Within one year after the WHO declared the pandemic dimension of Covid-19, scientific ingenuity and unprecedented clinical development efforts gave the world a fighting chance of halting the progress of this infectious menace.  

A general sense of cautious optimism was soon challenged by the appearance of viral variants of concern, first Delta, then the Omicron variant. Together with growing patches of vaccine reluctancy and supply challenges across the globe, Omicron swiftly negated the possibility of an immune halt to the pandemic.  

Since then, a growing combination of fatigue, hedonic adaptation, and economic urgency has lowered the social threshold for accepting the consequences of a steady flow of infections, paving the way for Covid-19 to effectively become an endemic disease. Despite its unknown length, many countries are embarking on this journey towards endemicity. It will be plagued with stealth variants, outbreaks, impromptu restrictions, and more social unrest. Among the uncertainty that lies ahead, mapping some of the questions at hand for pharma and healthcare should prove to be a valuable guiding exercise. 

In countries benefiting from substantial vaccination rates, an obvious starting question revolves around the readiness for pivoting to recurrent immunization schedules that will help keep Covid-19 incidence within tolerable limits. While progress is being made to understand the optimal nature and frequency of vaccine boosting across different demographics, the effectiveness of vaccines targeting multiple variants or aiming to offer combined protection against other agents like the flu virus is yet to be determined. Larger doubts exist about the feasibility of a concerted international approach due to logistical, socioeconomic and political considerations. Without some degree of multinational alignment, much of the effort will be rendered futile.  

The condition known as long Covid will bring its own set of challenges to healthcare systems even in a post-pandemic scenario. This post-acute Covid-19 syndrome (PACS) can present with a myriad of symptoms that go from long-term effects on pulmonary and cardiovascular function to chronic fatigue and neurocognitive problems (neuroCovid). While prevention and rehabilitation will be key, addressing the needs of Covid-19 long-haulers with an adequate therapeutic toolkit will be crucial given the potential burden of this debilitating disease. We have previously reported on the upcoming results from trials testing drugs for long Covid.  

Then there is the question of a recovering supply chain. Uneven supply patterns have been hindering the rollout of antivirals. As the Russian invasion of Ukraine escalates against the backdrop of the pandemic, vaccine manufacturers and countries in the Global South face a new dilemma. Challenging as it sounds, if a solid recovery of the pharma supply chain is not ensured gradually, the medical toll of a Covid-19 incidence that is off tolerable limits will undermine any strategy relying on a near-global march towards endemicity.  

Another important lasting topic is whether the industry will apply organically some of the lessons that emerged from the need to keep trials running during the pandemic. The impetus of clinical research virtualization and the flourishing of telemedicine, whether that is a follow up visit on Zoom or having the investigational drug delivered to your doorstep, are challenging the need for persistent patient-provider colocation. Millions of people around the globe have become comfortable with self-testing. When it comes to drug development efficiency, archetyping the specific approaches being used in decentralised clinical trials (DCTs) will be key for proper impact assessment. The pandemic has raised the digitalization bar in pharma & healthcare: how this plays out for all the ecosystem stakeholders, especially patients and regulators, remains to be seen. But what is clear is that this new digitalization benchmark will shape future models of research and care. 

These are only some of the pharma and healthcare considerations that will be at play as half the world transitions to an endemic Covid-19 scenario. We are not stopping here; over the next two weeks, Clinical Trials Arena will keep bringing you exclusive data-led stories on these and other forward-looking topics. Our investigative reporting will provide you with key insights on how these two years of pandemic have reshaped the focus of pharma R&D investment as well as any lingering impacts on the clinical trial and medical device landscapes – stay tuned!  

Cell & Gene Therapy coverage on Clinical Trials Arena is supported by Cytiva.

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