91ÌÒÉ«

Healthcare systems are always at the forefront of infectious disease outbreaks, epidemics and pandemics. They should be a top priority for interventions to protect staff and patients from infection, so the healthcare system can try to function normally while vaccines are being developed and deployed.

In the wake of the COVID-19 pandemic, the UK government conceived the 100 Days Mission (100DM) during its presidency of the G7. At the Carbis Bay Summit, international governments, the and the biotechnology industry committed to developing safe, effective and accessible vaccines within 100 days of identifying a new pandemic threat.

But even an accelerated vaccine process takes time to test for safety and clinical efficacy, scale up, and distribution before it can be deployed at a population level.

During the pandemic, it took 362 days to dose the first person, 90-year-old Margaret Keenan. She received the first licensed COVID-19 vaccine produced by Pfizer. Less than a month later, 82-year-old Brian Pinker received the first dose of the licensed AstraZeneca vaccine. Over the next year, the UK embarked on a mass vaccination campaign, the likes of which the country had never seen. On 20 March 2021, more than 840,000 people received a COVID-19 vaccine, and over that entire week, more than 4.2-million people were immunised against the virus.

Nevertheless, people in many countries had to wait much longer for vaccines to reach them, with a large cost to human life.

In the next pandemic, even with a successful 100 Days Mission, certain population groups such as primary healthcare workers and vulnerable individuals, are at great risk and can determine the trajectory of an outbreak response. Healthcare workers are always the frontline of a pandemic response. They are simultaneously vulnerable to infection due to exposure from infected people seeking healthcare, and essential for providing the healthcare.

After initial in-country detection of pathogen transmission, there is a very small period to protect these groups from an outbreak-causing pathogen, and help them weather the initial waves of infection.

Monoclonal antibodies (mAbs) are one way to do that. These laboratory-made antibodies can offer people immediate protection against a given infectious disease. After they have been administered, mAbs can neutralise pathogens directly, in contrast to vaccines that train the body over a few weeks to recognise the pathogen and fight it. The protection offered by mAbs is temporary, but they can span that critical six-month window as infection transmission increases.

There are already laboratories and companies that develop mAbs for a variety of pathogens. For example, I work for , a UK-based biotechnology company that works on mAbs to prevent seasonal virus infections. Universities are also vital in the discovery and characterisation of mAbs. 91ÌÒÉ«, for example, has many groups working on mAbs for a range of infectious diseases, autoimmune conditions, and other ailments.

While it is impossible to exactly pinpoint the next emerging pathogen, or where it will come from, researchers are actively assessing which pathogens could potentially cause a pandemic, and trying to discover mAbs that can be used to neutralise them.

Authorities, research institutions, and companies should be prioritising research into these high-risk pathogen groups and preparing a suite of mAbs. These mAbs need to be at the point that, if the World Health Organisation were to declare a public health emergency of international concern, organisations are ready to initiate a Phase 1 safety clinical study and scale up production of the mAbs.

Imagine the utility of having 20,000 doses of an mAb that prevents infection by the Bundibugyo strain of Ebola virus right now, and the ability to make more doses rapidly. Such a reality could be possible if action had been taken after the last Ebola virus outbreak in 2016.

To be ready for the next pandemic, countries around the world need a plan today, so that they can mobilise quickly when they have to. And the first place that they could act is to protect the healthcare professionals, who are the first line of defence against pandemics.