We can’t cut corners, but we should also be willing to try new things. That’s how we developed multiple vaccines against COVID-19 in record time. The threat of pandemics will not disappear, and may grow even greater as factors like climate change and globalization facilitate the rapid spread of new diseases. So how do we make things go faster?
Challenge trials in emerging pandemics: UK pandemic ethics “accelerator”
In the early stages of a future pandemic-potential outbreak, time is of the essence. Human challenge studies can be excellent tools to study the traits of a disease, and provide unique information on things like correlates of protection, infectiousness, and pathogenesis. But exposing volunteers to a new disease is ethically very complex, which is why we started thinking about how to do our homework ahead of time. The result was The Ethics of Controlled Human Infection Model Studies for Mitigating Pandemic Risks report, sponsored by us and developed by the Oxford Uehiro Centre for Practical Ethics as part of the UK Pandemic Ethics Accelerator. Read about the report and launch event here.
Learning from Pandemic Policy: Operation Warp Speed 2
Operation Warp Speed was the US government effort to concentrate funding and regulatory support on the development of the COVID-19 vaccines. With OWS, the world saw successful, cutting-edge mRNA vaccines deployed in record time — not even a year after the pandemic was declared. 1Day Sooner advocates for the adoption of the Operation Warp Speed model for other diseases, especially ones we know have high pandemic-causing potential.
Following our Operation Warp Speed conference in Washington, D.C., in November 2022, 1Day Sooner published our white paper: Operation Warp Speed 2.0: Accelerating the Next Generation of COVID-19 Vaccines and Treatments. This paper includes policy recommendations for how best to institutionalize the successes of the original Warp Speed to similarly accelerate medical countermeasures against future outbreaks as well as other medical products of high social value. We focus on what we consider to be the most promising areas — regulatory authorization and market shaping incentives (advance market commitments).
Advanced Market Commitments
Vaccine development is extremely expensive and it can be difficult to ensure that the market will allow vaccine developers to recoup their research and manufacturing costs. This, in turn, demotivates would-be developers from conducting research.
An advance market commitment (AMC) circumvents this problem by guaranteeing a profitable market before the vaccine’s development. In an advance market commitment, organizations or governments agree to purchase a set amount of vaccine doses at a set price once the vaccine is approved. This mechanism incentivizes development by assuring the vaccine developer that their efforts will pay off and ensures that the vaccines can enter the market at a reasonable price. This dynamic means an advance market commitment not only helps a vaccine reach the market but also makes the vaccine more accessible once it does.
AMCs can be used to prepare us for the next pandemic. We already have a good sense of what pathogens are most likely to cause serious outbreaks that could evolve into pandemics (see the WHO’s priority pathogens list). But before a pandemic, there’s not much incentive for the private sector to intervene. This could be fixed by a government guarantee in the form of an AMC to purchase successful vaccines or treatments that meet certain thresholds. This way, political debates over funding can be partially circumvented, because money will only be spent if there is a successful end product.
1Day Sooner’s report, An Advanced Market Commitment to Incentivize a Universal Coronavirus Vaccine Before the Next Variant, highlights just how much value could be generated by using an AMC to stimulate the development of a universal coronavirus vaccine.
AMCs require clear-cut, precise definitions of what an acceptable end product looks like, called Target Product Profiles (TPPs). Here you can read the TPP Playbook for developing TPPs, and here you can see a TPP for an intranasal COVID-19 vaccine.
Indoor Air Quality Interventions to Fight Disease
We did it for water, so why don’t we do it for air? If we cleaned the air like we clean public water, we could drastically reduce the threat of numerous respiratory diseases like influenza and COVID-19. In the 20th century, many countries saw sustained, successful efforts to decrease chemical and industrial pollution in the air, but airborne pathogens still remain a blindspot. 1Day Sooner conducts research and advocacy efforts to spur further research into and adoption of indoor air quality interventions, particularly the use of germicidal UV light (GUV) that can kill pathogens but does not harm humans.
Like we use chlorine to clean our water, we may end up using far-UV light, proper filtration, and ventilation to rid the air of contamination on a massive scale. Air Safety to Combat Global Catastrophic Biorisk, a collaborative effort between 1Day Sooner and Rethink Priorities, outlines the next steps to get there.