib. It was only after they ran trials that proved our hypotheses that they started to engage with us. And it was only with big pharma behind us that we had a voice in the conversation,” said Baroness Joanna Shields OBE, CEO at BenevolentAI.

As we take a step back to prepare for the next pandemic, Disease X, how can we accelerate these already remarkably rapid responses? BenevolentAI’s journey demonstrated that hard evidence alone wasn’t enough – and perhaps, this can be a starting point for change.

The fields of technology and science have grown at a rapid rate, reshaping societies and the way we live. Perhaps it is time that they are heard, even without powerful advocates; that they are supported by policies and legal frameworks designed to match, or at least get a little closer, to the rate in which these communities have grown. By doing so, we can respond faster and do better when Disease X hits.

Reframing the Pandemic

“Science is important, but international response to a pandemic in the first few days is even more important,” said Wang. For this to change, Wang echoes Professor Tan Chorh Chuan’s view from 20163: that outbreaks need to be treated as global security issues and we need to start seeing global health emergencies the same way we view terrorist attacks.

Reframing this helps to shift mindsets and systems. It drives us to set aside resources to build our defences against unknown but impending threats. In the case of therapeutics, existing drugs such as baricitinib were repurposed to treat patients with COVID‑19. Damian O'Connell, CEO, Experimental Drug Development Centre at A*STAR, explained that under time pressure, this made more sense than developing an entirely new antiviral drug. Research to discover new drugs and approval to get these drugs to market would take a significantly longer time.

But what if resources could be channelled to start building a library of antiviral drugs for zoonotic diseases even without an immediate need? When the next outbreak hits, these drugs could then be deployed for mass production to treat specific diseases swiftly and more effectively.

Viewing the pandemic as a global security issue also helps to change the language we use and contributes to how individuals, organisations and leaders choose to react. Consequently, Wang suggests that international bodies such as the World Health Organisation (WHO) could rethink their structure to be better positioned to address these threats. “If we are to look at future pandemics as global security threats, perhaps a model more similar to Interpol (International Criminal Police Organisation) could be considered,” he opined.

Trust, Support and Risk

The rapid rollout of scientific discoveries to combat COVID‑19 was possible because of end-to-end cooperation across industries. From developing therapeutics in labs, to kickstarting supply chains and accelerating regulatory timelines without compromising safety.

In the case of 3D-printing nasal swabs, Dr Ho Chaw Sing, Managing Director at National Additive Manufacturing Innovation Cluster, shared that they were not able to move forward without an actual product, despite having a proof of concept. However, with Temasek Foundation’s support, they were able to convince competing companies from US, Indonesia, India to amalgamate their resources. “We were able to work together to come up with a design, develop the swab for patient trials and clinical validation and eventually ramped up manufacturing in seven weeks,” said Ho. This collaboration, in turned, helped to relieve the shortage of nasal swabs in Singapore – a humble but essential step in COVID‑19 diagnostics.

In another instance, O'Connell highlighted that transparency between stakeholders was critical to the quick development and deployment of the COVID‑19 diagnostic toolkit. “I think it was the honesty of the discussion and the early engagement with HSA (Health Sciences Authority) – being upfront about the data we had and what we could only get later down the line; speaking frankly about issues that could arise with data interpretation. These open, ongoing discussions helped HSA to weigh the risks in the context of a crisis, while upholding safety standards.”

In any partnership, we can start by recognising where our interests align, initiate early conversations, and have open discussions to build trust. By doing so, we can then take bold steps forward to achieve a common goal – regardless of our roles in public or private sectors.

As we build our defences for future pandemics, we can do so in a way that recognises Disease X as a global security threat.

We can aspire to adapt current mindsets and systems from what we have learned in the past year.

We can start to build more trust across industries, even if it seems like we are at odds.

We can remember that at the end of the day, we are all working to do good together.