Opinion: Pandemic preparedness

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Martin Stocks, CEO of Iceni Glycoscience, discusses how preparedness for the pandemic relies on leveraging the technologies and insights of innovative startups.

I was privileged to receive an invitation to attend the Coalition for Epidemic Preparedness Innovations (CEPI) Summit earlier this month. 

CEPI – which has been largely founded by the Bill & Melinda Gates Foundation and Wellcome Trust - has already proved its value many times over during the course of the Covid-19 pandemic, in terms of coordinating the vaccine rollout and championing vaccine-sharing with poorer nations.

Indeed, it was truly impressive to see at the Summit so many governments, NGOs, agencies and companies from all over the globe and across sectors, academia through to corporate – with a clear intent for them to work in harmony to address a serious global issue.

CEPI’s five-year pandemic preparedness plan lays out a $3.5 billion roadmap to compress vaccine development timelines to 100 days. And, on top of that, the foundation is funding the development of a broadly protective Betacoronavirus vaccine using mRNA platform technology. 

The five-year “moonshot” will undoubtedly be challenging but it’s a very worthy goal. One thing’s for certain, you don't achieve anything like that unless you actually set out to do so.

To put the 100-day target into perspective, the ‘rapid’ Covid vaccines took approximately a year to bring to market - nearly four times as long as CEPI’s ambition. These were started from an already advanced position as the SARS-CoV2 vaccines built on a lot of early development of vaccines for SARS and MERS, which allowed the main players to “plug in” the SARS-CoV2 spike proteins into an existing vaccine platform. 

The 100-day mission is therefore going to require an enormous amount of resource and coordination. It will require adaptation across the whole landscape of vaccine development, from R&D all the way through to regulatory process and distribution of the product.  

A key aspect of the R&D proposals is the production of prototype vaccines. CEPI is asking people to look at the types of virus or bacteria most likely to cause a problem and then make a ‘model vaccine’ for every single one of them. This would produce a starting point for each pathogen family, providing an advanced starting point for the development of a vaccine to “Disease X”, with much of the R&D legwork already done. 

It's entirely doable – although, effectively, you're spending years developing a vaccine that may never be used and for which you may never receive any commercial return, so the effort will require direct financial support for the innovators.

Moderna and the mRNA technologies in general received a lot of kudos at the Summit and quite rightly so; mRNA, being such a phenomenally powerful and flexible platform, will undoubtedly play a major role in sorting out the next viral pandemic. 

However, there is a danger that stems from their being feted as the Great White Hope for future vaccine development.  mRNA is not a universal panacea and there are plenty of bacterial pathogens where an mRNA approach would be difficult, if not impossible. For example, you can't put a single mRNA into somebody and expect it to make a bacterial glycan. It just won't happen.

And that’s why it’s important for CEPI to keep leveraging revolutionary science, new technologies, and the insights and opportunities offered by the innovative startup community across the board of technological platforms.

For me, the highlight of the Summit was the announcement of CEPI’s $42million investment in Cambridge biotech startup, Diosynvax – a partnership that will support the University of Cambridge spinout in developing a vaccine candidate which could provide protection against existing and future variants of SARS-CoV-2 and other major coronaviruses too.

DIOSynVax uses a combination of protein structure, computational biology and immune-optimisation to maximise protection to outmanoeuvre and minimise future pandemic threats. What’s more, its vaccine candidates can be deployed in a variety of vaccine delivery and manufacturing platforms, including its own innovation, a needle-free jet injection.

It’s an extremely encouraging sign that CEPI is prepared to partner with a relatively small company that is doing something truly experimental - and I hope we will see more of these collaborations and projects with innovative UK startups.

We have already learned from Antimicrobial Resistance (AMR) that the traditional and safe bet of taking an existing antimicrobial drug and trying to modify it to overcome resistance is of limited value. If bacteria already have a starting point for resistance, it is inevitable that resistance to the new variant drugs will appear quickly, and in some cases drug-resistant variants have been detected even before the drug gets to market. It is clear that completely new targets and modalities are required.

In the case of bacterial vaccine development, the key antigens are often glycans or glycated proteins or lipids. In this circumstance, mRNA technologies cannot deliver a vaccine as many of the bacterial sugars that are used to make their capsules and cell walls simply don't exist in people; you can't code for them because the raw material isn't there in the body to make them.

So, as with AMR, there is a need for radically different proposals for vaccine development, which are at least as likely to come from small, innovative startups as from the large pharmaceutical conglomerates. There needs to be a step back to look at the broader picture - and an openness to adopt as many different technological approaches as possible in order to provide full coverage and protection against future microbial threats.

A significant strand of our work at Iceni Glycoscience is focused on bacterial pathogens of strategic importance, where there is clear potential to develop glycan-based solutions. We are one of the very few companies capable of delivering on this aspect of vaccine development – and it’s one which could greatly benefit CEPI’s pandemic preparedness picture.