Emory researchers, scientists and health care providers have worked at the forefront of innovation throughout the pandemic to combat the devastating effects of COVID-19 in Georgia communities and around the world. The development of molnupiravir, an oral antiviral drug discovered by researchers at Emory University, is one of the most notable examples of this work.
Molnupiravir appears to significantly reduce the risk of hospitalization or death in patients with mild to moderate COVID-19, according to interim data from a study conducted by Merck and Ridgeback Biotherapeutics, which are currently developing the drug after licensing it from Drug Innovation Ventures at Emory (DRIVE). On Oct. 11, Merck announced that it submitted an application to the FDA for its Emergency Use Authorization. If authorized, molnupiravir could be the first antiviral pill for COVID-19.
Emory University President Gregory L. Fenves joined Jodie Guest, professor and vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, to discuss Emory’s role in this discovery and the university’s long history of research excellence.
Their conversation is part of an online video series hosted by Guest, who also leads the Emory COVID-19 Outbreak Response Team, addressing topics related to the COVID-19 pandemic. Watch the full conversation here.
Q: President Fenves, why do you think this discovery happened at Emory?
A: “This discovery happened at Emory because Emory is an innovative university. Our faculty, our researchers, our scientists look at the most important problems and seek out answers and solutions to them,” says Fenves. “There’s no other problem that’s facing us more immediately than the COVID-19 pandemic, so scientists like Dr. George Painter — who, by the way, has an undergraduate degree and a doctorate from Emory University — their mission is to treat disease, to help reduce suffering and to save lives. That’s the underlying DNA of the university.”
Fenves adds that Emory is organized and positioned for monumental discoveries, and that research universities such as Emory provide the perfect setting for innovation, invention and development. “It begins with science — understanding human biology, understanding disease, how disease affects humans and looking at the biological and molecular mechanisms that affect people.”
“But science alone doesn’t cure disease — this is why Emory is so special as a university,” he continues. “Discovery such as an antiviral drug that affects RNA replication” like EIDD-2801, now known as molnupiravir, “is the starting point. It’s an essential starting point, but it’s not enough. Emory recognized this a number of years ago to found DRIVE (Drug Innovation Ventures at Emory).”
DRIVE, a non-profit LLC wholly owned by Emory, effectively operates like an early-stage biotechnology company and focuses on the discovery and development of antiviral drugs for emerging infections, pandemic threats and biodefense.
At the beginning of the pandemic, Painter, CEO and founder of DRIVE, and his colleagues suspected that the antiviral for influenza, which they had been researching with funding from the National Institutes of Health (NIH), could be repurposed to treat patients with COVID-19. Interim data from Merck’s analysis of this antiviral, now named molnupiravir, appear to suggest they were right.
“That work by DRIVE and Dr. George Painter and his colleagues shows that this type of discovery can be moved into a clinical setting much more rapidly than would be typically found,” Fenves says.
Q: Why is drug discovery so incredibly important to Emory?
A: “I’ve only been at Emory one year, so I’m learning what is so special about Emory, and that is — across the university, in health sciences, in our college of liberal arts, in our professional schools — a desire to serve humanity,” Fenves says.
Historically, this desire to serve has produced innovations with global implications. As an example, Fenves cites the antiretroviral drug Emtriva, discovered by Emory researchers Raymond Schinazi, Dennis Liotta and Woo-Baeg Choi in the 1990s, which has since transformed treatment for patients with HIV/AIDS around the world.
“So, this is a model that has worked well at Emory,” Fenves says. “One of the things I’m interested in doing, as we look to the future, is how do we make that model work even better, so that we can really serve our mission to help humanity through scientific advances and developments like molnupiravir.”
Q: What is unique about the ways in which Emory supports research?
A: “First of all, we do a lot of research,” Fenves says. “This last fiscal year, Emory had a record of nearly $900 million in federal grants and contracts for research — the highest in the history of the university,” and an increase of 7.6% from the previous year. Based on these figures, Emory is expected to continue to rank first among universities in Georgia for NIH’s COVID-19 research funding.
“But, we’re also in a city and a state that’s committed to this,” he continues. “Our next-door neighbor is the CDC, and that partnership with a federal agency is so crucial to the health of the nation. It is a model for health policy and public health around the world, and it has been a very big part of what we’re able to do at Emory.”
“We’re also in a city that has other great universities,” Fenves says. “We have no better partner in that than the Georgia Institute of Technology, which is just about six miles away. With Georgia Tech, we have tremendous collaborations and complimentary capabilities, with their engineering and technology and Emory with its health sciences. The collaboration has been terrific –– building a culture of research and a culture of discovery and inventiveness –– not just within our own campus but with our colleagues around Atlanta.”
As an example of these partnerships, Fenves cites the RADx program, in which the Emory University School of Medicine Department of Pediatrics, Children’s Healthcare of Atlanta (CHOA), and Georgia Tech shared in a $31 million award from the NIH to rapidly transform innovative technologies into widely accessible COVID-19 diagnostic testing.
Fenves also underlines the role of the state and the Georgia Research Alliance (GRA) in supporting scientific research at Emory. “GRA has been very important in recruiting outstanding scientists to the state of Georgia and the universities in Georgia, so we’re very glad to be a partner with the state of Georgia and the GRA — helping set up the core facilities that have really been important for giving our scientists the tools that they need for these types of discoveries.”
Q: How does discovery fit in alongside the other contributions Emory has made during the pandemic?
A: “When I moved to Atlanta in July of 2020, we were in the early stages of the pandemic. Emory Healthcare, our hospitals and physicians that are part of the Emory Healthcare Network, were simply heroic in treating patients and addressing the needs of our individuals and families in the area,” Fenves says.
“From Feb. 17, 2020, as the pandemic was beginning in the United States, to Sept. 26, 2021, just a couple weeks ago, care teams in Emory Healthcare admitted 16,700 patients and discharged 15,400. During that time, the health care system had a 93% COVID-19 survival rate,” which is among the highest of any health care system in the world.
“It was the doctors, nurses, technical staff and hospital operations that mobilized very quickly,” he says. “That, to me, is the number one contribution that Emory has made — treating very, very ill patients and having most of them go back to their families.”
Fenves also notes Emory’s decades-long contributions to vaccine research. “With our Emory Vaccine Center led by Dr. Rafi Ahmed, there has been fundamental clinical translational work that has led to the development of vaccines around the world,” he says. Building upon that work, Emory played a role in testing all three COVID-19 vaccines currently in use in the U.S. — Pfizer, Moderna and Johnson & Johnson — and was one of the leading clinical sites for the Moderna Phase 3 trials.
“One of the reasons that Moderna wanted to work with Emory is because of our track record within the Atlanta metro region of being able to serve patients with their needs — and we have a very diverse population,” he says. “Emory had one of the largest and most diverse clinical sites for the testing of the Moderna vaccine, which was very important in assessing its safety and its efficacy, but also communicating to everybody how this vaccine works and why it’s important to take.”
In addition to critical contributions in health care, Emory also supports public health innovation through the Rollins School of Public Health. During the pandemic, students, faculty and staff at Rollins “have been tremendous partners both throughout Emory and of course with the CDC, and the county health districts across Georgia, and as a resource across the United States and around the world. I know [Guest’s] work in the Outbreak Response Team has been very important in providing testing and support around the metro area.”
The Outbreak Response Team, led by Guest and powered by Rollins’ students, has provided free COVID-19 testing to communities hardest hit by the pandemic. They have also developed educational materials to help reduce COVID-19 transmission. “They’re an incredible group of students and it has been such a privilege to work with them,” Guest says.
Q: How does Emory’s care mission support and improve Emory’s research impact?
A: “The problems we’re addressing in human health — in population health, if you expand beyond individual patients — are very complex. And like problems that are very complex, there is not one expertise that will solve that problem,” Fenves says. “That’s a strength at Emory and within the Woodruff Health Sciences Center, especially, of being able to bring different ideas and perspectives and create this interdisciplinary culture that is essential to solving some of the most complex problems.”
“A significant aspect of why the Woodruff Health Sciences Center has been so effective is that the internal partners bring basic science, epidemiology and other public health aspects into a health care setting within Emory Healthcare,” he continues. “There’s a tremendous back-and-forth, a very positive, virtuous cycle that takes place between the researchers, the scientists and the clinicians. And that cycle is essential for us to be able to rapidly respond to things like the COVID-19 pandemic and one of the reasons that Emory Healthcare has been so effective in its survival rate.”
Although the COVID-19 pandemic is not yet over, Emory scientists, health care providers and public health experts are already preparing for the next pandemic. “What have we learned from this one?” Fenves says. “That’s where the interdisciplinary nature, bringing the different schools and expertise within Emory — and outside Emory, with our partners — is so essential for being able to answer that type of question.”