Intense rigor and standards make up the core values of scientific research and medical progress. Though a sequential, slow and arduous process, this empirical approach has become the standard because of the track record of safety and reassurance it has institutionalized when medical advances are brought to market. Yet, for public health issues in desperate need of new treatment options, the research process consumes precious time that patients do not have.
Just as the axiom that necessity is the mother of invention, the urgency of the COVID-19 pandemic laid bare the necessity to invent a process for faster medical progress— and the means to do so. The COVID-19 vaccine mission encompassed eight months of accelerated scientific research at the cost of approximately $18 billion. A calculated risk that paid off with several FDA-approved vaccines and faster distribution of these products than ever before. The accelerated development process used for COVID-19 vaccines and diagnostics sped up product development through several mechanisms. They took advantage of new vaccine technology already developed for other diseases and began manufacturing the most promising candidates while still in the middle phase of clinical trials. Pharmaceutical companies conducted larger-scale volunteer-based trials for rapid data collection and continually investigated product safety. The efficiency of this approach in hastening scientific research leaves several lessons for research bodies fighting against major diseases— like cancer.
This year marks the 50th anniversary of the War on Cancer, launched through the National Cancer Act. The legislation greatly increased funding for cancer research, about $1.6 billion over three years, and gave rise to the National Cancer Institute. This funding push fostered the belief that a cure for cancer was within arm’s reach. Basic scientists knew better— research requires patience and persistence— and regarded the War on Cancer with great skepticism. At the time, even the most basic mechanics of cancer biology remained unclear. How could scientists hope to conduct productive applied research and produce a miracle cure without a complete picture of the disease?
The disconnect between public expectations and researchers’ capabilities lead some to view the War on Cancer as a rather unsuccessful. The truth is far from this— sustained funding into cancer research produced several pivotal discoveries. Scientists found the first cancer-causing genes like BRCA and launched the Cancer Genome Atlas. In addition to these stunning developments into the understanding of the pathology of cancers it has also directly led to innovations in treatment. Scientists discovered ways to decrease cancer risk and learned to more effectively treat some of the deadliest cancers.
Despite all the progress in research, cancer remains the second leading cause of death in the U.S., just as it was back in 1971. In 2016, Vice President Joe Biden launched the Cancer Moonshot mission, planning to pour roughly $1.8 billion into cancer research over seven years. The mission aimed to reignite scientific research and collaboration for areas of cancer research with the most promise of benefitting patients. So far, the Cancer Moonshot has funded over 240 research projects amongst its vast network of scientific initiatives— leading to meaningful progress in immunotherapy, early detection, and treatment resistance, amongst others.
According to the American Cancer Society, the past 50 years of advances in cancer research produced a 31% decline in death rates from the peak of cancer deaths in 1991 to statistics from 2018. That’s approximately 3.2 million fewer deaths from cancer— not a cure, but undoubtedly optimistic of future progress. That was until the 2020 COVID-19 pandemic overtook the world.
One thing an immunocompromised cancer patient does not want is to find themselves in the middle of a global pandemic. Great concern rose about the likelihood of severe disease and death by COVID-19 in cancer patients. Surprisingly, several large studies found that cancer did not increase the risk for COVID complications. Researchers remain cautiously optimistic in this regard, with several long-term follow-up studies from the National Cancer Institute and American Cancer Society still underway.
Instead, pandemic fallout came in the way of inhibited health care access and potential worsening of existing health inequities in cancer. Even with the rise of Telehealth, patients still experience delays in receiving necessary cancer care or screening. Black and Hispanic/Latinx individuals shoulder a heavier burden of COVID-19 and cancer— with no clear idea of whether or how telehealth benefits them. The lack of healthcare access that occurred throughout the pandemic leads cancer experts to predict an increase in late-stage diagnoses and preventable cancer deaths due to the pandemic.
A likely resurgence in cancer deaths places pressure on the scientific community to speed up progress in cancer treatment. A steady increase in federal and private sector funding for research projects could provide the support needed for potential breakthroughs. Current funding lines for the National Cancer Institute have failed to meet the increased demand for scientific research. The institute has seen a 50% increase in R01 grant applications (others only a 5.6% increase), leading to many high-quality projects being rejected due to a lack of funds. Only 11.6% of research project grants (RPGs) were successfully funded in the fiscal year 2019. Yet, the RPG success rate for the National Institutes of Health as a whole rose during that period—making this a selective cancer funding issue.
Cancer research not only needs increased funding to battle pandemic fallout and meet the demand for innovation but also a bold new approach to cancer cures. On the heels of COVID-19 vaccine production restructuring, similar approaches would propel cancer treatment forward at an accelerated rate without compromising safety and reinvent the scientific method to combating major diseases.
As Dr. David Shulkin, the Former United States Secretary of Veterans Affairs, argues in his recent commentary on COVID-19 vaccine innovation, the success of this mission rests on several fundamental aspects, including collaboration, efficient planning, and innovating the research process. The large multi-company collaboration of COVID-19 vaccine innovation flies in the face of previous research and discovery occurring “in silos,” valuing independent achievement over teamwork towards a common goal. This approach unified academic researchers, pharmaceutical companies, government agencies, and the military with undivided attention towards a common goal. Instead of funding or business alliances, the approach used each partner for their core competency to ensure mission success.
The COVID-19 vaccine mission made sure these efforts were not wasted by implementing agile development, a method predominantly used in software development till recently. This allows for the stretch goals necessary to motivate the entire team while breaking down a complicated problem into manageable sections and running them alongside one another. Now, instead of moving from one milestone to another, teams are conquering multiple milestones at once and moving faster towards their goal. While this approach incurs a significant risk and greater possibility of failure, effective planning can minimize negative outcomes. The COVID-19 vaccine mission did this by investing in multiple vaccine candidates and technologies, running them side-by-side to maintain their timeline.
The Men’s Health Network, part of the One Voice Against Cancer consortium, warns in its funding letter for 2022 that “the results of clinical trials and the broader drug development process can take years to realize, meaning that, without aggressive measures to mitigate the impact (of the pandemic), the full effect of these disruptions on therapeutic innovation in cancer care is likely to be felt for years to come.” Applying the lessons learned from the COVID-19 vaccine mission to cancer research, with appropriate funding, could help scientists to meet the need for cancer treatment innovation.