Viral threats surge in a warming world

Antiviral therapeutics for all are more critical than ever, says READDI CEO Jimmy Rosen on stage at the 2023 Milken Institute summit.

Six people sit on a stage during a panel discussion.

By READDI November 8, 2023 — During a panel discussion titled “Climate Change and Health: Creating Healthy, Sustainable Communities,” the growing threat of viruses was bound to come up.

And it did.

After noting that cases of locally transmitted dengue — a viral infection also known as breakbone fever — have begun emerging in Southern California, and that the World Health Organization’s chief scientist recently warned that dengue will likely become endemic in the southern U.S., panel moderator Carmen Paun, a Politico global health reporter, asked READDI CEO Jimmy Rosen if his team is working on antivirals for dengue.

“The answer is yes,” Rosen said. “We’re very focused on solutions.”

Rosen described how READDI is developing broad-spectrum antivirals — effective against multiple viruses in a given family — to prepare for the next new viral disease. Since the source is still unknown, virologists call it Disease X.

“Dengue comes from the flavivirus family, as does Zika and several other viruses that all of you have heard of,” he told the audience. A broad-spectrum antiviral that targets the flavivirus family “can be deployed against an existing disease [dengue] and help current populations, but you can also put that drug on the shelf for Disease X that may come out of the flavivirus family.”

But what about Disease X? What is the value of a portfolio of antiviral drugs for a disease that does not yet exist? That’s a much harder question to answer.”

Six people posing for a portrait in front of screen reading "Milken Institute Future of Health Summit 2023"
From left: Carmen Paun, Politico; John M. Balbus, Office of the Assistant Secretary for Health; Daniel Buss, Pan American Health Organization; Martin Edlund, Malaria No More; Jimmy Rosen, CEO of READDI; and Monique Vledder, World Bank Group.

The panel discussion took place on opening day of the 2023 Milken Institute Future of Health Summit in Washington, DC. The three-day event drew hundreds of invited speakers and attendees to share ideas and advance work around the theme “Closing the Gap: Better Health for More People.”

As a summit presenter, Rosen joined leaders from government, philanthropy, academia and research, including Xavier Becerra, secretary of the U.S. Department of Health and Human Services; Atul Gawande, surgeon, bestselling author and assistant administrator for Global Health at USAID; and half a dozen members of Congress.

Committed to global access

One worry, Paun said, is that people in the developing world with viral diseases like dengue will continue to be neglected, even as the U.S. and Europe wake up to the viral threat. How, she asked, will READDI prevent this from happening?

“READDI is a nonprofit organization, and a huge part of our ethos within the organization is a global access commitment,” Rosen said. “We will make these drugs affordable and accessible to everybody who needs them, when they need them, where they need them.”

Small molecule antivirals — pills that can be swallowed with a drink of water — are well-suited to equitable global access. Unlike vaccines, they don’t require refrigeration. They are shelf-stable and relatively easy to ship. READDI’s goal is to develop a portfolio of broad-spectrum, small molecule drugs that are active against entire families of viruses before Disease X emerges.

“In the time between the COVID outbreak and [when] vaccines were available, a million people died,” Rosen said. “And this in a disease that has a one half of one percent mortality rate. The next pandemic could be 20 times that. The ability to bring therapeutics that prevent severe illness, hospitalization and death to the point of care rapidly is something that we’re trying to make a reality at READDI.”

Given that the Milken Institute is a nonprofit think tank that “brings together the best ideas and innovative resourcing to develop blueprints for tackling some of the most critical global issues,” the discussion turned often to how to pay for public health problem-solving.

“Private investment follows incentives,” Paun said. “How can we create financial incentives for pharma and other large players to invest in control of diseases that are being aggravated by climate change?”

Pharmaceutical companies create drugs for markets that exist, Rosen responded. For instance, if there are X number of cases of a certain cancer each year, and you can develop a course of therapy in 10 years that you sell for $150,000 per patient, you can apply projections and calculate a probable return for investors.

Woman holding microphone speaks on a panel.
The World Bank's Monique Vledder responds, while Martin Edlund (left) from Malaria No More and READDI CEO Jimmy Rosen listen.

Bridging the ‘valley of death’

“But what about Disease X?” he asked. “What is the value of a portfolio of antiviral drugs for a disease that does not yet exist? That’s a much harder question to answer.”

READDI’s approach, Rosen explained, is to bridge the so-called “valley of death” between drug discovery and development by de-risking a portfolio of small molecule assets. “This is going to take the generosity of philanthropy and the investment of governments to de-risk these programs to the point that financially motivated investors will begin to participate,” he said.

“What you’re describing is spot on and is even worse for diseases that are almost exclusively happening in developing countries, like neglected tropical diseases,” said panelist Monique Vledder, head of global health, nutrition and population at the World Bank Group. “We’re looking at what can be the role of the [World Bank] in de-risking, [such as] advanced market commitments.”

Joining Rosen and Vledder on the “Climate Change and Health” panel were John M. Balbus from the Office of the Assistant Secretary for Health; Daniel Buss from the Pan American Health Organization; and Martin Edlund, CEO of Malaria No More.

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