How has the coronavirus pandemic brought these insights into sharper focus?

When COVID-19 hit, the global scientific community immediately decided, “Let’s shareall our research and knowledge in order to understand this virus and create a vaccine, a treatment.” All the presumed reasons that we couldn’t share suddenly evaporated. It became clear that the real reasons we haven’t been sharing more are artificially constructed by society. People didn’t want to change the system.

And why do people want to change the system now? Because we’re in a crisis. But childhood cancer is also a crisis. Dementia is also a crisis. Tropical diseases that primarily affect people in the developing world are also crises. Future pandemics that we can predict now, just as we predicted COVID-19. will be crises.

And so I hope that this ability to share continues beyond this current moment and this current virus, to a radically new universe of how we think about and fund the development of new medicines. That’s the work I’m devoted to.

What does that new universe look like?

In this new universe — and it is an entirely possible universe to create — we need to proceed from the premise that access to medicine is a basic human right, and that scientific and medical research are primarily societal rather than economic goods.

At a practical level, this means adopting open-science principles: sharing research and knowledge, in real time, without patents. For example, at the Structural Genomics Consortium [the open-science drug discovery I founded in 2004 to study the human genome], we have released the structures of more than 1,300 proteins. Under the charitable Agora Open Science Trust, I have founded two open science drug-discovery companies devoted to developing drugs for conditions that are either too complex or too rare — like dementia, or a highly fatal children’s brain cancer — for pharmaceutical companies to invest in.

Open science accelerates discoveries. Say I have an idea for an Alzheimer’s drug. Maybe it doesn’t work, but when we do the experiment out in the open, we can see why it doesn’t work. Then other scientists and other labs in other countries don’t have to do the same experiment — and the money that would have been used to compete over one idea can now be distributed over 10 ideas.  We learn from them all. And, ultimately, the price of the drug reflects one failure rather than 10.

What’s your latest project?

We’ve just launched VIMI (the Viral Interruption Medicines Initiative), a non-profit whose mission is to ​develop the drug treatments urgently needed to fight COVID 19 and the next pandemic​. VIMI aims to develop 10 drugs ready to be tested in clinical trials as soon as the next pandemic hits. We’ve secured partnerships with universities in the United States and Europe, and with a non-profit affiliate called ​READDI (the Rapidly Emerging Antiviral Drug Development Initiative)​, which was formed to facilitate fundraising from American philanthropists.

We will operate under extreme open science principles: sharing research, no patents, not for profit.

This isn’t a new idea. We are copying shamelessly from other successful open- science pharmaceutical companies — like DNDi, the Drugs for Neglected Diseases Initiative, or Doctors without Borders’ Access Campaign, both of which are successful, open-science models of drug discovery for the developing world.

We need catalytic funding from governments, foundations, and other partners to make this a going concern.

Is open science a viable business model?

Yes. One viable option, for example, is to offer pharmaceutical companies a license to produce the new medications at a reasonable profit over cost.

Naysayers will argue that an open-science model works only for neglected diseases, or diseases of developing countries, because clearly there’s no rational way for an investor to invest in those. But I argue that the market doesn’t work for any disease. It’s not working for Alzheimer’s, or Parkinson’s, or pediatric cancer, and I can just keep going.

And — as we can all see right now — the current system is not working in a pandemic. When we awake from the scope of COVID-19, we will realize that millions of people died in the developing world from this virus. Millions. And what poor countries cannot afford is what the world cannot afford. If Malawi, for example, does not strike out its COVID threat, it is going to come back. We need to think about global eradication, not local. And we need to do it now.

How has Covid-19 affected the children and communities you work with?

My patients come from the most vulnerable communities across Canada. These children and families are excluded. They live in very poor conditions. They have experienced all kinds of “toxic stresses”: poverty, histories of violence and trauma, substance abuse, racism.

The epidemic has exacerbated these problems. People are socially isolated in small apartments. They are losing their jobs, or working on the front lines. We are seeing increases in fear, violence, anxiety and depression. Mental health issues are the biggest by-product of the coronavirus in children — more, in fact, than the disease itself.

Children’s daily security net is gone: school counsellors, teachers and daycare workers who refer them to protection are no longer there. So, we have become front-line workers to make sure our children and families are well protected.

You’re now delivering care via telemedicine. What are you noticing about the shift?

Before the pandemic, I saw vulnerable patients maybe once a week or month — often less — which was not ideal. Trust is the foundation of social pediatrics and when you see a patient infrequently, it is very difficult to develop that trust.

Now, with the pandemic, I’m getting closer to the families. With telemedicine I can talk to my vulnerable patients every week, even every day. It takes five, ten minutes. We can see many more families and children because no one has to travel. The adolescent population is usually very difficult to reach. But during Covid they can talk to us from their couch. We can ask a family member to join us to discuss a treatment plan or an issue. And I’ve been surprised how willing they are to co-design and follow the therapy that we propose together. We’re hearing them say, “Okay, I want more next week. Are you going to be here?” We’re finding that telemedicine and audio really helps.

It seems that the conditions created by COVID-19 have created opportunities to move forward on and scale new ways of delivering mental health services. What do you think you’ll take forward into your practice after the pandemic?

We are social entrepreneurs so we are used to adapting and innovating all the time. We’re always seeking ways to become closer to families like cycling or going grocery shopping together in their communities. We have structured our Garage à musique social pediatrics centres where we use the tools of music education as a gateway to other support services for children and youth. We were in many ways ready for the pandemic without knowing it was coming.

A few months ago I wouldn’t have thought that telemedicine would be as helpful as it is. It’s very surprising. We’ll continue after the pandemic because it’s a real opportunity to see our children more often and keep our families closer to offer more services. We had a robust and adaptable model and now we have a new layer of technology that increases our ability to engage and unite people.

Right now, the general population is becoming more aware of inequity and the ways in which children’s rights are being violated. People are more empathetic with their neighbours and with people who are suffering. They are giving money to the neediest causes. It’s a good time to address these issues when people are willing to change their mindsets and their social behaviours.

This pandemic is creating very hard challenges but some lasting good is coming out of it.