Tomas Cihlar: “The next big pandemic will come from a virus that we already know”

– Covid 2024.Where are we?

It depends on where you are and your perspective, because there are people, like doctors, who face patients with different challenges. I am in the research field, thinking more about the development of new drugs to address not only current problems, but also what awaits us in the future, or even where the virus could evolve. It’s been about a year and a half since the pandemic was declared over, but that doesn’t mean Covid has disappeared. The biggest challenge is that people don’t want to hear much about Covid, because it was a difficult period for many. However, andIn 2024 more than 30,000 people have died from covid: clearly, it is still a problem. It is necessary to ensure that there are sufficient resources dedicated to early diagnosis and treatment of the disease. It is also essential to continue promoting vaccination, as rates have decreased in the last year. From a research point of view, our focus is on improving treatments, especially for high-risk patients, such as the immunocompromised, in whom the virus remains in the body longer. We are also working to better understand long Covid, which is still not well understood what causes it or how to treat it.

– Covid is no longer a priority and now there is more talk about new pandemics, such as bird flu. Do you think we have learned enough from the Covid pandemic to be prepared for a new one?

I think we’ve learned a lot, especially about how to take advantage of new vaccine platforms, such as mRNA vaccines, which are now being investigated for flu, HIV and other viruses. But we must continue to apply these learnings to other viruses. Avian flu has been with us for a long time and is evolving. Now, even farm animals, such as cattle in the US, can be infected, indicating that we must remain vigilant.

At Gilead we have been working on pandemic preparedness even before it was given that name. I was part of the team that developed remdesivir from the beginning, and this was made possible by 10 years of prior research. When Covid appeared, we already knew that remdesivir was effective against other related coronaviruses, such as SARS and MERS. This allowed us to act quickly and launch clinical trials to treat hospitalized patients, leading to remdesivir becoming the first antiviral approved for the treatment of COVID-19.

– One of the problems we face is that we do not have models to predict the next pandemic or the mutation of viruses.

There are approximately 200 viruses that can infect people, and we know most of them. It is likely that the next pandemic will be caused by a virus related to those already known, as occurred with covid-19, which is related to SARS and MERS. We focus on identifying viruses that are most likely to cause a pandemic due to their high transmissibility or pathogenicity.

Respiratory viruses, such as Covid-19, are the most efficient at transmitting from person to person, because they can spread before those infected show symptoms. Any new epidemic will likely be caused by a virus related to the ones we already know about. Therefore, we develop drugs that cover several types of viruses within the same family, such as coronaviruses.

– HIV remains a problem, especially in countries in sub-Saharan Africa and some areas of Asia.

We have been working on HIV for 30 years, and we have constantly innovated. We started with treatments that required many pills a day, and now we have advanced to one-pill-a-day regimens and are working on the next generation of treatments: long-acting medications, which could be taken once a week, monthly, or even as one injection every six months.

Additionally, we are seeing promising advances in the use of these long-acting treatments for prophylaxis (PrEP), which could be an alternative to the HIV vaccine. A recent clinical trial with lenacapavir in young women in Africa showed 100% efficacy, which is a very encouraging result.

We are in that process, working hard to prepare the submission to the FDA with the hope that the drug will be approved next year. But beyond approval, our goal is to make this treatment accessible globally, especially in low- and middle-income countries.

We know that we need to have five times more people using PrEP than we have now to really stop the spread. And as we try to end the pandemic in the next decade, access to PrEP is crucial, especially in sub-Saharan Africa and low- and middle-income countries.

– If you had limited resources, both in time and money. What medical or scientific challenges would you first address outside the field of biology?

For me there are two key things. First, we need to live in peace and on a planet we can inhabit comfortably. Viruses are just one of the many problems facing humanity today. If I had unlimited resources, I would like to understand socioeconomic issues and where the differences between people come from, since that is the source of many problems. How can we reconcile differences in religion and ethnicity so that people work better together? For me, the most important thing is to prevent wars and maintain a spirit of global collaboration. The other big concern, of course, is climate change. We can fight all viruses, but if we do not address climate change, these viruses will continue to change. We are already seeing this with dengue and other mosquito-borne viruses, as the geographic range of mosquitoes is changing dramatically with climate change. We are now fighting these viruses in areas where they did not exist before. Most scientists agree that this is a consequence of climate change, and I think addressing climate change is also part of pandemic preparedness.