Pandemics impose large human and economic costs on society. According to the World Health Organization, almost 7 million people died worldwide during the COVID-19 pandemic. The International Monetary Fund estimates that by 2024, COVID-19 will have reduced global economic output by $13.8 trillion relative to prepandemic forecasts. Scientists have predicted that another pandemic is highly likely.
The National Institutes of Health (NIH) has identified several viral families that have the potential to cause future pandemics. However, as of May 2023, no known drugs for a number of these viral families had been approved or were in clinical trials funded by the Department of Health and Human Services (HHS), according to HHS.
The Government Accountability Office (GAO) has identified a number of technologies to speed antiviral drug development, such as using artificial intelligence to identify drug candidates.
Experts GAO spoke with noted that a number of factors complicating the market’s efficient functioning make it unlikely that market forces alone will induce the development of antiviral drugs at levels that would maximally benefit society and aid future pandemic preparedness. However, GAO says policymakers could use several mechanisms to incentivize investment in antiviral drugs. “Push” mechanisms, such as research grants, can incentivize early research, while “pull” mechanisms, such as purchase commitments, can incentivize the production of completed antivirals.
In 2022, the White House issued the National Biodefense Strategy and Implementation Plan, which called for the development of two novel antiviral drugs. Experts GAO spoke with also identified a number of approaches to guide the use of economic incentives. These approaches include developing (1) a number of antiviral drugs to the point of phase 1 clinical trials, which could be less costly than developing fully approved drugs; (2) a wide range of antiviral drugs that act against different parts of the viral lifecycle; and (3) broadly acting antiviral drugs for a wide range of pathogens.
GAO identified three policy options that may help to spur antiviral drug development. For example, policymakers could ensure focus on pathogens and pathogen families, such as flaviviruses and bunyaviruses, that are most likely to cause severe future pandemics, with an emphasis on pathogen families for which no drug candidates are currently in clinical trials. Policymakers could also use economic incentives to stockpile certain drugs in advance as well to ensure sufficient manufacturing capacity.
GAO’s policy options are provided to inform policymakers—including Congress, federal agencies, state and local governments, academia, industry, and international organizations—about potential approaches and actions to address gaps highlighted in this technology assessment. Policymakers would need to consider how to align these potential actions with existing federal programs and initiatives.