Blog article: Preparedness Planning on Public Health Emergencies (PHEs)

As the FPM’s Ethics and Practice Committee’s webinar series on Preparedness Planning for Public Health Emergencies enters its final stages, some dominant themes have emerged. The journey started by reviewing the particular role of the pharmaceutical industry in responding to such emergencies (particularly in the context of COVID-19) and looked in turn at the impact of COVID-19 on clinical research in vaccines and therapeutics as well as the particular implications for paediatrics, rare diseases, and cancer. The final two webinars of the series cover data and knowledge sharing aspects and the emerging ethical issues.

The series has brought the Faculty into the heart of the COVID-19 pandemic, with regard to pharmaceutical medicine but also considering the global response.  Inevitably attention has focused on COVID-19 and the public health emergency of the moment. Questions arose as to whether we had sufficiently learned the lessons of previous public health emergencies and if now, with a true pandemic running full course, we would make sufficient use of the webinars’ and other learnings in addressing future PHEs or even a second wave of the current one.

How pharmaceutical companies, clinicians and researchers have adapted to fit changed circumstances

In the first webinar in the series, we considered the ways in which the pharmaceutical industry had contributed to the response to the COVID-19 pandemic. An immediate priority was ensuring the integrity of the supply-chain to make sure that medicines remained available for all patients and all conditions. This seems to have been successfully achieved, in many countries, despite major challenges in delivering anaesthetic drugs for the increased numbers of ventilated patients. However, as we learned further into the series, the challenges of maintaining an adequate supply of medicines to LMICs were not always successfully overcome.

The next priority was working with academia to develop vaccines, what appeared to be the only long-term route to minimising the impact of the SARS-COV-2 and hopefully seeing an end to infections. In a webinar specifically examining vaccine development, the major scientific obstacles were described, in addition to some of the societal and funding challenges.[1] The adaptations to the normal development timelines required to respond urgently to the crisis were described and the challenge of scaling-up manufacture were emphasised. Fortunately, the level of collaboration between all involved has been impressive.

In a search for effective treatments, many pharmaceutical companies have been taking a closer look at their existing portfolio of products and examining where their products’ known mode of action may indicate potential utility in directly attacking SARS-CoV-2 or in reducing the impact of an overly-aggressive immune response, which has often been the reason for the most severe impact on those infected. We were also given a word of caution regarding the consequences for those with the condition for which a product was indicated, if supplies should be diverted to treat those with COVID-19 where the outcomes might be much less certain.[2]

We also heard how changes have been made in the way studies are conducted, with visits to treatment centres reduced whenever possible. As many of us adjust to increased remote working and video-conferencing, patients involved in studies will also often welcome the possibility of at least some visits being virtual ones. Blood samples can be taken in the patient’s own homes by visiting phlebotomists. An interesting recent development in remote monitoring offers utility in the current COVID-19 impacted circumstances. The use of wearable devices is becoming commonplace and the Internet of Bodies (IoB) is starting to rival the Internet of Things (IoT) as the best way of exploiting technological advances to the benefit of us all.[3] It is likely that adaptation to the challenges of COVID-19 will bring lasting benefits to the way we conduct trials. Patients may be more willing to be recruited to studies if the burden of clinic visits is reduced and more monitoring can be done remotely.