Covid-19 emergency disrupts the fight against other diseases

As scientists across the world scramble to develop a vaccine for coronavirus, swathes of pharmaceutical firms have been forced to press pause on clinical trials.

Hundreds of trials in the UK have either been cancelled or delayed as laboratories refocus their resources to prioritise frontline care for Covid-19 patients.

“Covid has had a devastating effect on everything that we do the way we work, our personal lives and it’s had a devastating effect on the NHS, which provides the facilities in which the clinical research is undertaken,” says William van’t Hoff, chief executive of the National Institute for Health Research (NIHR).

“The NHS has had to refocus its work towards Covid and is under huge pressure and so much of the elective routine work that the NHS has traditionally done has had to be paused, which means clinical research has had to be paused.”

According to the NIHR, some 57pc (equivalent to almost 800) of clinical trials in the UK are pressing ahead as planned during the crisis. This research is able to continue due to it being deemed vital to patients’ well-being, the NIHR says, but is also contingent on the capacity available to hospitals which enable firms to carry out the trials. Determining whether it is in the best interests of a patient to go ahead with a trial can create a moral dilemma for firms. They must choose between the risk of bringing a patient into a hospital during a pandemic or delaying the trial for an indefinite period of time.

“There are very challenging ethical decisions around what the best way forward is,” van’t Hoff adds.

“Some of those decisions are within our power. And some of them are not within our power because of the constraints that Covid has imposed upon us societally and globally.”

Drugs firms and scientists are unanimous in the view that fighting coronavirus must take precedence in the current environment, but some experts are concerned about the implications for companies, particularly among smaller biotech firms. Industry trade body the BioIndustry Association is in talks with the Government over securing funding for the sector, which by and large is reliant on the pace and speed of research being approved.

“The companies that are going to feel the pinch the most are going to be the smaller biotech companies,” one senior banker says.

“A lot of these companies survive off the timing of when they’re going to be able to announce positive clinical data. And if they don’t, then they have to think about how they scale down a little bit in order to just not burn cash until things get going again.”

Social distancing measures have also had a detrimental impact on sourcing candidates to participate in trials for certain diseases.

One such example is trials to develop vaccines for respiratory syncytial virus, a seasonal virus which can cause bronchiolitis in children. With RSV passed on in a similar way to coronavirus, infection control measures have inadvertently resulted in decreased circulation of the virus.

Emily Carter-Richardson, pharma analyst at GlobalData, says that while this is positive for a population with an already stretched health system, lower overall prevalence could have a detrimental effect on candidate vaccines currently in development, such as those being carried out by GlaxoSmithKline, Johnson & Johnson and Pfizer.

“Vaccine clinical development is often troubled by failure to demonstrate protective efficacy, and this is particularly a problem for infectious diseases with low prevalence,” she says.

“Consequently, the only option a company may have is to extend trials, to include RSV seasons in 2021 or 2022 that hopefully will not be impacted by Covid-19–related infection control measures – if not, vaccine developers risk the possibility of missing the primary endpoints.”

With around 7,500 molecules across all types of diseases in development within the UK life sciences sector, experts say it is vital to get clinical trials back up and running to ensure potential medicines of the future work and are safe.

Sheuli Porkess, a director at the Association of the British Pharmaceutical Industry, says: “We need to make sure we learn from what’s happening now because when you look at Covid research we’re seeing studies approved at incredible speed. We’re seeing new ways of doing trials and different ways of thinking about the research and those are are important for all research across all disease areas, not just Covid.”

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