The demands of fighting the COVID-19 pandemic are draining resources from global health research and development (R&D) programs and disrupting clinical trials and other work, presenting a potential post-pandemic scenario of a world more vulnerable to a host of infectious threats.

That’s what our organization, the Global Health Technologies Coalition (GHTC), learned after conducting extensive, candid conversations at the end of 2020 with global health researchers around the world from both the public and private sectors. We reached out to them to understand how the fight against COVID-19, an effort that has often relied on their expertise and innovations, may be imperiling science to reduce the burden of many other infectious pathogens. That includes malaria, tuberculosis, HIV/AIDS and a broad spectrum of neglected tropical diseases.

Their reports revealed an urgent need to bring together the global health research community and our allies—in government, industry and international institutions—to avoid lasting damage to hard-fought progress and prevent further delays in delivering new advances.

Everyone understands that right now, COVID-19 must be the focus. We spoke with many researchers who were proud to see their capabilities contributing to developing better diagnostics, vaccines and new treatments. But they also were keenly aware of the toll it was taking on any work not related to the pandemic.

Scientists, speaking confidentially in order to provide a frank assessment, talked about staffing and funding being shifted to focus on pandemic-related work—and with no clear indication on when non-COVID-19 work would resume, or if diverted funding would be restored.

Meanwhile, clinical trials—the most costly and complex aspect of developing new health interventions—have been hit especially hard by pandemic-related shutdowns. Nearly every interviewee involved in clinical trials, many of which are located in low- and middle-income countries, reported significant issues, including trials being delayed indefinitely. The biggest disruptions have involved phase 3 trials. That’s understandable, as these trials are logistically complex and typically require managing thousands of participants. But reaching Phase 3 means a project is tantalizingly close to delivering a new breakthrough, which makes interruptions at this stage particularly devastating.

Researchers reported pausing many or all of their late-stage trials. One clinical trial administrator reported that where a trial was already underway, numerous trial participants were not showing up for essential follow-up visits at the clinic due to fears of contracting COVID-19. Virtual follow-ups were proving challenging in many cases, in part due to infrastructure barriers in low-resource settings—such as the need for many people to regularly purchase new SIM cards for their phones, which changes their phone number. Virtual visits are also not an option for trials that require in-person follow-up to collect samples.

Outside of clinical trial disruptions, scientists noted a number of discrete challenges. For example, there were reports of work stymied because laboratory reagents or personal protective equipment (PPE) were needed for pandemic response. Operational expenses have increased significantly for many projects, due to issues like higher shipping costs and additional resources needed for safety.

The cumulative effect of so many obstacles is presenting staggering challenges for global health researchers. But there is a way to recover from these setbacks—and avoid a situation where we emerge from the battle against one deadly disease less prepared to fight off many others.

First, we must work with our partners in the public and private sector to ensure scientists are given the resources and flexibility to recover from their pandemic-related problems and restart their work. Second, we must emphasize that decades of investments in global health R&D generated new insights and alliances that have played a big role in speeding the development of COVID-19 interventions. The fast pace of that work, especially around vaccines, demonstrates that, with greater funding, the field is poised to produce rapid progress in fighting many other infectious diseases.

In fact, we did hear a measure of optimism among some of the researchers we interviewed that the harsh experience of the pandemic—and the fact that scientists are leading the effort to end it— could create a new era in which investments in global health R&D become an enduring political priority.

But another scenario is one in which disruptions caused by the pandemic are compounded by long-term funding problems. Global health R&D funding always has been a hard sell and the economic impact of the pandemic is likely to constrain spending in both the public and private sector for years to come. It will require a concerted effort by our community to ensure global health R&D quickly regains lost ground and, equally important, that we can capitalize on opportunities revealed by pandemic-related advances to accelerate work on a number of diseases.

Jamie Bay Nishi is director of the Global Health Technologies Coalition (GHTC), a coalition of 30 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people. For more on this topic, read the GHTC’s full synthesis of the interviews: Pain Points and Potential: How COVID-19 is Reshaping Global Health R&D.

Image Credits: Dato Koridze /STUDIO for TB Alliance.