As we emerge from the shadow of COVID-19, it’s clear that our global health security remains fragile. As the mpox outbreak continues to spread, the rise of a virus with various strains and modes of transmission has exposed the stark threat that epidemics and pandemics still pose, with antivirals yet to be developed and approved. We can’t afford to be complacent—the next global health crisis is not a matter of if, but when.
Consider this: Experts project that future respiratory disease epidemics could claim an average of 2.5 million lives globally each year. Even more alarmingly, we could face a pandemic on the scale of COVID-19 or worse every 33 to 50 years, with devastating human and economic impacts.
The COVID-19 pandemic exposed glaring weaknesses in our ability to respond swiftly to novel pathogens. Traditional antiviral drugs, while valuable, are largely specific to single viruses, and thus risk losing efficacy when new strains occur. This has been seen in COVID-19 and remains a concern in mpox with its distinct strains. In COVID-19, this meant that new, dedicated antivirals had to undergo development and lengthy regulatory pathways, and at-home antiviral drugs like Paxlovid were not available for nearly two years after the beginning of the outbreak.
The COVID-19 pandemic illustrated that speed is of the essence to limit infections and save lives, necessitating a new approach, and broad-spectrum antivirals could be the game-changer we’re looking for. These innovative antivirals offer the potential to combat a wide range of pathogens, including those we have yet to encounter. Think of them like the Swiss Army knife of antiviral treatments. Much like mRNA vaccine technology, these antivirals could be quickly adapted to new threats, providing a flexible and rapid response to emerging outbreaks.
The potential impact of having such tools at our disposal is staggering. Research from Germany’s Federal Agency for Disruptive Innovation (SPRIND) suggests that the early availability of antiviral therapeutics could prevent a mind-boggling $28.2 trillion in global losses during a COVID-like pandemic. This isn’t just about money—it’s about saving millions of lives and creating a world where we could nip a potential pandemic in the bud.
SPRIND’s modeling shows that with broad-spectrum antivirals available in the first 100 days, we could reduce severe infections and deaths to less than 1% of what we saw with COVID-19. In a future pandemic, that could mean saving 6 million lives globally and averting 91% of the kind of economic losses and disruptions to education that resulted from the last pandemic.
Given their transformative potential, why isn’t there a scramble to develop these kinds of drugs? The answer lies in a series of market failures that create a gap between what’s best for society and what’s profitable for businesses. The public health benefits of these antivirals—their ability to slow outbreaks and provide insurance against future, as yet unknown pandemic threats—aren’t reflected in their market price. The timing of future pandemics is unpredictable, which makes it risky for companies to invest heavily in drugs that might not be needed for years or decades.
Those life-saving antivirals are currently underpriced, so the ideal scenario of having them ready on day one of an outbreak doesn’t align with the profits that pharmaceutical companies stand to make from those treatments during a full-blown pandemic. It’s a classic case of private incentives not aligning with public interest.
To bridge this gap, we need innovative funding approaches. Traditional push funding, where governments directly fund research, has its place. But for broad-spectrum antivirals, pull funding mechanisms like advance market commitments (AMCs) could be more effective. An AMC is essentially a promise to buy or subsidize a product if it’s successfully developed. This approach shares the risk between taxpayers and investors, allowing us to pursue ambitious goals without putting all the eggs in one technological basket.
The concept isn’t just theoretical. SPRIND is collaborating with economists at the University of Chicago to develop a practical market-shaping mechanism for these antivirals. If thorny issues like how to structure payouts, navigate regulatory pathways, and balance current commercial uses with pandemic preparedness can be tackled, then it could kickstart innovation in this potentially life-saving technology.
The unpredictability of viral threats demands nothing less than a paradigm shift in how we prepare for and respond to pandemics. However, realizing this potential requires us to think differently about how we incentivize and fund medical innovation so we’re not caught flat-footed. By investing in platform-based broad-spectrum antivirals and creating the right economic frameworks to support their development, we can build a more resilient global health ecosystem. The next pandemic may well be inevitable, but with the right tools and strategies, its impact doesn’t have to be.
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