This is also true of long COVID drug development. In August, the NIAID took over the clinical trial platform for this post-viral disease. Why the shift?
I mentioned before the ACTIV platform, which is how we got Gilead’s antiviral remdesivir studied immediately. And we used a similar platform approach to study a whole bunch of other treatments, like immune modulators and steroids, for COVID. We didn’t have to use any placebos and could do rapid assessments of drugs — quickly discarding agents that don’t work.
Many people have been asking for a similar approach for long COVID. The feeling in this community is that there hasn't been enough urgency to get a product here. If you talk to many people living with long COVID, you can really appreciate that a lot of people are suffering. We decided that it would make a lot of sense to apply a similar approach to long COVID under the NIAID. And in fact, we just opened the portal for people to submit ideas for drugs that can be tested, whether they're therapies or devices or other interventions. We really want people to submit ideas to us so that we can start getting some of these things into trials.
A challenge with long COVID is that there aren't a number of candidates that may work. There's no obvious treatment right now that screams ‘this needs to get studied immediately’. I think it's going to take some work. But we have to do it, and we have to do it quickly, because this is a really hard problem.
There is also uncertainty around long COVID pathobiology, appropriate endpoints and trial designs. In the case of HIV prophylaxis, it took decades to get from approved antivirals to effective PrEP. Any lessons from that experience for long COVID?
One thing we learned from COVID is that once we have good drug candidates, we can move really quickly. The challenge is that we don't have obvious candidates. But at a recent meeting about long COVID that we hosted, somebody reminded us that AZT [azidothymidine] was originally developed as a chemotherapeutic for cancer [in 1964] and was sitting on a shelf in the National Cancer Institute until somebody said we might want to look at it. Was AZT a game changer? In retrospect, not really; we learned pretty quickly that it wasn't going to be the full answer to AIDS. But, on the other hand, it opened the door to the possibility that we could actually treat this thing.
A lot of people were citing that as an example that we shouldn’t assume that we don't have something that might work for long COVID. We need to have an organized assessment of what we've got, and that's part of the reason we wanted to get that portal out there.