How will the new coronavirus pandemic end?

It could prove to be seasonal, meaning it peters out with the weather with a chance of returning at this time next year. A significant plurality of all people on Earth could contract the disease—prolonging its duration, slowing it over time through a gradual buildup of herd immunity, and inevitability leading to the death of millions. Or one of the many pharmaceutical companies hard at work on inventing a vaccine could succeed and administer their product widely and cheaply, though at least a year will go by before this comes to pass. 

Our best option—the option that will save the most lives in the least amount of time—is to accelerate the development of therapeutic antiviral drugs that treat infection and prophylactic antiviral drugs that prevent infection. Two approaches can realistically achieve this. The first is to repurpose existing antivirals. The second is to develop de novo, from scratch. Pharmaceutical companies and national health agencies have begun to pursue both strategies aggressively as the Covid-19 outbreak intensifies.

Lucky for them, a massive corpus of laboratory studies conducted around past coronavirus outbreaks already exists—remnants of drug discovery efforts marshaled around SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) that never came to fruition. Much of the preclinical and phase I clinical trials showed promise and, had they advanced to the stages required for FDA approval, we might have had therapeutic or even prophylactic antivirals in our possession on the eve of Covid-19. What happened to halt the pipeline then, and how can we accelerate it now?

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Originally published on Forbes (April 3, 2020)