There are more than 280 clinical trials for covid-19 registered so far in the EU clinical trial register and more than ten thousand articles have been published internationally since January 2020, including more than 2200 on new treatments and vaccine development. [1,2] These testify to the intense and large-scale mobilization of the global scientific community to develop means to stem this pandemic that has reached over 20 million cases and caused more than 800,000 deaths so far worldwide.

This unique commitment of the scientific community to address one of the most serious global public health crises in a century is to be commended. However, in search for treatment, the imperative need for rigorous trial methodology and implementation cannot be jeopardised. [3] In addition, and inevitably, in the absence of new molecules, many current antiviral and/or anti-inflammatory drugs may be tested for re-purposing. The danger is that the scientific research landscape will become saturated with many duplicative trials that may bring little innovation and limited certainty and expose patients to needless risks. Without co-ordination in this initial phase, there could be missed opportunities for better treatments, as well as delaying patient recruitment in high-quality trials exploring new treatment strategies. Indeed, one of the lessons learned from efforts to find effective therapies for MERS and SARS is that for numerous compounds that had been found to have an activity when tested in vitro, these results did not necessarily translate into efficacy in vivo. [4]

While we applaud the most remarkable effort of the European Commission to launch the successful international covid pledging conference in May, we urge a similar sized effort for research coordination on treatment and prevention of covid-19 with, for instance, the European Medicines Agency at the forefront, not only for the benefit of new covid-19 treatments, based on prioritizing not yet tested molecules, but also to support vaccine development. The wider operational sharing of resources, such as specialist animal facilities, the cooperation on production of industry grade reagents for surrogate markers of protection to use in trials, and the identification of additional vaccine trial centers, as well as public campaigns to help to recruit volunteers for these trials, are key elements that could speed up the availability of an effective vaccine.

However, while we make a plea for exceptional coordination and investment effort in research, we must remain aware of the danger of an excess of covid exceptionalism in the planning of future research funding that would come at the expense of other urgent global health needs. Tuberculosis, malaria, and HIV have well documented research needs and any redirection of funding from these poverty-related diseases to covid-19 would be highly deleterious to global public health. Early estimates show that, in particular, global TB incidence and deaths may increase dramatically as a direct consequence of the pandemic and the lockdowns imposed in many high-burden countries. [5] As such, the reduction of research funds to support improved TB research and control will not only ruin earlier investments made in the past decade, but also have direct consequences on the quality of programme management and the availability of better diagnostics and treatments in the near future. 

Subsequently, we strongly believe that research funding for covid-19 is key to developing the tools needed to control this global pandemic, but this cannot be done at the detriment of other heavy burden diseases. The European Commission can show leadership and coordination in ensuring covid-19 research funds are invested wisely, but should be vigilant that research in investments for tuberculosis, malaria, and HIV are continued and built upon in the context of the EDCTP or its follower programmes in the forthcoming Horizon Europe Framework Programme.

Michel Pletschette, senior researcher department of Tropical Medicine and Infectious Diseases-Medical Center, University of Munich, Germany

Christian Lienhardt, research director, Institut de Recherche pour le Développement (IRD), INSERM – Université de Montpellier, Montpellier, France

Grania Brigden, head of department, International Union Against Tuberculosis and Lung Diseases (The Union), Paris, France

Michael Hoelscher, professor and director, department of Tropical Medicine and Infectious Diseases-Medical Center, University of Munich, Germany

Maria Capobianchi, head of department, National Institute of Infectious Diseases Ospedale Spallanzani, Rome, Italy 

Giuseppe Ippolito, scientific director, National Institute of Infectious Diseases Ospedale Spallanzani, Rome, Italy 

Competing interests: None declared.

References:

1] https://www.clinicaltrialsregister.eu/ctr-search/search?query=covid-19

2] Chen Q, Allot A, Lu Z. Keep up with the latest coronavirus research. Nature. 2020;579(7798):193.   https://www.ncbi.nlm.nih.gov/ research/coronavirus/

3] Oldenburg CE, Doan T. Rigorous Randomized Controlled Trial Implementation in the Era of Novel Coronavirus Disease (COVID-19). Am. J. Trop. Med. Hyg., 2020 Apr 15. doi: 10.4269/ajtmh.20-0262

4] Zumla A, Chan JF, Azhar EI, Hui DS, Yuen KY.  Coronaviruses – drug discovery and therapeutic options. Nat Rev Drug Discov. 2016 May;15(5):327-47.

5] Stop TB Partnership. The potential impact of the COVID-19 response on tuberculosis in high-burden countries: a modelling analysis. http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_FINAL.pdf