What I expect from 2022: duality
Hopes and fears in the year ahead…
Conor McKechnie, VP of Marketing at Cytiva, gives us his predictions on the year ahead. From new vaccines and medicines to new digital technologies, it seems that 2022 will be year of excitement, but with room for change.
It’s apt that January is named for two-faced Janus, Roman god of transitions, duality, beginnings and endings. Listening to our customers and my team, looking ahead, every hope comes with frustration, every advance with concern.
New vaccines will drive new medicines, despite our failing the global poor
We marvel and celebrate the speed with which global scientific collaboration has brought more than 500 COVID vaccines into development, with 19 approved for use[i].
Two of these show that mRNA can be a safe and effective new technology. This is medical progress as important as recombinant proteins were when they were discovered 50 years ago. The tragedy of the pandemic has accelerated and intensified the biotech industry’s focus on mRNA in a way that will benefit patients long after the pandemic ends. There are now more than 40 mRNA therapies and vaccines in phase two and three clinical trials for diseases such as cancer, heart failure, diabetes, zika, HIV/AIDS and malaria, with two reporting in 2022.
The pandemic will help us understand other disease areas too. For example, long COVID has many similarities, but is not the same, as myalgic encephalomyelitis (ME), or chronic fatigue syndrome (CFS). This affects up to 24 million people worldwide and researchers working on long COVID and ME/CFS stand to benefit from each other’s work.[ii]
Inequity in access will prolong this pandemic, but not the next one
Access to new medicines is never equal. With vaccines, this is not just a problem for poorer countries. It is a problem for all. I have written before that no one is safe from COVID-19 until we are all safe.
While most high- and middle-income countries will vaccinate most of their people by the end of 2022[i], low-income countries, specifically most of Africa and Central Asia, will not and likely never will. These delays could cost the global economy US$2.3trn by 2025[ii] and maintain these countries as the most prolific reservoirs of new variants that pose a perennial threat to global health.
Vaccines and biologics are both biotechnologies created from living ingredients, as opposed to chemically synthesized medicines, but they are not created equal. We know from the Global Biopharma Resilience Index[iii] that widespread access to currently expensive biologics to treat diseases depends on better manufacturing, talent, R&D and supply chain infrastructure. mRNA could change that for vaccines which require billions of doses administered to entire populations, not just the sick. Initial research[iv] shows that mRNA vaccines could be made for much less than Dr. Cyrus Poonawalla of the Serum Institute of India’s famous “cost of a cup of tea,”[v] and we could affordably address the needs of the world’s poorest in future pandemics, despite the current lack of coherent and united political will among rich nations to do so in this one.
Digital technologies are helping and not helping
Digital technologies will continue to both improve and challenge our health, frustrate and help our response to COVID. They have been fundamental in directly enabling collaboration among the scientific community, and in accelerating the transformation of what it means to “be at work”. Factory acceptance testing for new vaccine facilities have even been conducted remotely[i] when locked-down engineers could not travel, and record numbers of patients have accessed healthcare through new digital channels.
McKinsey puts the increase in telehealth at 38-fold from a pre-COVID baseline[ii], and digital technologies will also help expand access to care in other diseases. Regulatory agencies such as the U.S. FDA and the Germany’s BfArM have taken steps to bring evidence-based approval to digital health apps. German national health insurance, for example, now reimburses 25 digital health apps with indications in musculo-skeletal, cancer, heart disease, mental health and metabolic disorders[iii].
Yet digital technologies also reduce pandemic response effectiveness and make us unwell, especially in mental health. While vaccine access hinders progress in low-income countries, vaccine hesitancy fomented by malicious social media disinformation[iv] will prevent developed countries from reaching herd immunity thresholds. We have heard whistleblowers report on the negative mental health impact of social media, and we continue to unleash new ones without thinking through the consequences.
The virtual world
Each technological advance here expands opportunity to do good, and creates, it seems, yet another outlet for the worst in us to do harm. This is not new, and neither is the damage caused by trolls, cyber-bullies and those seeking to radicalize online. It is 18 years since Second Life saw the first serious attempt at a “metaverse”, almost 30 years since Neal Stephenson first coined the term, and about the same time since reports on the psychological effect of Mr Bungle’s attack[v] in the text-based virtual reality of LambdaMoo. There are already small studies looking at, for example, the possible impact of metaverse avatars on body dysmorphia[vi] among young women.
There is so much to be excited about for the coming year, and as ever, there needs to be more research and science, more thinking and foresight, more balance, if we are to go into 2022 and see both faces of the future.
References:
[i] Global Data, as of December 4 2021.
[ii] “The four most urgent questions about long COVID”; Nature 594, 168–170 (2021): https://doi.org/10.1038/d41586-021-01511-z
[iii] “How much will vaccine inequity cost?” Economist Intelligence Unit https://www.eiu.com/n/campaigns/how-much-will-vaccine-inequity-cost/
[iv] Ibid.
[v] Biopharma 2021: The Resilience Rethink https://cdn.cytivalifesciences.com/dmm3bwsv3/AssetStream.aspx?mediaformatid=10061&destinationid=10016&assetid=49915
[vi] Kis Z, Kontoravdi C, Shattock R, Shah N. Resources, Production Scales and Time Required for Producing RNA Vaccines for the Global Pandemic Demand. Vaccines. 2021; 9(1):3. https://doi.org/10.3390/vaccines9010003
[vii] GAVI Alliance pledging conference for immunization, 2011 https://www.cyruspoonawalla.com/content/media_GAVI.html
[x] Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) https://diga.bfarm.de/
[xi] Social media and vaccine hesitancy, BMJ https://gh.bmj.com/content/5/10/e004206
[xii] Julian Dibbell, A Rape In Cyberspace: How an Evil Clown, a Haitian Trickster Spirit, Two Wizards, and a Cast of Dozens Turned a Database Into a Society, The Village Voice, December 23, 1993 http://www.juliandibbell.com/articles/a-rape-in-cyberspace/
[xiii] Park and Ogle. How virtual avatar experience interplays with self-concepts: the use of anthropometric 3D body models in the visual stimulation process. Fashion and Textiles https://doi.org/10.1186/s40691-021-00257-6
