by Christopher Rota
figures by Daniel Utter
The COVID-19 pandemic has touched every corner of American society, including the lives of scientists. The past year has seen many researchers dramatically shift the focus of their work, as experts from across different disciplines came together to study this novel disease and develop potential therapies. The National Institutes of Health, the United States’ foremost public biomedical research agency, and the Department of Defense both tacitly recognized the unprecedented pace demanded by this effort, naming their vaccine development and distribution plan “Operation Warp Speed.”
However, the intensity of our collective focus on COVID-19 has generated concern that we are not only overcrowding this area of research, but also neglecting the study of other important diseases. This “covidization” of biomedical research, a term coined by Dr. Madhukar Pai in an editorial in Nature Medicine last year, has been evident across the scientific community, from unexpected changes in the funding priorities of grant agencies to editorial publication choices by leading journals. On the one hand, this reaction is a warranted and proportional response to the immensity of the crisis we are facing. However, it has also reignited long-standing arguments within the scientific community about how infectious disease research is prioritized and funded — namely, that we only provide adequate resources after an outbreak has already occurred. By examining our responses to previous pandemics, we can gain insight into not only where these concerns come from, but also how we might break old habits and avoid repeating our past mistakes.
How Does the Response to COVID-19 Compare to Other Public Health Crises?
Prior to the current pandemic, there have been multiple times in recent memory where the scientific community has responded en masse to the outbreak of a novel disease. From the Spanish Flu outbreak in the early 1900’s to the Zika virus outbreak in 2015, these crises each demanded and received dedicated attention from the biomedical research community, though not always immediately. The initial years after the HIV/AIDS outbreak, for instance, were characterized by denial rather than action. Scientific historians have noted, however, that the United States generally has a common pattern regarding these crises. We seem to almost always react to them, rather than try to anticipate them.
While it is impossible to absolutely predict when a completely new virus is going to emerge, observers have argued that our current “knee-jerk” approach to funding infectious disease research (depicted in Figure 1) is fundamentally flawed. While we do typically supply an abundance of resources for researching novel disease treatments just after an outbreak occurs, this funding is usually trimmed from the budget again as soon as we perceive that the threat has passed. The result is a lack of support in the periods between active crises, which limits scientists’ abilities to survey the field, recognize, track, and sound the warning bell about diseases before they have a chance to become major problems. Thus, while we do a great job of treating these diseases after an outbreak, we miss out on the opportunity to potentially prevent them through establishing consistent, long-term surveillance efforts.
An excellent recent case study of this phenomenon is the funding response to the 2014 Ebola epidemic. After the initial outbreak, Congress apportioned a large sum of money to the Centers for Disease Control (CDC), the United States Agency for International Development (USAID), and other groups to marshal a response. The goal of this effort at the outset was not only to help treat Ebola patients, but also to build up the research capacities of countries where Ebola is endemic to help them better respond to future outbreaks.
However, by 2018 this funding dried up, which led the CDC and USAID to close down many of the programs they initiated during the height of the crisis. One of these was PREDICT, a “virus hunting” effort specifically aimed at identifying novel pathogens that could cause future pandemics. This lack of foresight has already proven to be costly; Ebola has reemerged in the Democratic Republic of the Congo not once, but twice since 2014, including in the present day. While the World Health Organization’s (WHO) containment efforts have been relatively successful, one cannot help but wonder how the situation might be different if the United States had maintained its support for longer.
For the ongoing COVID-19 pandemic, our funding response has unfortunately been generally more of the same: applying band-aids to our problems after-the-fact, rather than thinking about how we can mitigate them proactively. PREDICT, for instance, was recently resurrected in response to the pandemic, even though its window of greatest usefulness has arguably passed. Overall, the biggest differentiator of the research response to this pandemic as compared to previous crises has been the sheer size of it. Using the number of published papers containing disease-related keywords as a measure of research output, a recent investigation found that the COVID-19 response has massively outstripped those of past outbreaks. On the one hand, this surge could be positively interpreted as an improvement in the scientific community’s capacity to react more quickly to crises. On the other hand, this unprecedented volume of studies has raised concern over whether all of them are trustworthy or indeed necessary, with many duplicate or uninformative studies having been detected in another investigation by STAT news. This trend has raised concern about whether the extra resources being funneled to COVID-19 research are actually being used effectively, as well as if some of it would be better spent on studying other pressing diseases instead.
“Covidization”: A New Chapter in An Old Story
With all of this information in mind, how then should we judge the extensive focus of the scientific community on COVID-19? One can argue that focusing extra resources on studying this novel disease is warranted and we shouldn’t admonish researchers and publishers for providing what the public and government are asking for. As previously mentioned, “covidization” in and of itself is not representative of a new problem in infectious disease research; similar concerns were voiced by the community in response to the surge of funding post-Zika virus outbreak and yet the outcome from that effort has seemed to be largely positive.
However, what is most concerning about our response to COVID-19 is that it has the potential to exacerbate the “boom and bust” funding cycle for public health research, as well as biomedical research more broadly, in an unprecedented way (see Figure 2). With the funding currently flowing easily, it is unsurprising that many scientists have flocked to research COVID-19 in whatever capacity they can, though the resulting product seems to be of varying quality and value. However, what will happen if that river dries up again in a year or two, as history strongly suggests it will? The answer is unclear, but it seems unlikely to be good.
One solution to this problem, which others have already proposed, is to lean into the momentum behind this research effort and redirect funding towards studies that address fundamental scientific questions in infectious disease biology, rather than those solely focused on COVID-19. Conducting this kind of basic research is crucial to the long-term health of our national research enterprise; indeed, the mRNA vaccine technology used by Moderna and Pfizer to develop their COVID-19 vaccines was established by government-funded basic science researchers. By making such an investment, we can lay the groundwork for developing treatments not only for COVID-19, but for the future pandemics that may lie just over the next horizon.
Chris Rota is a fifth year Ph.D. student in the Biological and Biomedical Sciences Doctoral Program at Harvard Medical School. In the lab, he studies pediatric brain cancer, working at the intersection of cancer biology and developmental neurobiology to uncover the basic processes that underlie tumor growth. Besides writing for the SITN blog, he also runs the Science by the Pint event series, which strives to create greater levels of interaction between scientists and the general public.
Daniel Utter is a 6th year Ph.D. student in Organismic and Evolutionary Biology at Harvard.
For More Information:
- Interested in seeing more data on how scientists have responded to COVID-19? Check out this recent study by Philip Shapira, a researcher at the University of Manchester, available in preprint on BioRxiv (please note that this study is currently not peer-reviewed and should be treated as preliminary)
- Want to read more about why basic scientific research is important? Read this influential report initially prepared for the members of the National Academies in 2007 and updated in 2010, which is still widely cited today.
- Curious about how the NIH sets the priorities for how it funds scientific research? Check out the NIH’s latest strategic plan document here.