Emerging infections
Asia has long been the source of infectious diseases that have escalated into epidemics or pandemics, notably SARS-CoV-2 and influenza. As new pandemic threats continue to arise, research at MORU focuses on genomic and immunological surveillance of emerging infections, the development and evaluation of new methods of assessing therapeutics, and their large-scale assessment in order to inform policies and practices.
Emerging infections and pandemic preparedness at MORU
The MORU Tropical Health Network is uniquely positioned to generate critical data on emerging infections thanks to ongoing research activities and strong collaborations in regions with high population density and frequent human–animal interactions, conditions that increase the risk of zoonotic spillover.
In recent years, MORU has led COPCOV, the world’s largest pre-exposure chemoprophylaxis trials for COVID-19, and SEBCOV, which provided key insights into the social and behavioural impacts of the main public health measures i.e. quarantine, isolation, social distancing and travel restrictions.
Our current research focusses on evaluating antiviral therapies for respiratory virus infections, including influenza, SARS-CoV-2 and respiratory syncytial virus (RSV); serological investigation assess seroprevalence and incidence of febrile illness, including emerging infections and vector-borne diseases, the development of neutralising antibody and pseudo virus assays for viral pathogens, and genomic sequencing of pathogens of pandemic potential. Looking ahead, we hope to be able to extend our studies work on other diseases with epidemic potential, including chikungunya, dengue and other arthropod-borne infections.
Drug repurposing and access
Developing new treatments for emerging infections is inherently slow and costly. During the COVID-19 pandemic, repurposing existing medicines proved to be a highly effective strategy. Drugs such as remdesivir, molnupiravir, dexamethasone and tocilizumab, which were originally developed for other conditions, demonstrated clear benefits for patients with SARS-CoV-2.
Our trials prioritise affordable, broad-spectrum, generic antiviral candidates selected through repurposing principles. This approach accelerates development and enhances access to effective treatments for vulnerable populations in low- and middle-income countries.
Adaptive Platform Trials
To evaluate antiviral treatments efficiently, MORU conducts multi-country adaptive platform trials for influenza, SARS-CoV-2 (the largest such study in the world), and RSV in low-resource settings.
These trials use a robust standardized virological endpoint, the rate of oropharyngeal viral clearance, to compare multiple drugs simultaneously. Interim analyses allow effective and ineffective treatments to be identified early, reducing sample sizes, costs and time to results. This approach is substantially more cost effective than current approaches to comparing and therefore choosing antiviral drugs and assessing their dose-response relationships (phase 2). These trials also contribute to ongoing genomic and serological surveillance of viral variants and their effects on treatment efficacy.
This approach proved its value during COVID-19 by ruling out rapidly ineffective drugs like ivermectin and favipiravir, while supporting the use of remdesivir, molnupiravir and the main protease inhibitors (nirmatrelvir and ensitrelvir). By enabling the pre-pandemic evaluation of promising therapies, this platform strengthens global preparedness.
