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How we can democratise medicine and create fair access

Living in the shadow of Covid-19, we’re all too aware of the impact that viruses can have on our daily lives, and how critical our response is.

Covid-19 highlights disparities in access to effective healthcare

Seven years ago, in the wake of the Ebola epidemic in West Africa, Bill Gates spoke about how we need to approach disease outbreaks differently. In an eerily accurate prediction, he explained that the next epidemic could be dramatically more devastating than Ebola due to our lack of preparedness. But with our advanced technologies and modern medicine it would be possible to mitigate a negative outcome.

Despite warnings from experts, the Covid-19 outbreak caught the world by surprise and many countries struggled to contain and treat the virus. The world saw it spread exponentially, leading to millions of deaths and tens of millions of people living with the long-lasting effects of the disease. The virus also highlighted the stark difference between developed and developing nations and how, when faced with a global threat, the world is still not ready to pull together and work for the good of the whole.

Changing the global approach to disease control

We need to approach mass disease outbreaks differently. To effectively prevent and treat Covid-19 and any future pandemics, we must ensure there is fair and equitable access to medicines, as well as robust supply chains to deliver treatment to places most in need. To address these issues, industry and academia – along with charities and philanthropic organisations – are looking at new and cheaper routes for manufacturing drugs and vaccines to fight future diseases. For Covid-19, one such drug has been in the spotlight in recent months – the antiviral therapy Molnupiravir.

Molnupiravir was originally developed to treat influenza but has since been shown to be effective in treating Covid-19. Studies show that it offers approximately a 30 per cent reduction in both hospitalisations and death from Covid-19 (for mild to moderate disease) in unvaccinated patients with at least one co-morbidity. Alongside its efficacy in treating the disease it is also relatively simple to produce, making it a useful tool in our arsenal. Now approved in the UK, India and the US, Molnupiravir could offer a lifeline to patients in developing countries where vaccination rates are low, while relieving pressure on already overstretched healthcare systems.

The need is clear: we must find efficient, sustainable and cost-effective ways to produce Molnupiravir and strip the drug’s manufacturing process from its “patent bonds” so these new methods can be employed by pharmaceutical companies around the world. We are now one step closer to achieving this goal thanks to a joint venture between The University of Manchester, Prozomix and Sterling Pharma Solutions, with funding from the Bill and Melinda Gates Foundation. Scientists have developed an efficient and low-cost biocatalytic process to manufacture Molnupiravir.

Discovering sustainable and cost-effective ways to production

Through directed evolution – a powerful enzyme-engineering technology – researchers have developed a new enzyme that produces N-hydroxy-cytidine (a key intermediate in the production of Molnupiravir) at high yield and as part of a time- and resource-efficient method. N-hydroxy-cytidine is then converted to Molnupiravir using a second enzymatic process.

This new technique offers scalability, efficiency and sustainability for industry, all of which are essential for securing fair access to drugs. When faced with a global pandemic, drug production methods should ideally be open-source and available for use by pharmaceutical manufacturing companies.

The research demonstrates the impact of collaborative work when faced with a global threat and is opening doors to more scalable and productive approaches to drug manufacturing. It is an important step towards democratising healthcare and affording everyone the same access to potentially life-saving treatments.

Making Molnupiravir accessible for all

The details of this new manufacturing route are freely available for companies to use. Any company interested in producing Molnupiravir via this new process can contact Prozomix to request free samples of the enzyme.

Biotechnology is one of The University of Manchester’s research beacons – exemplars of interdisciplinary collaboration and cross-sector partnerships that lead to pioneering discoveries and improve the lives of people around the world. For more information, head to The University of Manchester’s Biotechnology page.

Prof Nicholas Turner, Prof Anthony Green, Dr Sarah Lovelock, and Enna Bartlett are from the Manchester Institute of Biotechnology at The University of Manchester.

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