Ole Petter Ottersen, president Karolinska Institutet 2017-2023

I just read a paper providing a list of the 100 most cited articles in the early phase of COVID-19 . The list contains studies on the clinical manifestations of the new coronavirus and on the virus itself, on epidemiological issues, diagnosis, testing and treatment, and on the economic and social consequences of the current pandemic.

Perusing the list I make my reflections: where is basic science in all this? The same thought pops up every time I read a new paper on COVID-19: that we should bring to the fore the breakthroughs in basic science that paved the way for the extraordinary scientific achievements that we have experienced in the year that has elapsed since Dr. Tedros Adhanom Ghebreyesus on 11 March 2020 announced that the new coronavirus disease 2019 (COVID-19) can be characterized as a pandemic. These achievements have led to new vaccines and other advances in record time. 

Not to detract

I am not writing this to detract from the accomplishments of clinicians and epidemiologists – far from it. The clinical research community deserves accolades and praise for the speed by which it has zoomed in on the challenges at hand and helped improve the understanding and treatment of COVID-19.

My point is that we should also take time to highlight and honor the science that has built the very platform for the current achievements. I am talking about the basic science that brought us the genetic code, the knowledge about viruses and RNA viruses in particular, and not least the insight in cell biology and immunology that has figured so prominently in current debates about public health measures and vaccination strategies.

Includes other disciplines

Obviously the platform of basic science extends beyond biology and includes other disciplines such as technology development (PCR, genome sequencing) and research on lipids – “the unsung component” of messenger RNA (mRNA) COVID-19 vaccines. We only need a glimpse of the list of Nobel Prizes to understand why we are better equipped to handle COVID-19 than the Spanish flu. Many of these prizes (and not least the very last one in physiology or medicine, honoring the discovery of the hepatitis C virus) aptly underscore the interdependence of basic and clinical research.

We are still in the midst of a pandemic (or more hopefully near the tail end of it) but it is nevertheless essential that we now embark on a discussion on how we can be better prepared next time around. Simply put: when the next pandemic hits, the pathogen must not be allowed to get the same head start that SARS-CoV-2 got about a year ago.

Building capacity

It is a question of identifying and characterizing zoonotic viruses with pandemic potential (and generating vaccines against them), it is about building capacity for medicine and vaccine production on all continents and in the global south, it is about delineating a governance system for just distribution of medicines, vaccines and healthcare resources on the global level, and it is about improved access to large-scale patient information combined with improved surveillance and data sharing between nations.

But it is also about strengthening the platform on which it all rests: basic research. By its very nature, basic research has a long-term perspective and is therefore easily eclipsed in the midst of a crisis.

Tempting

Obviously in any crisis it is tempting to supplant basic research with research that is perceived as being more immediately relevant to the crisis at hand. This is what threatened to happen last year when proposals were put forward to steer the European Research Council (ERC) towards a specific focus on COVID-19 related research. Luckily, the proposals were turned down and ERC survived as a funding body dedicated to curiosity driven research across all disciplines. Post pandemic there should be an increased investment in research – mission driven as well as curiosity driven. 

As for medicine and health, the lesson learned from the current crisis is that we need more research along the entire spectrum, from bench to bed and vice versa. On the level of the nation states this will certainly translate into a bigger share of GDP devoted to research. But the additional costs are dwarfed by the costs of locking down societies and by the economic, societal and personal costs of lost lives – as a direct effect of COVID-19, or as a consequence of proportional or disproportionate public health measures.  

Spot on

Mariana Mazzucato was spot on when she in 2013 retraced major scientific and technological developments to state funded basic research. In her book “The entrepreneurial state”, she used cell phone technology as an example. We could equally well highlight vaccine development. The pace at which new vaccines were made available under the present pandemic must be seen in the light of major breakthroughs in basic research, some several decades back in time. Pharmaceutical companies have made great strides at unprecedented speed. But again – these strides are firmly anchored in state funded research. This is worth remembering when we now discuss how vaccines should be distributed globally and how intellectual property rights should be handled. 

In their article entitled “Decades of basic research paved the way for today’s ‘warp speed’ Covid-19 vaccines”. John P. Moore and Ian A. Wilson write: In the U.S. alone, the National Institutes of Health provides approximately $4 billion dollars a year to immunology and vaccine research programs, with further substantial support from private funders such as the Bill and Melinda Gates Foundation. These multiyear, multimillion dollar investments in basic science provided the foundation from which the new vaccines rapidly emerged.

“Belong to humanity”

In another paper, discussing the generation of one of the new vaccines, (Government-Funded Scientists Laid the Groundwork for Billion-Dollar Vaccines), Peter Maybarduk, director of Public Citizen’s Access to Medicines program, is cited as saying that “Federal scientists helped invent it and taxpayers are funding its development. … It should belong to humanity.”

I will return to the issue of vaccine distribution in a forthcoming blog.

Let me conclude:

Internationally as well as here in Sweden we should be extremely cautious when we – in our eagerness to combat the present pandemic – direct funding to specific COVID-19 related topics. There should be no doubt: we welcome rapid injections of funds into timely issues such as (most recently) vaccination research and treatment of post-COVID syndrome.  But earmarking of funding must not happen at the expense of basic science and curiosity driven, bottom-up research. Basic science – the bedrock of societal and technological development – has a long-term perspective. As such it is utterly sensitive to discontinuities in funding. And as such it is easily forgotten when a crisis hit.

My take home message this time around – to governments, funding bodies, investors, and philanthropists – is the following:  

More than ever do we need a solid platform of basic research so that we will be better prepared for the next crisis – be it a new pandemic or another crisis impacting the society at large.