Antivirals against SARS-CoV-2: current situation and approaches to improved preparation for future pandemics (2021)

Current data suggests that the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) will become endemic in the long term; as such, it will continue to circulate among parts of the population, meaning that even after the pandemic has subsided, infections will continue to occur which may result in severe cases of COVID-19 and fatal outcomes. As a result, in addition to available vaccines, comprehensive diagnostics enabling the early detection of infected persons and available symptomatic therapies, there is a need for antiviral agents (antivirals) which are suitable for use in the treatment of specific groups of persons. This applies, for example, to those who have not been vaccinated at all or only partially, and to those who have not built up sufficient immunity even after multiple vaccine doses. In addition, new variants of the virus could develop, against which the vaccines might provide reduced protection. At global level in particular, antivirals could – provided they can be administered orally or by inhalation and are available in sufficient quantities – make a significant contribution, as large parts of the global population do not have sufficient access to vaccines or medical infrastructure. Antivirals to treat SARS-CoV-2 available to date have either had limited effectiveness or significant adverse side effects or have been too time-consuming and costly to manufacture and administer. These factors have considerably limited their widespread application.

However, the current pandemic has also highlighted an insufficient level of preparedness for newly emerging pathogens. In this connection, fundamental research, clinical development and stockpiling of broad-spectrum antivirals will play a major role in enhancing our ability to better respond to emerging pandemics in the future.

Against this background, the German National Academy of Sciences Leopoldina recommends the development of therapies against SARS-CoV-2 and of broad-spectrum antivirals, the strengthening of infrastructures for fundamental and translational research, particular requirements for clinical studies dealing with highly contagious respiratory viruses and an improved monitoring of circulating virus strains.