Pauline Gareau explains how antidotes and other medical countermeasures are essential to respond speedily to public health emergencies.

Whether a terrorist threat, industrial accident or battle zone attack – chemical, biological and nuclear risks are present and real. Given the current worldwide political unrest, populations are exposed to a constant threat linked to these CBRN risks.

Events around the globe have shown that there are no boundaries or geographical limitations to encountering activities that inflict harm onto societies and disrupt everyday lives. The risk for populations is increasing and chemical and nuclear materials are still too easily accessible and often poorly stored and managed in industries worldwide.

In addition to war or terrorist threat, the industrial risk linked to chemical and nuclear exposure is of growing concern. With a worldwide 3.2% industrial production growth rate that includes manufacturing, mining and construction, the increase in industries and mass production, especially in developing countries, is putting larger employee populations at risk of exposure to toxic chemical or nuclear agents in the workplace as well as people living close to industrial sites.

Biological risks and emerging diseases became prime threats during the monumental global crisis caused by the spread of SARS-CoV-2. Total economic paralysis occurred during several weeks in 2020, and the impact is still being felt today. The potent and varied mode of actions wielded by viruses, toxins and fungi also make them likely raw material for manufacture and deliberate release as biological weapons.

How should we best prepare?
Anyone anywhere is at risk of exposure to toxic chemicals such as blood and nerve agents, heavy metals or nuclear material from accidents – as well as infection by emerging diseases. Protecting populations by taking the appropriate measures to best prepare for a possible incident is crucial. Outbreaks of Ebola; Novichok poisonings; use of Sarin; the Covid pandemic; nuclear disasters – in the past two decades many of these were largely unexpected. Unknown threats that we cannot predict today could be forthcoming.

Countries, regions and relevant industries must therefore be able to anticipate threats in order to be in a position to respond and implement medical countermeasures as soon as possible following a CBRN attack or accidental industrial exposure.

The importance of antidotes
Immediately following a CBRN event or any other exposure to harmful chemical or biological materials, the appropriate antidotes need to be administered together with appropriate decontamination and supportive measures in order to be effective. Knowing how to quickly recognise an exposure and which antidotes to use will determine how many lives can be saved.

Antidotes are the lead medical countermeasure in the event of contamination and cannot be purchased off the shelf in the large volumes that would be required following a terrorist attack or industrial accident. It can take several months to manufacture and supply antidotes, by which time it would be too late to minimise the outcome of an exposure. The development of new antidotes takes time and requires that research be conducted well ahead of need, especially to deal with new threats.

A priority measure is to establish central or regional stockpiles of antidotes before an incident occurs, in order to treat victims.

Following recent events, states realised the importance of cooperation and discussion. In Europe, in response to the Covid-19 pandemic, HERA (Health Emergency preparedness and Response Authority) was set up in September 2021 as a permanent structure to plan EU pandemic management with adequate tools and resources well in advance of a public health emergency.

HERA aims to prevent, detect, and rapidly respond to health emergencies. The Authority will ensure the development, production and distribution of medicines, vaccines and other medical countermeasures. Although we are in the early stages of this new European programme, the effort put into it sounds promising.

Similarly, in 2006 the US established BARDA (Biomedical Advanced Research and Development Authority), which supports the advanced development and procurement of drugs, vaccines and other products considered priorities for the nation’s health security. In procuring medical countermeasures for the Strategic National Stockpile, BARDA enhances the capabilities of the CDC (Centers for Disease Control and Prevention) to better organise an operative response in the US.

What’s next?
In addition to HERA and BARDA, each country – either directly or indirectly  – will still need to initiate its own threat evaluation of specific hazards at the national, regional and local level, in order to acquire the requisite stocks of antidotes and other countermeasures. However, the overall lack of guidelines results in inconsistencies in each country’s approach and unequal local response.

Following this unprecedented period, innovation and resilience are key and should be accelerated to cope with each crisis. To best prepare for the CBRN challenges of the future, efforts and resources must be combined at the earliest stage between private and public entities – and there must be discussion and decisions made on how to address unmet needs.

SERB, BTG Specialty Pharmaceuticals, and Veriton Pharma are combining to form a growing specialty pharmaceutical company and a dedicated ally to healthcare providers treating patients with critical conditions, focusing on emergency care and rare diseases.

For more than 30 years we have made treating these complex and life-threatening conditions possible, supporting clinicians, healthcare systems and governments while offering hope to patients and their families.

We have one of the most comprehensive, wide-ranging Emergency Care portfolios in the world, covering CBRN risks such as nerve agent, cyanide and heavy metal poisoning. Our medical countermeasures are mainly manufactured within Europe and exported to over 100 countries.

As a fully integrated company we have the experience and capabilities to acquire, develop, and manufacture our medicines to the highest standards, and make them available worldwide through our secure supply chain.

Pauline Gareau is Senior International Product Manager of the Emergency Care franchise at SERB. She joined the company in 2020 after working in several pharmaceutical industries as Brand Manager and Medical Science Liaison.

Stockpiles of antidotes are essential to be best prepared.