“The next big pandemic will come from a virus we already know.”
Tomas Cilar was not interested in science and preferred sports. However, towards the end of his university studies, while working on his dissertation at a Prague institute, he accidentally discovered how exciting and powerful science can be. This change led him to become a research enthusiast and complete his PhD at the same institute that later discovered tenofovir, a key drug against HIV. He is currently vice president of virology at Gilead.
– Covid 2024.Where are we?
It depends on where you are and your point of view, because there are people, such as doctors, who encounter patients with different problems. I’m doing research and thinking more about developing new drugs to solve not only current problems, but also what the future holds or even where the virus might be evolving. It’s been about a year and a half since the pandemic was declared over, but that doesn’t mean Covid has disappeared. The biggest problem is that people don’t want to hear much about Covid because it has been a difficult period for many. However, AndMore than 30,000 people died from covid in 2024: clearly still a problem. It is necessary to ensure that there are sufficient resources allocated for early diagnosis and treatment of the disease. It is also important to continue promoting vaccination as infection rates have decreased over the past year. From a research perspective, our focus is on improving treatment, especially for high-risk patients, such as immunocompromised people in whom the virus stays in the body longer. We are also working to better understand long Covid, which is still not entirely clear what causes it and how to treat it.
– Covid is no longer a priority and there is now more talk about new pandemics such as bird flu. Do you think we have learned enough from the Covid pandemic to be ready for another?
I think we’ve learned a lot, especially about how to take advantage of new vaccine platforms like the mRNA vaccines that are now being studied against influenza, HIV and other viruses. But we must continue to apply this knowledge to other viruses. Bird flu has been present in our country for a long time and is developing. Now even farm animals such as cattle in the US can be infected, meaning we must remain vigilant.
There are about 200 viruses that can infect humans, and most of them are known to us.
At Gilead, we have been working on pandemic preparedness since before it was even given that name. I was part of the team that developed remdesivir from the very beginning, and this was made possible through 10 years of preliminary research. When Covid emerged, we already knew that remdesivir was effective against other related coronaviruses such as SARS and MERS. This allowed us to act quickly and begin clinical trials to treat hospitalized patients, making remdesivir the first antiviral drug approved for the treatment of COVID-19.
– One of the problems we face is that we do not have models to predict the next pandemic or mutation of viruses.
There are about 200 viruses that can infect humans, and most of them are known to us. It is likely that the next pandemic will be caused by a virus related to those already known, as happened with covid-19, related to SARS and MERS. We focus on identifying viruses that are most likely to cause a pandemic due to their high transmissibility or pathogenicity.
Respiratory viruses such as Covid-19 spread most efficiently from person to person because they can spread before those infected show symptoms. Any new epidemic will likely be caused by a virus related to those we already know about. Therefore, we develop drugs that cover several types of viruses of the same family, such as coronaviruses.
– HIV remains a problem, especially in sub-Saharan Africa and parts of Asia.
We have been working on HIV for 30 years and are constantly innovating. We started with high-pill-a-day treatments and have now moved to one-pill-a-day regimens and are working on the next generation of treatments: long-acting medications that can be taken once a week, monthly, or even one injection every six months .
In addition, we are seeing promising advances in the use of long-acting prophylaxis drugs (PrEP), which may provide an alternative to the HIV vaccine. A recent clinical trial of lenacapavir in young women in Africa showed 100% efficacy, which is a very encouraging result.
If I had unlimited resources, I would like to understand socio-economic problems and where differences between people come from.
We are in this process and are working diligently to prepare an application to the FDA with the hope that the drug will be approved next year. But beyond approval, our goal is to make this treatment available worldwide, especially in low- and middle-income countries.
We know that we need five times more people using PrEP than we currently have to really stop the spread. And as we try to end the pandemic in the next decade, access to PrEP is critical, especially in sub-Saharan Africa and low- and middle-income countries.
– If you had limited resources both in time and money. What medical or scientific problem would you address first outside of biology?
For me there are two key things. First, we need to live in peace and on a planet where we can live comfortably. Viruses are just one of many problems facing humanity today. If I had unlimited resources, I would like to understand socio-economic problems and where differences between people come from, since this is the source of many problems. How can we reconcile differences in religion and ethnicity so that people work better together? For me, the most important thing is to prevent wars and maintain the spirit of global cooperation. The other big problem, of course, is climate change. We can fight all viruses, but if we don’t address climate change, these viruses will continue to change. We are already seeing this with dengue fever and other mosquito-borne viruses, as the geographic range of mosquitoes changes dramatically with climate change. We are now fighting these viruses where there were none before. Most scientists agree that this is a consequence of climate change, and I think addressing climate change is also part of pandemic preparedness.