Dr. Francis S. Collins, Director of the National Institutes of Health published an editorial in the March 12th edition of Science.  In his article, Dr. Collins commented on the lessons learned from COVID-19 during the past year.  His Institute was instrumental in the development of vaccines through applied research into basic and applied molecular biology and also establishing protocols and supervising field trials of vaccines and therapeutics.

Progress in research dealing with the pathogenesis of viruses, diagnostic procedures, therapy and vaccine development have all contributed to progress in suppressing COVID-19, regarded as the most serious public health emergency in a century and responsible for disruption of our economy.  Dr. Collins correctly emphasized that the development of mRna vaccines of which the Pfizer and Moderna are examples, was based on research on basic molecular biology conducted over the past 25 years. He stressed the importance of cooperation among scientists, Federal agencies and private enterprise. The collective and synergistic efforts among scientists and bioengineers compressed five years of effort into less than six months to develop vaccines that were tested against natural exposure.  Dr. Collins notes that the U.S. gained valuable experience in recruiting subjects for trials through the Community Engagement Alliance (CEAL).  Scientists at NIH consider that inclusion of diverse ethnic groups in trials is critical both for evaluation and subsequent acceptance of vaccines.

The NIH has been instrumental in developing and evaluating antiviral drugs such as remdesivir, various immunosuppressive drugs including dexamethasone, monoclonal antibodies and anticoagulants.  In the U.S. the Therapeutic Interventions and Vaccines (ACTIV) initiative coordinated the activities of Federal agencies, academia and at least twenty pharmaceutical companies under the leadership of the Foundation for the NIH.  Protocols to evaluate therapeutics were developed by ACTIV and have resulted in commercialization of a number of products that are now in use to treat patients following FDA Emergency Use Authorization.  Dr. Collins deprecated the inadequately designed trials many of which were intended to justify the use of quick-fix solutions for COVID-19 including hydroxychloroquine, that became a political issue both in the U.S. and Brazil for evident reasons.

As an alternative to attempting to repurpose existing drugs, Dr. Collins suggested the need to develop antiviral drugs against a wide range of potential pathogens so that Phase 2/3 trials can be initiated quickly following the emergence of a novel infection.

NIH was at the forefront of developing COVID test systems.  Although PCR assay is highly sensitive and specific, delays between collecting a specimen and receiving results invalidate the test and quarantine approach to containing an infection, especially during an early stage of any outbreak.  Recognizing the need for rapid testing, the NIH Rapid Acceleration of Diagnostics (RADx) program was developed to encourage commercial companies to present proposals.  From 700 applications, 137 were evaluated and received funding.  To date there are 28 diagnostic tests that are collectively used on 2.5 million patients daily.  Dr. Collins effectively channeled the resources of the NIH to become an effective scientific venture capital endeavor.

Implicit in the Collins editorial is the need for international cooperation to acquire and share knowledge and experience from scientific groups in other nations faced with similar or slightly different circumstances.  In this respect the World Health Organization that was defunded by the previous Administration played an important role in addressing an understanding of COVID through the Solidarity Trial. Considerable practical knowledge was learned from the U.K. Randomized Evaluation of COVID trial conducted in the U.K.

We are indeed fortunate that we have an organization such as the National Institution of Health funded with world-class scientists and led by administrators with vision, courage and perception who are capable of marshalling resources to resolve both emerging public health emergencies and ongoing erosive conditions.