Thread by @JeremyFarrar

Great pleasure to join the @isirvAVG Therapeutics Meeting.
Thank you to Alan Hay & Fred Hayden & Organising Committee.
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1) Critical need for therapeutics for COVID19 in prevention, treatment & to halt progression of illness. Understandable focus globally on vaccines but even when we have vaccines we will still need therapeutics (& Diagnostics & Health Systems to make them available).

Always good to remember that for many infectious diseases we do not have vaccines despite many years of great effort & we know therapeutics can play critical role in reducing transmission, burden disease & save lives - HIV, TB, Malaria, Dengue & many others.

2) Need to understand underlying causes of infection & pathogenesis through discovery science - virology, transmission, host & pathogen genetics, immunology, PK:PD & to see this as a multi-system infection, not only respiratory.

To understand the rapid dynamic of the infection, the changing course of the illness through the acute phase, the causes of deterioration & the 'Long-COVID' clearly a major clinical impact.

How therapeutics work across all ages, genders & in those with co-morbidities & how specific drugs work alongside best clinical care, oxygen, fluids others.

3) Lessons other acute dynamic viral infections:dengue,flu, MERS,SARS-1 etc. But not assume what might be true others will be true in a novel infection with no or limited immunity. Anti-infection drugs are invariably better when given early, but may be benefit throughout illness.

4) Experimental medicine studies in small groups of patients are critical to understand pathogenesis & how treatments might work. But when logic & early evidence critical to assess these treatments in large, prospective randomised controlled trials with comparable outcomes.

Tribute to @WHO Solidarity, #RECOVERY, @NIH, @isaric, @EDCTP @EU_Commission, China & other networks assessing new & repurposed drugs at scale to know what works & what does not. Avoid politicisation of clinical trials, medicine & public health.

Throughout COVID pandemic there have been too many small clinical trials that cannot provide definitive answers to critical questions & too many claims of what works without the evidence needed to help patients.

5) Setting up clinical trials in a crisis is (almost) impossible. These networks have to exist all the time, providing important clinical evidence on issues important when there is no epidemic & able to pivot to work on epidemics when they happen.

Depend on trusted relations,sustainable funding,dedicated teams & bring value in inter-epidemic periods & be able to respond when situation changes.The basis of @isaric & similar networks @NIH, Red Network Mexico, EDCTP, PREPARE in @EU_Commission & others isaric.tghn.org

This all needs open interactions & collaboration across borders, across teams, with academia, industry, Govt & philanthropic funding & critically industry. Regulators must be engaged throughout helping to defining what is needed to move from idea to reality

6) Amid horror COVID19 will be huge advances understanding & treatment for acute viral infections, focused on COVID, but with impact many other infections for which we do not have good treatments & preventative therapies now whether anti-viral, immune modulators, combinations etc

7) We must ensure the understanding, new & repurposed treatments are accessible globally those who need them. Global access at centre of what we do for COVID - for diagnostics, treatments, vaccines, oxygen, PPE & Health Systems. This is the ACT-Accelerator who.int/initiatives/ac…

If we get this right in crisis COVID, we can ensure the scientific advances enhance & save lives globally from COVID, but also are applied to treatment, manufacturing, distribution & access to treatments for other critical illness, that mAbs are available & affordable globally

For COVID, other infections, but also for the treatment of cancer, autoimmune diseases, for snakebite & others. This requires the discovery science, the R&D, changes to manufacturing & distribution. And with access at its core mission.

Best wishes for the @isirvAVG Conference - a huge challenge, but one that can be met, & which will make a huge difference to COVID, but also beyond COVID.
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