The valley of death: why Australia failed to develop clinically effective drugs in COVID-19

There is a paucity of public discussion of costs spent on drug trials during coronavirus disease 2019 (COVID-19) and their value, and of large public outlay on research funding for vaccine and drug development that did not deliver medicines nor vaccines for Australians. This oversight left us at the behest of global supply chains, politics and commercial cost-plus pricing for vaccines. It is possible that these outcomes were the result of some major cognitive biases and the failure of a clinical pharmacologist's voice in the leadership teams. Biases included unawareness of the complexities of taking interesting chemicals in vitro to development into therapeutic use that can be tolerated, show efficacy and have appropriate disposition in humans; lack of a systems approach to therapeutic development; and an understanding of the relevance and translatability of pharmacology, physiology and clinical drug development. We believe that reflecting on and addressing these biases will help Australia reposition itself better with a therapeutics and clinical trial strategy for future pandemics, built into the strategy of a Centre for Disease Control.

Automated summary

There is a lack of public discussion on the costs and value of drug trials during COVID-19, as well as the failure of research funding to deliver medicines and vaccines for Australians. This has resulted in dependence on global supply chains and commercial pricing for vaccines. Cognitive biases and the absence of clinical pharmacologists in leadership teams may have contributed to these outcomes. Reflecting on and addressing these biases is crucial for Australia to develop better therapeutic and clinical trial strategies for future pandemics.