V roce 2021 ale přijdou dobré zprávy.

Stále existují dva hlavní důvody, proč být optimistický. Jedním z nich je, že masky, sociální distancování, a další zásahy mohou zpomalit šíření viru a zachránit životy, druhým, že vakcíny ho v těle zničí. Je  naděje, že na jaře roku 2021, budou vakcíny a léčby, o nichž jste četli ve zprávách, dosahovat rozsahu, kdy budou mít globální dopad. I když i tam bude ještě třeba určitých omezení (na velkých veřejných shromážděních například) a počet případů a úmrtí začne jít rychle  dolů. Alespoň v bohatých zemích. Život bude mnohem blíže k normálu, než je tomu nyní.

V tomto příspěvku, se chci podělit o to, kde se nacházejí inovace na COVID-19. Začnu s vakcínami, protože byly ve zprávách nejvíc.

Jak fungují vakcíny COVID-19

Ve svých klinických studiích účinnosti byla vakcína AstraZeneca(vyráběna v Indii- pozn. redakce) v průměru kolem 70 procent účinná, oproti 94 až 95 procentům u vakcín Pfizer a Moderna. Ale 70 procent je stále dostatečně vysoká, aby byla účinná při zastavení nemoci. A je to důvod, proč být ptimista u jiných vakcín, které mají podobný přístup, jako je vakcína Johnson & Johnson.

Nedivím se vám, pokud máte problém sledovat všechny společnosti pracující na vakcínách. Ale je to pěkné. Vzhledem k tomu, že tolik společností sleduje různé přístupy, existuje mnohem větší šance, že se některé z nich ukáží jako bezpečné a účinné. Jsou tu už dvě a další mohou přijít.

Je neslýchané mít tolik společností, které pracují na vakcínách proti stejné nemoci, protože výroba vakcíny je ze své podstaty riskantní práce. Nejen, že to může trvat roky, aby se produkt dostal na trh, ale může to stát miliardy dolarů. Zahrnuje to ale velké vědecké výzvy, zvláště když nemoc je pro nás tak nová jako tahle.

Proč bylo tolik společností ochotných riskovat tentokrát?

Soudě podle rozhovorů, které jsem vedl s jejich předními vědci a vedoucími pracovníky, myslím, že jedním z důvodů je, že viděli šanci využít své odborné znalosti, aby pomohli ukončit pandemii. Pomohlo také, že narostl počet těch, kteří přispěli k tomu, aby nesli část finančního rizika. V některých případech to byla národní vláda, například USA nebo Německa. V jiných zemích to byla skupina s názvem CEPI, Koalice pro inovace připravenosti na epidemii, která je financována naší nadací a několika vládními a filantropickými partne.

Samozřejmě, vývoj samotných vakcín je jen částí výzvy. A možná to ani není ta nejtěžší část.

Jak se dělá 5 až 10 miliard dávek?

Svět bude muset vyrobit kolem 5 miliard dávek, pokud existuje vakcína, která vyžaduje pouze jednu dávku, nebo 10 miliard v současném scénáři dvoudávkových vakcín. (To je za předpokladu, že 70 procent světové populace musí být pokryto, aby se prolomit přenos nemoci.)

Je 5 až 10 miliard dávek hodně? Ano, všechny vakcínové společnosti na světě obvykle produkují celkem méně než 6 miliard dávek ročně. To zahrnuje očkování proti chřipce, rutinní očkování dětí a tak dále. Aby tedy výrobní kapacita vyráběla všechny potřebné vakcíny COVID-19, aniž by omezoval ostatní, bude muset přinejmenším téměř zdvojnásobit a pravděpodobně téměř ztrojnásobit.

Abychom pomohli zmírnit výrobní zátěž, naše nadace pomohla dát dohromady to, čemu se říká "dohody druhého zdroje". Spárovali jsme očkovací společnosti v bohatých zemích s protějšky v rozvojových zemích, které se specializují na výrobu bezpečných, vysoce kvalitních a cenově dostupných dávek při velmi vysokém objemu.

Dohoda s druhým zdrojem je navržena tak, aby co nejlépe vytěžil obě dovednosti. Společnost, která vyniká ve výrobě, souhlasí s výrobou výrobků navržených jinou společností s životaschopným kandidátem na vakcínu. Například největší výrobce vakcíny na světě, Sérový institut Indie, vyrábí dávky vakcíny AstraZeneca. Už zahájili výrobu, takže budou k dispozici dávky pro země s nízkými a středními příjmy, pokud bude vakcína skupiny AZ schválena k použití. A naše nadace převzala část finančního rizika, takže pokud nebude schváleno, sérum nebude muset nalézt plnou ztrátu.

Je těžké přeceňovat, jak neobvyklé jsou tyto dohody z druhého zdroje. Představte si, že Ford nabízí jednu ze svých továren pro Hondu na to přestavět. Ale vzhledem k rozsahu problému a naléhavosti jeho řešení, mnoho farmaceutických společností vidí přínos spolupráce novými způsoby, jako je tento. Společnosti reagují na krizi tím, že mnohdy zkrachují s obvyklým obchodem.

A jak rozdělíte 5 až 10 miliard dávek po celém světě?

In addition to manufacturing, there’s the challenge of making sure that COVID-19 vaccines will be distributed equitably. That’s both a logistical hurdle and a financial one.

Sixteen pharmaceutical companies have already committed with our foundation to ensuring that vaccines and other lifesaving tools will be made available in a fair way. The world’s top experts in shipping and delivery will need to figure out how to move all these vaccines around the planet while keeping them at the right temperature every step of the way. National governments will be responsible for in-country distribution of vaccines on a scale and level of complexity unlike any other public health campaign ever.

And rich countries will need to step up with new funding through organizations like GAVI, which has a phenomenal track record of helping immunize children in poor countries.

The issue of equity is one that both Melinda and I have been working on, not only as it relates to vaccines, but also the way the recovery needs to encompass everyone, including people of color in the U.S. and people in poor countries around the world. Melinda will cover this in detail in our Annual Letter, which we’ll release next month.

One other challenge will remain when vaccines are widely available: the sizable percentage of people who will hesitate to take them. Some are afraid of vaccines already. Others may worry that the COVID-19 vaccines were rushed and might be less safe than, say, the flu shot they get every year. And in some communities, people have an understandable historical mistrust of the government’s role in medical studies.

It doesn’t help that there are false conspiracy theories about vaccines, including some that involve Melinda and me. For our part, we will keep talking about the sole reason we fund vaccines: because we’re passionate about saving lives and making sure all children have a chance to grow into adulthood. We feel a responsibility to give our wealth back to society, and we believe that no outlet for our giving returns more value to the world than helping develop and distribute vaccines. They are a medical miracle that made it possible to cut the childhood death rate in half in the past two decades.

I hope credible leaders—politicians, community leaders, scientists, and family doctors especially—will help explain the safeguards in the system. The FDA is one of the most respected drug-regulating agencies in the world for a reason. Its approval process is second to none. No safety steps were skipped in approving COVID-19 vaccines. If enough people are willing to join the first wave of recipients, then hopefully others will see the benefits and want to take it too.

In the search for treatments, failure was a success

As I often tell the team at the foundation, we can’t be afraid of failing—and when we do fail, we should do it quickly and learn from it. Here’s an example of how we failed quickly with potential COVID-19 treatments, but in the most productive way possible.

In March, we joined Mastercard and Wellcome in creating the Therapeutics Accelerator. The idea was to use robots developed by the pharmaceutical industry to quickly screen thousands of existing chemical compounds in the hope that one of them might lead to a treatment for COVID-19. We wanted to know: Do any biotech or pharma companies already have something on the shelf that could be the solution to the pandemic?

The answer was no.

That was disappointing, but it was a useful disappointment. It spared the medical field millions of dollars and a year or two of laboriously going from one company to another, testing one compound after another. In that sense, it wasn’t a failure at all. Scientists knew within months where the dead ends were, so they didn’t waste time going down them.

One of the successful treatments you’ve probably heard about is a steroid called dexamethasone. The cool part of the story is how quickly scientists were able to figure out that it works for severe cases of COVID-19.

The dexamethasone trial was done through a network called RECOVERY, which was set up with various protocols that allowed it to run rapid trials of COVID-19 drugs. It took just four months for RECOVERY to demonstrate that the drug reduced mortality by 30 percent in severe cases—and they did this study amid a lot of confusion and misinformation about other putative therapies that didn’t work out. Dexamethasone has become a standard of care in severe cases, and the speed with which it was studied and approved is a good sign for the future.

Another approach to treatment you may have read about is called monoclonal antibodies. These are created by taking the antibodies in the blood of COVID-19 survivors and flowing them past a spike protein to see which ones stick the most. (The stickier they are, the better they are at attacking the virus.) Then you figure out the gene sequence that makes that antibody, use a factory to make billions of copies of it, and give them to patients.

Although you may not have heard about antibody treatments before the pandemic, there’s nothing new about them. Today they’re used in some of the most popular medicines in the world, including arthritis treatments.

The key question surrounding COVID-19 antibodies is whether manufacturers make enough of them so they can be delivered to the entire world? It depends partly on the size of the required dose. Some treatments have involved doses as large as 8 grams. If something substantially smaller—such as 0.5 grams—works well, then it will be possible to treat far more people. Scientists also need to see if it’s possible to replace the current IV infusion with a two-shot dose.

If researchers solve the dosage and infusion challenges, then the main limiting factor will be manufacturing capacity. To deal with that, our foundation underwrote a second-source agreement in which Fujifilm Diosynth will produce an antibody developed by Eli Lilly. These doses will be earmarked for low- and middle-income countries and priced accordingly, so that millions of affordable doses will be available within 90 days of regulatory approval.

That uncomfortable COVID-19 test is becoming obsolete

There’s a lot of confusion about testing for COVID-19, and it’s important to be clear about what’s working well and what isn’t.

There are three different instances that involve testing for the virus. One is if you’re severely symptomatic—sick enough to go to a clinic or hospital—and your doctor needs to know how to treat you. Early on, the U.S. health care system had trouble getting enough tests for these cases, but that problem has largely been solved.

The second instance is if you have only mild symptoms, or none at all but you might have been exposed to the virus. In this case, you need to know if you are infected, so you can isolate yourself and protect others. Even if you don’t have symptoms or haven’t developed them yet, you can still spread COVID-19, so you need to get your test results right away.

Unfortunately, the U.S. is lagging badly in this area; tests often take several days to deliver results, rendering them essentially useless. We need to invest in better tests and more efficient systems for processing them so people can act quickly to protect their loved ones and their communities. Just last week, there was some good news on this front when the FDA approved the first diagnostic that people can use at home, without sending a sample to a lab. It works a lot like an at-home pregnancy test.

Then there’s the third use for testing: disease surveillance. Despite what the name seems to imply, this has nothing to do with watching people. Instead, disease surveillance is what allows public health experts to estimate the number of cases in a location and the rate at which new infections are occurring. Armed with this information, government leaders can make informed decisions about the best ways to stop the virus from spreading.

If you have the first two testing instances covered, you should have the population-level data you need to do disease surveillance. But—as we’re seeing in the U.S.—if you don’t know who might be infected, you can’t do it well.

We’ve been funding a local effort in Seattle to fill this gap. Thousands of people in the area—some symptomatic, some not—have filled out a brief online survey, conducted a self-test by swabbing the tip of their nose, and sent the results in for processing. A similar effort is under way in the San Francisco area.

One cool innovation that’s making this work possible is the ability to let people collect their own samples by swabbing the tip of their nose. (A study that we funded was the first to show that this is just as accurate as the standard nasopharyngeal swab.) If you’ve ever had one of the nasopharyngeal tests, you know how uncomfortable they are—and how they can make you cough or sneeze, which is bad news with a respiratory virus like COVID-19 because it increases risks to healthcare workers. With any luck, the days of the jam-a-stick-to-the-back-of-your-throat COVID-19 test will soon be over.

What’s important about the Seattle and San Francisco projects is that they’re helping researchers see how the virus spreads. And in the future, the system for sending out and processing test kits will be useful for detecting other new pathogens that might arise.

The testing challenge is especially acute in sub-Saharan Africa. Many countries there can’t afford the most accurate tests. And they don’t have the infrastructure to conduct surveillance studies, so policymakers aren’t working with the most up-to-date information.

This is the kind of problem that innovation excels at solving. Several companies are working on rapid tests that could be produced by the tens of millions. One is the British company LumiraDx, which has created a device that’s roughly the size of a thick cell phone, with a card reader at one end. A health care worker takes a sample from a patient, inserts it into the machine, and gets results within 15 minutes. After removing any personal information that could identify the patient, the device uploads the results to a central server. Analysts then use the data to follow the disease in real time, giving policymakers up-to-the-minute information on where to focus prevention and treatment efforts.

Our foundation is part of an effort to deploy an initial supply of 5,000 readers in 55 countries throughout Africa. Although that’s a relatively small number for such a large area, it’s a good start. And the benefits may not be limited to COVID-19: In the future, the same machines could be used to test for HIV, tuberculosis, and other diseases.

Still other companies are working on ways to make the highly sensitive tests that are in use now faster and cheaper, and to expand the manufacturing of less-sensitive but cheaper tests from tens of thousands a day to many millions a day. The pace of innovation in this field really is impressive and is going to benefit everyone.

How are developing countries doing?

One thing I’m happy to have been wrong about—at least, I hope I was wrong—is my fear that COVID-19 would run rampant in low-income countries.

So far, this hasn’t been true. In most of sub-Saharan Africa, for example, case rates and death rates remain much lower than in the U.S. or Europe and on par with New Zealand, which has received so much attention for its handling of the virus. The hardest-hit country on the continent is South Africa—but even there, the case rate is 40 percent lower than in the U.S., and the death rate is nearly 50 percent lower.

We don’t have enough data yet to understand why the numbers aren’t as high as I worried they would get. It helped that some countries locked down early. In Africa, another reason may be that the population is young compared with the rest of the world’s, and young people are less susceptible to the virus. Another reason could be that its large rural population spends a lot of time outside, where it’s harder to spread the virus. It is also possible—though I hope this is not the case—that the true numbers are higher than they look because gaps in poor countries’ health care systems are making it hard to monitor the disease accurately.

One fear of mine has proven to be justified: COVID-19 is having a ripple effect with other diseases. Last month, I was surprised to learn that it was only the 31^st most common cause of death in Africa. By comparison, it has ranked number four around the world, and number one in America.

Why does it rank so low in Africa? It’s not just the relatively low incidence of COVID-19 there. It’s also because shifting health workers to focus on the coronavirus disrupted efforts to detect and treat HIV/AIDS, malaria, tuberculosis, and other diseases. As a result, COVID-19 stayed low on the list of health threats, but other problems came roaring back.

Another reason is that patients are more reluctant to go to clinics for fear they might become infected—and that means more severe conditions are going undiagnosed. In India, for example, the diagnosis rate for tuberculosis has dropped by roughly a third. With more undetected cases, more people will probably die from the disease.

This is another reason why the world’s goal should be to make sure that lifesaving tools reach—and are practical for—every country, not just rich ones.

COVID, climate, and the year ahead

Last spring, when the extent of the COVID-19 pandemic was becoming clear, I wrote that “this is like a world war, except in this case, we’re all on the same side.”

I am glad to report that the optimistic view that the world would come together to fight COVID-19 has largely turned out to be right (with some notable exceptions). There’s no way we would be as far along as we are if governments, companies, and scientists around the world weren’t, more often than not, working closely together.

This global cooperation is one reason why I see promise in the year ahead—and not only the promise of getting the pandemic under control. I believe the world also has a chance to take concrete steps on one of the other great challenges of our time: climate change.

Next year, leaders from around the globe will meet in Glasgow, Scotland, for the first major United Nations summit on climate change since the Paris meetings in 2015. The U.S. is poised to resume a leading role developing and deploying the clean-energy innovations needed to eliminate greenhouse gases.

I hope to spend much of my time in 2021 talking with leaders around the world about both climate change and COVID-19. In Melinda’s and my Annual Letter next month, I’ll write about what the world’s experience with COVID-19 means for preparing for the next pandemic. And in February I’ll release my new book, How to Avoid a Climate Disaster, in which I share what I’ve learned from 15 years of studying the problem and investing in solutions for it. I hope the book will help drive the conversation in a productive direction.

A year from now, I do think we’ll be able to look back and say that 2021 was an improvement on 2020. The improvement may not be enormous, but it will be a noticeable, measurable step forward for people around the world.

I hope you have a safe and healthy 2021.