The world’s biggest pharmaceutical firms are little prepared for the next pandemic despite a mounting response to the Covid-19 outbreak, an independent report has warned.

Jayasree K Iyer, executive director of the Netherlands-based Access to Medicine Foundation, a not-for-profit organisation funded by the UK and Dutch governments and others, highlighted an outbreak of the Nipah virus in China, with a fatality rate of up to 75%, as potentially the next big pandemic risk.

“Nipah virus is another emerging infectious disease that causes great concern,” she said. “Nipah could blow any moment. The next pandemic could be a drug-resistant infection.”

Nipah can cause severe respiratory problems and encephalitis, swelling of the brain, and has a mortality rate of 40% to 75%, depending on where the outbreak occurs. Fruit bats are its natural host. Outbreaks in Bangladesh and India were probably linked to drinking date palm juice.

It is one of 10 infectious diseases out of 16 identified by the World Health Organization as the greatest public health risk where there are zero projects in pharmaceutical firms’ pipelines, according to the foundation’s biennial report. They also include rift valley fever, common in sub-Saharan Africa, along with Mers and Sars – respiratory diseases that are caused by coronaviruses and have far higher death rates than Covid-19 but are less infectious.

Four products are meanwhile in development for the mosquito-borne chikungunya virus that has spread rapidly in recent years, across the Americas, Africa and in India: a vaccine, a medicine, a diagnostic tool and a new space insecticide spray from Bayer that also works for dengue and Zika.

The report says that despite years of warnings that novel coronaviruses were likely to cause a global health emergency, the pharmaceutical industry, as well as society at large, was ill-prepared for the Covid-19 pandemic.

There were no projects on coronaviral diseases in drugmakers’ pipelines prior to the Covid-19 outbreak but as it turned into a global pandemic the industry within months developed several vaccines. A total of 63 Covid-19 vaccines and drugs are now approved or in development.

Antimicrobial resistance – the emergence of drug-resistant superbugs, partly due to a lack of antibiotics in lower-income countries – also poses serious risks.

“In terms of antimicrobial resistance (AMR), we have antibiotics that still work, but time is running out to develop replacements,” said Iyer. “Tuberculosis, which we used to think could be eradicated, is becoming widespread in some communities due to multi-drug resistant strains.

She warned that an ‘AMR pandemic,’ where drug-resistant pathogens – organisms that cause disease – are the global norm, is not only “unthinkable – it is inevitable, unless the pharma industry seriously commits to developing replacement antibiotics”.

The foundation’s report monitors 20 major drugs companies and the availability of their medicines for 82 diseases in low to middle income countries. Companies’ efforts to develop new drugs continue to centre on a handful of diseases, including HIV/Aids, tuberculosis, malaria, Covid-19 and cancers.

The UK drugmaker GSK came top of the index again while the US firm Pfizer made it into the top five for the first time, behind GSK, Novartis and Johnson & Johnson.

Novartis was the first company to develop a systematic approach to ensure products reach poorer countries – which face more than 80% of the global burden of diseases – more quickly. The other leading companies are AstraZeneca, GSK, Johnson & Johnson, Germany’s Merck, Pfizer, Sanofi and Takeda. GSK develops access plans for all projects once intermediate clinical trial results are positive.

Under chief executive Albert Bourla, who took the helm in 2019, Pfizer has started access planning for all products two years before launch. Japanese firm Takeda’s plans for its dengue vaccine project include a commitment to register the vaccine in dengue endemic countries, voluntary licences and tiered pricing strategies.

However, at the moment many drugs are not getting to low and middle-income countries at all, even years after launch. Some 64 out of 154 products analysed are not covered by any kind of access strategy – equitable pricing, voluntary licensing or donations – in any of the 106 countries examined.

Iyer will embark on a virtual roadshow in February to alert investors in pharmaceutical firms to the report findings and mobilise them to put pressure on the companies.

Emma Walmsley, GSK’s chief executive, said: “We remain strongly committed to improving research, access and development of new medicines and vaccines for global health diseases, in particular HIV, TB and malaria, future pandemics and antimicrobial resistance.”

The Access to Medicine Foundation is funded by the UK and Dutch governments, the Bill & Melinda Gates Foundation, the Wellcome Trust and Axa Investment Managers.

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