Esther Krofah: Vaccines, Variants, and Lessons for the Next Pandemic

Esther Krofah, executive director of FasterCures, talks to COVID-19 Africa Watch about the public health lessons learned so far from the COVID-19 pandemic.

Interview

Key Takeaways

Below are some of the main takeaways from COVID-19 Africa Watch’s conversation with Esther Krofah, executive director of FasterCures, a center of the Milken Institute, which works with its partners to build a patient-centric system where science is accelerated, unnecessary barriers are overcome, and lifesaving and life-enhancing treatments get to those who need them as rapidly as possible.

  • The medical community has learned a great deal over the last year, particularly on the treatment side of the fight against COVID-19. Hospitalization results in death less often now than at the beginning of the pandemic.
  • The big story is the development of several viable vaccines. The speed at which these vaccines were developed reflects at least three factors: 1) increased collaboration among government, the scientific community, and the private sector; 2) financial investment by government in vaccine candidates that had not yet been proven effective (which was highly uncommon prior to the pandemic); and 3) the pay-off of many years of investment in mRNA technology and research.
  • Vaccine distribution is a race against time against the spread of variants, which are more transmissible and, as a result, more deadly. In general, though, the world should be moderately concerned about variants and should keep them at bay by maintaining current COVID-19 safety protocols.
  • Three main lessons have emerged from the COVID-19 experience that can help societies prepare for the next pandemic. First, there should be continued investment in medical technologies and medical research. Second, there needs to be more investment in public health systems, at both the international and the local levels. And third, the private sector has proved to be a key player during the current pandemic and should be better integrated into public health planning and the public sector response.

The interview was conducted by John Schellhase, a director of global market development at the Milken Institute. A transcript is available below.

Transcript

Interviewer

Hi, my name is John Schellhase, and I am a director of global market development at the Milken Institute, where I also run our COVID-19 Africa Watch website. I’m joined today by Esther Krofah, Executive Director of FasterCures, which is a Milken Institute center that focuses on some things that are very relevant to our current world situation: accelerating scientific discovery, breaking down barriers to the discovery of new cures and treatments, and making sure those treatments can extend life and enhance life.

Esther, great to see you. How are you?

Esther Krofah

I am doing well. Thank you so much for having me.

Interviewer

We’re really happy to have you here. And obviously FasterCures has been doing some very important work during the pandemic. I want to hear a little bit about that. Our overall arc for this conversation is we’re going to hit three points. We’re going to start talking about vaccines and therapeutics. We’re going go from there to talk about the different variants around the world, and then we’re going to end up thinking about lessons we’re learning now for the next pandemic.

So let’s start at the beginning of that with this issue of vaccines. Now, FasterCures has been tracking vaccines and projects around the world. Could you give me an update about kind of your tracker and where things stand there?

Esther Krofah

Yes, John, in fact this conversation comes at a great time as I was reflecting, we’re about a year since we started tracking the development of vaccines and therapeutics for COVID-19. I’m sure like much of the rest of the world, about this time last year, many of us started working from home really thinking about what does this mean for our lives? We looked across the work that we do at FasterCures and said, “Well, how can we be helpful?” And one of the first things that we did was create this vaccine and therapeutic tracker, really to help understand what is useful in trying to mitigate against this virus.

Looking at where we are now, there are over 324 treatments that are still in development for COVID-19 against all the various parts of the disease condition. Whether from individuals who are mildly ill to individuals who are severely ill, those efforts continue.

The FasterCures COVID-19 Treatment and Vaccine Tracker provides a comprehensive view of all COVID-19 treatments currently in development. Learn more here.

Certainly, a lot of attention has been placed on vaccine and development of vaccines for COVID-19. We have over 250 different vaccine development efforts around the world. When we started this tracker back in March, we were tracking about three dozen total of both vaccines and therapeutics. And to see that we’re now over 500 in terms of those efforts is incredibly outstanding in terms of what the world has been able to do.

So where are we? On the treatment side, I will say that we have learned a lot. We’ve learned a lot about the virus over the last year plus. We have a number of treatments that are effective to some degree for patients that are hospitalized. We have early answers on things like Dexamethasone or Remdesivir or monoclonal antibodies that help patients in the outpatient setting. But certainly we have seen the death rates decline dramatically, not just because of these therapeutics and medicines, but also the supportive care as doctors are learning a lot more about how to manage patients who need oxygen and the like.

“The big story is on vaccines.”

The big story is on vaccines. We’ve certainly seen a number of them come over the finish line with emergency use authorizations here in the US, but also around the world. Very important to note that we do need these vaccines distributed around the world, I’m sure we’ll talk about that, but seeing Pfizer and Moderna and recently J&J, certainly AstraZeneca in the UK, really have been able to make a big difference in individuals, particularly those who are high risk, get the vaccines and really help to blunt the effect of the transmissions that we’re seeing right now.

So a good story that’s coming out on the vaccine side, that if we talked about this last year, we probably would not have been at this point.

Interviewer

Well, let me ask you about that because it’s been very fast. And as the Head of a center called FasterCures, I imagine you have some insight into how that speed was achieved. What are the lessons in terms of the process of developing these vaccines over the last year?

Esther Krofah

Yes, now I do think the speed certainly is something that we have been very much paying attention to because we think about how can we apply this process to other disease conditions as well, as our name implies, wanting to ensure that we’re moving faster and safely, of course.

What happened in the course of COVID-19 I think were a number of things. One, increased collaboration. The scientific community as a whole turn their attention toward COVID-19, leveraging whatever capabilities they had and assets they had to try to find what could be helpful. We also saw significant investment by governments around the world in committing advanced manufacturing for vaccines in particular, even before we knew whether or not they would work or be effective. That is not something that we typically see in any kind of vaccine development efforts.

“This is building on many years of investments in technologies like mRNA. We moved faster because we were leveraging prior assets that we have studied, that we’ve investigated for other potential infectious diseases.”

The third thing I would say, which is really something that we should note for people who are hesitant about the speed of this, is that this is building on many years of investments in technologies like mRNA. We moved faster because we were leveraging prior assets that we have studied, that we’ve investigated for other potential infectious diseases. It happened to be a tool at our disposal that we could very quickly tap into for COVID-19.

Interviewer

Thanks for that. It’s been remarkable to watch. Can I ask about where we are now? Some countries like the United States and others are moving very quickly on distribution, and some countries have really achieved incredible things in terms of vaccinating their populations. Other countries are still at the starting line of this process. How do you view the  global access to vaccines and what should we be thinking about over the next few months?

Esther Krofah

We are getting underway with vaccine distribution. We’re seeing fits and starts to that process. Certainly, here in the US, we had a slower process at the beginning, but it’s really quickened. But what you talked about really is the goal, which is we need to get these vaccines distributed all over the world. We have seen organizations like CEPI, GAVI, the WHO worked through the Act Accelerator through the COVAX facility to ensure that countries around the world that cannot engage in these bilateral agreements with the big pharma companies that have these vaccines be part of a pooled joint venture, if you will, to try to procure vaccines for their countries. And the great news out of that, is through the COVAX facility, 32 million doses of vaccines have been made available to participating countries.

That is a big win. We saw that distribution start in February. Ghana in West Africa was one of the first countries that got access to these vaccines, which is fantastic. Because in any typical year for any new vaccine, a new medicine, it takes many, many years to get it distributed around the world. So, I think that’s a significant achievement. Of course, we have seven billion people around the world. So the work is cut out for us in terms of getting that distribution globally, but this is a remarkable achievement on behalf of the work that’s happened through the COVAX facility.

Interviewer

Thanks, Esther. I want to turn now to this theme of variants. How concerned are you about variants overall?

Esther Krofah

Variants I think are something we need to be concerned about, we need to watch for.

So I think right now it’s really a story of cautious optimism, which is that there are three variants of concern around the world, the B117, which was first identified in the UK, the B1351 first identified in South Africa, and the P1 variant first identified in Brazil. And what’s of concern is that these variants are more transmissible than the original wild type COVID-19 virus. And if it’s more transmissible, we’re likely to see more people infected and unfortunately, more hospitalizations and then more deaths.

What’s mitigating all of this is the vaccines. So I think right now we’re in a race against the variants. We saw how quickly it spread in the UK. There was a huge spike that went up around the December timeframe because of that variant. Same thing in South Africa with that variant. And we’re beginning to see that around the world as well.

How concerned should we be? I think we should be moderately concerned, but we need to do everything that we can right now to get as many people vaccinated as possible, especially given that some of these vaccines may be less effective in certain types of variants, for example, the South African variant. And we’re learning much more about the Brazilian variant. So a lot for us to make sure that we stay ahead of these variants, and certainly we should not let down our guard.

Interviewer

You said we should be moderately concerned. So is our attitude just going to be ‘wait and see;? Or how should we be looking at this?

Esther Krofah

Yes, I think we should ‘wait and see’, but there are things that we can do. They are the same things that we have been doing. I know that we are all tired. We all want to get back to our lives as normal, throw away the mask, stop the social distancing, get back out there to the ball games, but we still need to continue those same mitigation efforts that we’ve had so we can get the caseloads down. The caseloads come down, the potential for the virus to spread also goes down, which will really allow us to get past this much more quickly than what we were likely to see.

Interviewer

Okay. Thank you, Esther. That’s fascinating actually. Considering these current variants and also thinking about the fact that this is not the last pandemic we’re likely to see, what are the lessons that you think are the most important to take away from the experience of the past year in terms of how the world has managed the health crisis caused by COVID-19?

Esther Krofah

I would say three things, John. First, I think we need to acknowledge how completely devastating this pandemic has been. When I looked at numbers recently, we are approaching millions of deaths around the world that we did not necessarily have to see, over two million deaths around the world, which is actually quite saddening. We’re seeing over 550,000 deaths here in the US, and many, many more that have been infected.

I think that’s the starting point, as well as just the devastating economic impact that many families have had to suffer. Those facts are sobering because it allows us to be much more proactive with these lessons learned. I would say three things.

“The first in lessons learned is that we need to continue to invest in medical technologies that allow us to be better prepared going forward.”

The first in lessons learned is that we need to continue to invest in medical technologies that allow us to be better prepared going forward. I will say that we benefited from the previous investments that were made. For example, I mentioned the mRNA technologies. As a global community, we need to continue to invest in our medical research enterprise.

The second thing is that we need to invest in our public health systems. We have significantly underfunded our public health systems globally and at the very local level, from contact tracers to labs and facilities that can test for viruses and respond and mitigate them very quickly, ensuring that organizations like WHO and others have the resources that they need in order to act quickly. We cannot relent when we get past this pandemic.

The third thing I will say is the role of the private sector. We did see the private sector step up, put aside competitive interests to really help us as a global community. There are technologies that lie in the private sector that we can better utilize in the course of any future pandemics. For example, in our work at FasterCures, we’re working on an initiative around an early warning system.

There are technologies, including global genome sequencing technology, that can really help us in the future identify viruses, sequence those viruses, get that data to the scientific community for mitigation and response efforts.

So we should not neglect the role of the private sector, which would give them a way to play within the public health community and global responses that I think we’re going to need very much into the future.

Interviewer

Thank you for that. I think those are three incredible takeaways for where we are. Could you tell me a little bit more about the early warning system? I’d like to hear more about that.

Esther Krofah

Early on in the pandemic, we started to have conversations with many stakeholders around the question, how did we get here? What do we need to do differently? One of the things that emerged is, well, we have the ability to be able to identify early viruses, whether they’re viruses emerging from animals or humans with the potential for spillover effects. For example, when you see animals and humans start to interact in environments that are closer than probably what is safe, we can start to detect potential for these events occurring.

And so we created an advisory group to help us think about, well, what would such an early warning system look like if we can predict and then identify viruses before they turned into either epidemic or a pandemic? That advisory group has been with us over the last several months as we’ve undergone a series of roundtable discussions to create this vision for an ideal early warning system to thwart any future pandemic. We’ve talked about things like data, data collection, new technologies that I mentioned, including genome sequencing technology. We’ve talked about ways that we can collaborate and coordinate as a global whole. And all of that work and effort will result in a white paper that we’ll be releasing later on this spring, but really, it’s a starting point for discussions and moving toward implementing this early warning system very much with WHO and other multilateral organizations as partners.

Interviewer

Esther, thank you so much. And thank you for all the work you’ve been doing this last year at FasterCures. My hats off to you and your colleagues and my colleagues at the Milken Institute for the work you’re doing. And thanks for taking the time to talk with us today here at COVID-19 Africa Watch.

Esther Krofah

Thank you for having me.

 

 

 

via COVID-19 Africa Watch
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