By Kirill Dmitriev
Since the start of the coronavirus crisis, Russia had received criticism in international media over its response to the pandemic. In reality, the country is setting an example others can learn from in many vital areas. Russia is one of the global leaders in testing for the virus, in producing efficient drugs and it is rapidly approaching mass production of its own vaccine.
The Russian Direct Investment Fund (RDIF), the country's sovereign wealth fund, has played a key role in fighting the virus in Russia. We learned about the threat in late January from our network of international partners, advised the government in its assessment of it and moved ahead with investment.
With countries like the United States predicted to reach a staggering 100,000 cases a day, it is important that we quickly develop focused solutions based on proven technologies with no time to spare. We believe that RDIF has now developed key elements of such a practical solution.
Working jointly with some of the world's top institutional investors, we have selected and funded what we believe are the most promising COVID-19 testing systems, drugs and vaccines. Our assumptions, analysis and approach may be helpful to others who are making critical decisions about how to combat the virus.
No magic bullet
We believe that there will be no magical solution; the virus will not simply disappear. New outbreaks show that the relaxing of social distancing can lead to new waves of the virus. Meanwhile, the long, multi-year processes required for drug and vaccine testing will prevent hypothetical new breakthroughs from being available anytime soon.
Consequently, we need to focus on the best existing solutions and scale them up quickly through international cooperation.
This may seem like an obvious approach. Yet, the hope for quick solutions, the lack of deep analysis and deepening mistrust among nations has prevented it from being adopted by many countries.
Hopes that the virus will quickly disappear has led to many countries relaxing restriction measures too early and to companies underinvesting in biosecurity. News reports on potential breakthroughs have all-too-often failed to mention the risks involved or the length of time needed for regulatory approvals. This search for a new magic bullet has obscured the availability of proven existing solutions that can be quickly deployed.
We have taken a different approach. By cooperating with more than 15 of our partner funds internationally, we have moved forward and focused on three readily available solutions that are already playing major roles in defeating COVID-19 this year.
Quick and precise tests are key to opening economies. Only through extensive testing can economic activity, including international travel, resume.
We have developed a Russia-Japanese testing system under the EMG brand. It provides much faster results, in 30 minutes, compared to the 2.5 hours needed for many other tests. And the results are just as accurate when compared to traditional PCR testing system. We can give the results faster, and our test reagents increase by three to four times the throughput capacity of existing PCR testing systems.
Our testing system can be used not just in laboratories but in any location—allowing for rapid, accurate testing in airports, offices, factories, and prior to sports and entertainment events.
Our testing system has already helped to quickly locate and prevent potential outbreaks at many of Russia's largest industrial enterprises, as well as at offices and soccer competitions. Unsurprisingly, other countries have purchased more than 13 million of our tests—indeed, they account for more than a third of all tests completed in the U.S.
Rapid, accurate tests like ours will be essential to opening up the world economy. They can vastly ease international air travel, for example. They will soon be used in airports around the globe. Rather than spending 24 hours in a mandatory quarantine in Athens, travelers may soon, after a 30-minute wait, be able to go to Greek islands directly.
This is a solution to a trillion-dollar issue. According to UNCTAD, the global tourism industry will lose between $1.2 trillion and $3.3 trillion this year. More than 120 million jobs are at risk globally in the tourism industry alone, along with some 1.25 billion indirect jobs that could also be lost.
Because the cost of testing represents a tiny fraction of potential economic losses, we are currently undertaking pilot projects in three countries to create virus-free airport hubs that would allow tourism activity to safely resume.
When it comes to treatment, the focus should be on available antivirals because they prevent early and moderate infections of COVID-19 to develop into severe cases.
While we have also invested in medications for severe cases of COVID-19 based on plasma and in medications that defeat cytokine storms, we have concentrated on proven antivirals we believe will have the most impact on stopping the progression of the disease.
Gilead's Remdesivir and Avifavir, which we created in Russia as an improved coronavirus-specific version of the Japanese anti-influenza drug Avigan, became the first two regulatory approved anti-COVID antivirals in the world.
These drugs will be key to shortening infection times and hospital stays. Because they target the coronavirus through a known mechanism of viral RNA polymerase inhibition, they also have more limited and clearly understood side effects than other non-specific drugs. The main restriction is that Avifavir should not be taken by pregnant women or during the time of pregnancy planning.
In our clinical trials of Avifavir, we discovered that the effective dosage against coronavirus should be higher than when the drug is used against influenza. We additionally purified the substance to enable the increase in dosage without side effects and applied for international patents to the discovered changes in optimal dosage and treatment protocols. In our clinical trials, which enrolled 330 patients, more than 60 percent of those who took Avifavir tested negative for coronavirus on the fifth day of treatment — twice as many as in the standard therapy group. The median elimination of the virus took 4 days on Avifavir, compared to 9 days with standard therapy, thus reducing the time that patients are infectious and the length of their hospitalization. Three independent clinical trials in Russia enrolling over 700 patients confirmed our findings and so did the results of tens of thousands of patients already effectively treated by Avifavir in Russia. We have shared our results with Fujifilm, the producer of Avigan, and will cooperate with them closely on improving other ongoing clinical trials based on our findings.
While Remdesivir will not be available to be shipped internationally for some time due to massive purchases by the U.S. Government, we have already launched the international distribution of Avifavir, and increased our production to 300,000 courses a month, to supply both local and international demand.
Avifavir has already been bought not only by Russia's neighbours Belarus and Kazakhstan but also by Colombia, Brazil, Bulgaria, Mexico, Saudi Arabia, Peru and many other countries with more than 50 countries submitting purchase requests.
Other generic versions similar to Avifavir can be produced by other nations as well, enabling the mass distribution of the drug around the world, which is particularly advantageous as such generics are several times cheaper than Remdesivir. After we demonstrated the efficacy of the drug, two more based on the same substance were registered in Russia. A favipiravir-based product also received an emergency approval in India while Turkish Minister of Industry said that favipiravir will soon be registered in Turkey, calling the upcoming event "a source of pride and elation".
Also, Avifavir is available in tablet form, making it easier to dispense to public through pharmacies as prescription medication in comparison to hospital injections required for Remdesvir.
It is a huge challenge to select from the more than 140 vaccines currently in development, with more than 20 of these vaccines currently in different stages of clinical trials. No other vaccine has ever received regulatory approval faster than in 4 years.
Nonetheless, our analysis shows that adenovirus-based vaccines will be the first to market, with the expected regulatory approval this September. They introduce a gene of the spike of coronavirus into a human body through a previously proven adenovirus-based delivery mechanism.
Adenoviral vector-based vaccines have been developed since the 1980s. They have already received regulatory approval and have been efficiently used against the Ebola virus with a high degree of safety. Vaccines against MERS, Zika, influenza, and malaria are undergoing successful clinical trials. There are also prospective mRNA and other innovative vaccines that we hope will work at some point. But while mRNA is a brilliant new technology, no mRNA vaccine has ever received regulatory approval to be used to combat a virus.
Even if a mRNA vaccine moves at warp speed to gain regulatory approval, such approval will not be possible until 2021, since extensive safety testing needs to be done. This includes insuring that there is no negative impact on fertility — a key parameter for nations that plan to vaccinate a large part of their populations.
There are three adenovirus vector-based vaccines that have already showed strong results in Phase 1 of clinical trials. These have been developed by Russia's Gamaleya Institute, England's Oxford University in partnership with Astra Zeneca and China's CanSino Biologics. We believe that all three will be needed.
I am confident enough in Russia's Gamaleya vaccine that I received an injection of it. I developed a strong immunity in 20 days, even before the second booster shot that hopefully extends the immunity to two years.
Others will soon be able to do the same. By producing this vaccine through manufacturing partnerships in several countries, we will be able to ramp up production to 200 million doses by the end of the year.
We estimate that more than 3 billion doses of adenoviral vector-based vaccines will be produced in 2021, which will help the world to effectively combat the coronavirus. The Russian vaccine will also come with a unique patented test that identifies the increase in highly specific human antibodies attacking the spikes of the coronavirus. Thus, the effect of the vaccine and its duration will be easy to measure, by measuring the increase in the most efficient antibodies against coronavirus.
Above all, international cooperation
It is time to stop the never-ending debates about the most effective means to combat the coronavirus. They are jeopardizing lives, as well as the world economy. Countries around the globe must jointly put in place best practice — including mandatory mask wearing, maintaining social distancing, and sharing readily available solutions — before it is too late.
Our fund is cooperating with many nations in this field. We believe that only through a fully cooperative, global approach can this and future pandemics be successfully combated.
Kirill Dmitriev is chief executive officer of the Russian Direct Investment Fund, a sovereign wealth fund with $50 billion under management.
The views expressed in this article are the author's own.