How are companies responding to COVID-19 and are they prepared for the next potential pandemic?
The COVID-19 pandemic has demonstrated companies’ ability to rapidly mobilise in the face of priorities, but how can we better prepare for the next pandemic? This special report describes how some companies responded to COVID-19 and what is needed to prepare for the next potential pandemic.
Despite rapid action from some companies in response to the COVID-19 pandemic, the fragility of the industry is troubling when it comes to halting the pandemic. A larger group of companies is needed, both to address the health needs of COVID-19 and to prepare for the next pandemic. This long read special report describes how some companies responded to COVID-19 in the areas of activity looked at by the Index, including R&D, equitable access and IP management, and the lessons learned that will help the industry prepare for the future.
R&D targeting COVID-19
During the period of analysis*, 17 of the 20 companies in the scope of the Index were active in R&D for COVID-19 patients. They had a total of 63 projects in their pipelines for COVID-19. Of these, only five are antivirals, with nine vaccines and 11 antibody-based treatments. The rest aim to repurpose existing medicines for COVID-19 patients. Prior to the COVID-19 outbreak, no companies were conducting R&D on coronaviral diseases.
While there are products being developed for treating COVID-19 patients, there was little evidence for structures for ensuring access to these products in low- and middle-income countries. Seven out of 24 late-stage coronavirus projects analysed (Phase II or III) were covered by an access plan, such as a licensing agreement or pricing commitment.
The Index has assessed R&D projects targeting 16 diseases identified by WHO and Policy Cures Research as emerging infectious diseases (EIDs), including coronaviruses such as COVID-19.[1,2] Such diseases pose the greatest public health risk due to their epidemic potential and/or because there are insufficient or no countermeasures. The majority of these diseases are unaddressed, with no companies involved in R&D for 10 of the 16 emerging infectious diseases identified.
Sharing IP to accelerate COVID-19 R&D
The Index also examines whether companies share intellectual property (IP) assets with other researchers under terms designed to improve access to medicine. By sharing assets such as compound libraries, proprietary processes or technologies, companies can speed up the development of much needed new products.
Eighteen companies reported sharing IP assets with third-party researchers for COVID-19 research: AbbVie, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eisai, Eli Lilly, Gilead, GSK, Johnson & Johnson, MSD, Merck, Novartis, Pfizer, Roche, Sanofi and Takeda. However, companies are not involved in such platforms for all the other emerging infectious diseases identified. There is a need to expand beyond the existing focus of IP sharing agreements to improve preparedness for a potential future pandemic.
Responsible IP management to boost access
A rising concern amongst countries is that once a treatment or vaccine is approved for sale, the availability and accessibility will be limited. In October 2020, India and South Africa called upon the World Trade Organization (WTO) to allow countries to neither grant nor enforce patents and other IP rights to COVID-19 products for the duration of the pandemic. Such measures can enable generic medicine manufacturers to manufacture and supply products in certain geographic areas.
In March 2020, it was announced that AbbVie would waive its global patent rights on lopinavir/ritonavir (Aluvia®/Kaletra®), an HIV medicine, which was being tested as a COVID-19 treatment. In May 2020, Gilead signed a non-exclusive voluntary licensing agreement for remdesivir (Veklury®) with generic medicine manufacturers in Egypt, India and Pakistan to further expand its supply.
A rising concern amongst countries is that once a treatment or vaccine is approved for sale, the availability and accessibility will be limited.
Ensuring equitable access to products in response to COVID-19
Awaiting COVID-19 treatments and vaccines to become available and accessible, it is important that vulnerable populations are supplied with essential medicine and diagnostics, for NCD and respiratory diseases. For example, in July 2020, Novartis launched a not-for-profit portfolio for the treatment of symptomatic COVID-19. The portfolio included 15 medicines from Sandoz, Novartis’s generic medicine division, and was made available at zero-profit to governments in up to 79 low-income countries (LICs) and lower-middle income countries during the pandemic and until a vaccine or a cure is available.
Companies also engaged in various donations including financial contributions, equipment such as PPE, medicines for the treatment or diagnosis of COVID-19, medicines for co-infections or underlying diseases posing a risk for the disease pathway such as diabetes.
Building resilient supply chains in a pandemic
As a result of the COVID-19 outbreak, 2020 saw huge spikes in supply chain disruption. Production and exports, for example, in China and India — the world’s largest producers of active pharmaceutical ingredients (APIs) and generic medicines — were impacted by efforts to limit the spread of the virus through national lockdowns and border closures. This in turn affected supply chains worldwide with knock-on effects downstream and throughout the year.
At least eight companies reportedly took measures in response to/in anticipation of the supply disruptions caused by COVID-19. For example, Bayer, GSK, Novo Nordisk and Novartis mobilised dedicated teams to provide support and guidance to local and global supply chain activities, aimed at ensuring continuous supply of the existing portfolio.
Johnson & Johnson in collaboration with the Pandemic Supply Chain Network (PSCN) conducted a series of cold chain assessments in sub-Saharan Africa to identify gaps and areas where private companies like Johnson & Johnson can help in building cold chain capacity. Building on this initial mapping and gap analysis, the coalition aims to develop assessment tools to provide ongoing cold chain assessment capability for countries and partners.
Supporting health systems in low- and middle-income countries
Health systems around the world have been hit hard by the COVID-19 pandemic. The pandemic has put additional pressure on health systems and exposed existing gaps. Alongside the direct effect of COVID-19 on people’s health, studies have suggested that it will indirectly result in millions of deaths from other communicable diseases such as malaria, TB and HIV/ AIDS due to reallocation of resources.
Some companies have taken measures to support health systems by often leveraging or adapting the networks and activities they were already implementing. For example, Bayer and PATH shifted their focus in their community health workers training and outreach programmes in Senegal from malaria to COVID-19. Further, Bayer engaged in a partnership with Access Afya (AA) on COVID-19 with the aim of improving access to primary healthcare services in Kenya during the COVID-19 pandemic.
Little prepardeness for the next pandemic
In summary, COVID-19 is showing the industry how to accelerate R&D and better prepare for the next pandemic but challenges remain. The lesson of COVID-19 is that pandemic preparedness requires a robust and diverse range of private and public sector entities to be aligned and engaged in research against EIDs.
Partners must accelerate the passage of products through clinical development and approval, and manufacture and supply at global scale. R&D targeting EIDs must begin before epidemics break out, for example to develop platform technologies or to share IP to accelerate discovery and development. Ending a pandemic requires suitable products to be developed and fairly distributed so that people in LMICs are not last in line or left behind altogether.
- More companies engage in emerging infectious diseases R&D, yet the vast majority of these efforts (80%) are focused on COVID-19. There is little preparedness for the next pandemic: there are no projects in the pipeline for 10 of the 16 diseases identified as the greatest public health risk.
- The lag in access planning for COVID-19 R&D, despite hefty public funding, suggests that pharmaceutical companies and their partners must do more to embed equitable distribution into their strategies so that many more people can quickly benefit.
- COVID-19 has revealed some companies’ agility and adaptability as part of their health system strengthening efforts, leveraging existing networks in response to COVID-19. However, the shift of focus away from crucial public health issues may hinder progress in other disease areas.
- A limited number of companies have shown the ability to react to and anticipate significant supply chain disruptions. As part of these responses, companies need to ensure that low- and middle-income countries are not overlooked. Given that some vaccines need to be stored at temperatures as low as -80 degrees Celsius, the companies manufacturing them must ensure that cold-chain supply and storage challenges are accounted for and resolved so that the vaccines can be rapidly deployed upon approval.
- Beyond COVID-19, initiatives such as the non-enforcement for AbbVie’s lopinavir/ritonavir (Aluvia®/Kaletra®), the Novartis not-for-profit portfolio and Novo Nordisk’s first ever insulin donation to the WHO have positive effects on access. Some of these products are key treatments needed across a wide range of diseases, including HIV/AIDS. Such efforts should continue after the COVID-19 pandemic.
- Companies need to make sure that when vaccines are approved, doses are fairly distributed according to population vulnerability and needs. In November 2020, high-income countries had bought up more than 50% of the volume of the leading candidate doses, representing only 14% of the world population.
*Period of analysis: 1 June 2018 - 31 May 2020
** Some of the 63 projects identified for COVID-19 are not included in this figure as the companies responsible have not given permission for them to be disclosed.
 World Health Organization. Prioritizing diseases for research and development in emergency contexts.2020. https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts. Accessed December 23, 2020.
 Policy Cures Research. R&D Needs for Global Health. https://www.policycuresresearch.org/r-and-d-needs-for-global-health. Accessed December 23, 2020.
 So Anthony D, Woo Joshua. Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis BMJ 2020; 371 :m4750.