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Reducing mortality of COVID-19 with antibody-rich plasma? Europe may have the answer if it comes together

 

Michel Kazatchkine (Special Advisor to the Joint United Nations Program on AIDS (UNAIDS) for Eastern Europe and Central Asia), Jean-Louis Vincent (Université Libre de Bruxelles, Brussels), Michel Goldman (Université Libre de Bruxelles, Brussels) discuss the opportunities for passive immunotherapy as a treatment option for Covid-19 patients and a greater collaboration among European nations to achieve this goal. 

A few weeks ago, a small case series from China suggested that the administration of antibody-rich plasma from patients who had recovered from COVID-19, may significantly improve outcome in patients with severe forms of the disease in intensive care.

Interestingly, transfusion of convalescent plasma (so-called passive immunotherapy) has been shown to be associated with better outcomes of disease, during the SARS outbreak fifteen years ago. There is also evidence for the effectiveness of transfusion of convalescent plasma or of hyperimmune immunoglobulins in a number of viral infections, including pandemic influenza A H5N1 and H1N1, Ebola, and West Nile syndrome.

The conceptual basis for passive immunotherapy had been laid hundred years ago by European scientists, primarily Emil von Behring in Germany and Pierre-Paul Emile Roux in France, after it was established that recovery from some infections is dependent on the generation of neutralizing antibodies to the pathogen.

Within just two to three weeks after the early publication from China, clinical trials of passive immunotherapy with convalescent plasma have been initiated in the US (New York, Rochester and Baltimore), Canada, Singapore, South Korea and in Europe. European countries include Germany, Italy, France, the Netherlands and Belgium where blood transfusion centers have now started screening and collecting convalescent plasma from individuals for high titers of anti-SARS-Cov-2 antibodies.

Rapidly growing attention to this approach is based on a strong conceptual basis, evidence that recovery from COVID-19 is associated with the generation of neutralizing antibodies, lack of significant adverse reactions to plasma therapy, and the absence of any effective treatment for severely ill patients at this time.

In times of crisis, coordination at the national and global level is essential to agree on the management of the short- and mid-term public health measures that need to be implemented and on how to drive the development of specific therapies and vaccines.

Yet, looking at the response to COVID-19, the global picture is one of discord and lack of coordination. In Europe, the response has been underwhelming and chaotic, with each member state deciding public health measures to take and on the timing of their implementation unilaterally.

Scientists and clinical investigators are experienced in international cooperation particularly when responding to epidemics such as HIV/ AIDS, TB, SARS, MERS or Ebola. While researchers in the US remarkably announced their commitment to share their results on COVID-19 trials in real time (Dr Michael Joyner, Mayo Clinic) it is unfortunate  that clinical investigators in Europe could not come together and conceive a joint protocol that would have given higher power to the studies and shorten time to the answer.  How did the European countries that are used to actively cooperating in research and how did the European Union that is investing high amounts of funding in biomedical research, including for COVID-19, get here?

We believe it urgent and imperative that members states and the European Commission now join their efforts. A European platform should be created where data from the ongoing trials are shared, analyzed and reconciled. This move is critical at the early phase of assessment of passive immunotherapy with convalescent plasma in COVID-19. But it should not end there.

Leading scientists from Belgium, France and Switzerland will advocate for a strong coordinated research effort in Europe in a virtual conference-debate on “Mobilizing EU collective intelligence to defeat COVID-19” on Thursday, April 16 at 2:00 pm CET which can be viewed in real time. Because of its outstanding potential, a strong coordinated clinical research network in Europe is not just a nice idea. It is an immediate necessity.

 

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