Medical Progress: How Far We’ve Come, But Still a Long Road Ahead

The first article was titled “Four Decades of HIV/AIDS – Much Accomplished, Much to Do”.⁽¹⁾ One of the authors, interestingly, was A.S. Fauci… yes, that Anthony Fauci who has so frequently appeared in the media of late.

How does he find the time, one might ask? But that is another story.

Progress on HIV/AIDS

I decided to read the article partly because of the author, partly out of human interest, and partly because one of the requirements of successful investing is to read widely.

Another factor that piqued my interest is that one of our portfolio holdings – Gilead Sciences, Inc. – has been instrumental in driving forward the scientific understanding of the human immunodeficiency virus (HIV).⁽²⁾ Gilead has developed 11 HIV medications, including several important “firsts”: the first single-pill regimen to treat HIV and the first drug to prevent HIV infection. Its drug, Biktarvy^®, is the most prescribed HIV treatment in the U.S.

Since the acquired immunodeficiency syndrome (AIDS) was first recognized in 1981, the scientific progress in reducing the effects of the disease has been remarkable. Consider:

• In 1981, the prognosis for life expectancy was a bleak 6-12 months. Now, life expectancy while receiving treatment is close to normal.
• The risk of transmission to an uninfected sexual partner can now be managed with great effectiveness. A once-daily, single-pill drug regimen is 99% effective in preventing sexual acquisition of HIV infection by an at-risk uninfected person (Gilead produces two such drugs, Descovy^® and Truvada^®).
• The United States’ flagship initiative named “The President’s Emergency Plan for AIDS Relief” has provided testing to 79.6 million people, delivered antiretroviral therapy to 15.7 million people and enabled the birth of 2.6 million uninfected babies to mothers with HIV.

All of this is progress, and it provides some optimism for the approximately 40 million people living with HIV.

Progress on COVID-19

We hope that the success that science has had with AIDS treatment may contain lessons for addressing COVID-19. In the current environment, finding reasons for optimism can be difficult; case counts are rising again in many parts of the world and the sheer scope of the disease makes it different from any other virus the modern world has seen.

Yet, while advances in AIDS treatment took many years, today there is hope that progress on the pharmaceutical front might bring about a faster solution for COVID-19. As of July, there are 166 vaccine candidates in development⁽³⁾ and we expect pivotal data on many vaccine trials will arrive in the next few months. There is a lot at stake for all of us. But at Nexus we are watching the results from three leading vaccine candidates in particular:

• The University of Oxford and AstraZeneca. Their vaccine, known as AZD1222, is considered the most advanced candidate. AstraZeneca has stated⁽⁴⁾ that it is targeting “first deliveries” of the vaccine by September 2020. The most recent trial results show that participants who received the vaccine had significant immune responses for both antibodies (which may neutralize the virus) and T-cells (which can destroy cells that the virus invades).
• Pfizer and their German partner BioNTech. The two companies ran trials of their vaccine candidate, BNT162b1, in both the U.S. and Germany and found it delivered high levels of neutralizing antibodies and elicited T-cell responses. Pfizer has been a long-standing holding in Nexus portfolios.
• CanSino Biologics and the Beijing Institute of Biotechnology. A study of 508 volunteers found that this candidate, known as Ad5-nCoV, produced a strong immune response in the majority of the trial participants. Importantly, the trial was uncommon in that it included patients 55 years or older.

Unfortunately, there are no guarantees that these vaccines will work. If – as we all hope – they do, there are big milestones yet to be achieved on safety, effectiveness and determining the duration of the immune response.

What’s more, there are additional challenges to ensure sufficient quantities of vaccine can be manufactured, distributed and administered where it is needed around the world. There is no definitive answer on when any of these candidates might be broadly administered to people, but the consensus view is it won’t be until 2021.

Despite all of this uncertainty, we can draw some comfort that we are making progress in the fight against COVID-19. From an investor’s point of view⁽⁵⁾, this progress is a welcome sign that the probability is rising that economies, industries and companies will recover from this crisis. There will likely be setbacks on the road ahead, but the medical progress appears to be heading in the right direction.

Borrowing from the title of Dr. Fauci’s article, much has been accomplished, but there remains much to do.