
Creative or unethical? Researchers’ Covid-19 GoFundMe campaign spurs critics
It had been a business professor’s idea, back before Christmas, when the most infectious threat facing the US was a potentially harsh flu season. DRIVE Innovations, a non-profit biotech founded by a pioneering HIV researcher at Emory University, was looking for new ways of raising money and drawing press. Charles Goetz, who studied entrepreneurship, suggested GoFundMe.
What appeared online three months later had the smoothness of a VC pitch and the commanding lilt of a call to arms. That was the week the coronavirus moved from far-flung threat to looming menace for many Americans, when Vice President Pence was named to head the White House taskforce, the stock market suffered its worst fall since 2008 and the first cases of unknown origin appeared on the West Coast — a sign the virus was spreading within the US. GoFundMe put DRIVE’s campaign as the “Urgent Cause” at the center of its homepage. They promised a tantalizing antidote.
“What if you could help fund a cure for coronavirus?” DRIVE asked.
Their page explained they had developed EIDD-2801, the “most promising potential antiviral therapeutic for coronavirus that can be taken as a pill,” but needed funding to get to a human trial. A three-minute video weaved archival video to stitch a thread between the 1918 Spanish Flu, the 2014–2016 Ebola outbreak, and Covid-19. It explained more pandemics are coming, pandemics their drug could shield against. The fundraising goal was $5 million.
“We’re under attack,” a deep male voice said. “We need a weapon.”
The unusual campaign, its organizers told Endpoints News, pointed to the difficulty researchers have finding funding in a crisis, a concern echoed by other scientists who turned to crowdfunding or individual donors for their coronavirus research.
It would also baffle some bioethicists, who saw a non-profit trying to profit off mass panic and tossing around the word “cure” for a drug that had never been put in humans.

“I think it’s very unethical to go out to people who are worried and panicked, who are worked up, and say how would you like to put money in our kitty to pursue a research idea that is hyper unlikely ever to work,” Art Caplan, founding head of New York University School of Medicine’s Division of Medical Ethics, told Endpoints.
“And it also gives a suggestion that if the biotech found an answer — by some miracle — they know how to manufacture it in big doses, which they wouldn’t,” he added. “They would have to sell it to someone else and they would have to get it approved and make millions or billions of doses. There’s nothing coming soon.”
But just how unlikely would EIDD-2801 work? The drug emerged from some of the researchers that developed Gilead’s remdesivir, the first antiviral to capture the world’s hopes. And last week, after Science Translational Medicine published DRIVE’s preclinical work on SARS-CoV-2, the virus that causes Covid-19, the FDA approved a Phase I clinical trial testing their pill in infected patients. As new data cloud remdesivir’s future, it could emerge as one of the most promising antivirals weapons against Covid-19 — if it can make it in time.
“EIDD-2801 is a great advance,” Vineet Menachery, a coronavirus researcher not affiliated with the drug, told Endpoints in an email following the Science study. “The disadvantage of [EIDD-2801] is that it has not gone into human trial.”
A plan to save the world
In the 10 years since its founding, GoFundMe has emerged as both American lifeline and punchline. Its platform let desperate patients raise thousands for treatments and medical bills, but to some, it also articulated a kind of literary dystopia, a world in which healthcare went to whoever told the best story. “Health experts worry coronavirus will overwhelm America’s GoFundMe system,” The Onion cracked in March.
Occasionally that medical care meant basic research or an academic’s trial. Almost never, though, has a biotech used the platform. Industry costs are too high and other funding sources too apparent.
DRIVE Innovations was an atypical biotech. It was founded in 2013 by Dennis Liotta, a professor of organic chemistry at Emory University who in the early ‘90s invented emtricitabine, a chemical that blocks HIV from copying itself and is now used in several medications, including Gilead’s best-selling Descovy and Truvada. In the early years of the AIDS crisis, Liotta explained in a 2016 Tedx Talk, drugmakers had ignored the virus, in part because it killed patients so quickly companies didn’t think they could turn a profit. A related dynamic held true for viruses like dengue, Zika, and chikungunya — devastating diseases that received little attention from drugmakers because they affected poorer regions where companies were unlikely to recoup the cost of research and development.
The new venture, seeded with $10 million in HIV drug royalties, would research compounds for single-stranded RNA viruses, a broad category of deceptively simple pathogens that, by their estimate, accounted for 80% of the world’s “viral burden.” Except instead of stopping at lab testing and then licensing it — as most academics do — DRIVE would take it through a proof-of-concept trial or further, de-risking the investment for a larger biotech or pharma company, who could then bring it to market.
“We’d bring it to what we called a value inflection point,” Liotta told Endpoints. “We were trying to be ahead of the curve, trying to anticipate that one of these viruses might create a problem.”
Liotta tapped former Glaxco Wellcome virology executive George Painter as CEO and serial biotech executive David Perryman as COO. The idea filled a blindspot those around biotech had long recognized but often felt powerless to address.

“I think the non-profit approach is great,” Alex Karnal, managing director of the healthcare VC firm Deerfield Partners, told Endpoints. “One of the problems for our business is that we require our rate-of-return. To the extent those dollars can be donated, and they don’t require that same return, then the hurdle for moving it forward has been lowered.”
The company began with diseases that would draw government contracts. That meant Venezuelan Equine Encephalitis Virus, or VEEV, a potentially fatal infection that the Soviet Union tried to weaponize during the Cold War and that the government was particularly interested in having a defense against. They found a promising compound in a drug Liotta’s longtime collaborator, Raymond Schinazi, once tested on hepatitis called β-D-N4-hydroxycytidine, or NHC. (A second early compound, for hepatitis B, was spun out into its own biotech, called Antios).
The holy grail, though, was always a drug that worked on 3, 4 or more viruses. That would give it commercial potential and, in theory, make it a better defense against novel infections. They sent NHC to the NIH and elsewhere to screen against a multitude of viruses. Last October, they published the results for flu in Science Translational Medicine.
In ferrets, NHC killed the flu by a process they called “error catastrophe” and didn’t confer resistance — qualities that gave it promise against the flu strains that humans have little immunity to and that can thus cause pandemics like the 2009 h1n1 outbreak. The same year, the NIH granted up-to $15.9 million to run a human trial.

Still, that was promised money, not pocket money. And six years in, Perryman found himself facing a flaw implicit in DRIVE’s model. Government grants could be plentiful, but they didn’t pay for all the nuts-and-bolts operations of a biotech — they didn’t pay for his job or patents or other members of his staff. That’s when, in December, Charles Goetz suggested they try GoFundMe, a way of getting funds directly and potentially attracting larger donors.
“They pay for science, they don’t pay for people running things,” Perryman said of government contracts. “We wanted to try something that was potentially helpful, new and worst case scenario raised the awareness of what we’re trying to do.”
The campaign would not only be about flu but about their broader mission of tackling neglected infectious diseases. Perryman remembers sitting at a meeting later that month to set up the page and ticking off the viruses the compound has worked against: Ebola, the flu, SARS.
“The people in the room looked at me and went, what is SARS?” Perryman said. “I said, ‘You don’t remember what SARS was? My God, are you kidding me?”
Dennis Liotta giving a Tedx Talk (Tedx via Youtube)
Click on the image to see the full-sized version
“The US government is left scrambling”
SARS-CoV-2, epidemiologists now believe, had already begun spreading when that meeting took place. In early February, when the magnitude of the threat became clear, DRIVE said they would begin testing NHC against the new virus. It was in some ways the pandemic they had been preparing for.
“Most antivirals are what we call one-bug, one-drug compounds, so this one was pretty unique,” Liotta told Endpoints. “Maybe we’re in the right place at the right time.”
DRIVE was buoyed by the same evidence that buoyed many of the early drug and vaccine efforts: Data on other coronaviruses. A month after their flu study, they published a study in Virology that showed the drug was potent against MERs and SARs. “The emergence of coronaviruses (CoVs) into human populations from animal reservoirs has demonstrated their epidemic capability, pandemic potential, and ability to cause severe disease,” the authors wrote. “However, no antivirals have been approved to treat these infections.”
Unlike Gilead or Moderna, though, DRIVE said they didn’t have cash runways to pivot to a new disease. Their grants were earmarked for flu; use it for other research — lose the grant. The NIH soon opened an “urgent award” system where grantees could apply to redirect their funds to Covid-19, and the Biomedical Advance Research Agency (BARDA) called for applications. DRIVE said they were applying for government funds but that process funds was inherently slow.
In an outbreak, “the US government is left scrambling: where’s the money going to come from?” Perryman said. “What budget? What allocations? There’s a gap of time.”
The GoFundMe, Perryman said, could fill that gap. The campaign went live on February 27 and quickly raised over $10,000, bolstered by a $5,000 personal donation from Liotta. The campaign, though, was conceived in December. Asked if the switch to coronavirus-focused marketing had been an effort to draw people into a campaign that had been planned before anyone knew a novel coronavirus existed, Perryman said, “Yeah, maybe. But it’s more about this compound and the opportunities that came out of it.”

Yet other researchers have echoed their concerns. Peter Hotez, founding dean of Baylor’s National School for Tropical Medicine, built a trial-ready SARS vaccine in 2016 before NIH funding went dry. As he struggled to find money to test it on the new coronavirus, he told Endpoints he was suggested to start a GoFundMe. “A shame though that you have to go to that recourse because there is an inability of securing funds by other means,” Maria Bottazzi, Hotez’s collaborator, told Endpoints in an email last month about DRIVE’s campaign. “We still have not been successful in getting funding to move our vaccine out of the freezer.”
David Boulware, a tropical disease researcher at the University of Minnesota, raised over $15,000 on GoFundMe for a hydroxychloroquine trial in March, before the university stepped in, agreeing to fund the trial and reimburse the donors.
“We submitted for an NIH grant, but how long would that take?” he told Endpoints. “It was unclear.”

Mitchell Kronenberg, CSO of the La Jolla Institute for Immnunology, didn’t comment on the GoFundMe campaign or DRIVE but told Endpoints his research center had to look for new ways of raising money as they switched most of their operations to focus on Covid-19.
“It just takes longer to get federal money,” Kronenberg said. “They’re doing things to speed things up, but it’s still — the NIH is a $40 billion agency with thousands and thousands of employees … they can’t move the way an individual donor would.”
But was GoFundMe the right way to move? Some public health experts and ethicists were skeptical, if not outright furious. While agreeing the federal response could be slow and imperfect, they argued that using GoFundMe — an increasingly common phenomenon among academics, if not biotechs — prioritized the best story over the best science. At its worst, the campaign was a moral nightmare, a grab for funds from civilians afraid of a mysterious virus and possibly unaware of the high risks of biotech. There was no mention on the page that nature of drug development meant the drug would likely fail, as for-profit biotech’s IPO documents might.
“It downgrades the detailed understanding of science that has been such a mainstay of American science,” Jairam Lingappa, an epidemiologist at the University of Washington who worked at the CDC during the SARS epidemic, told Endpoints.
Caplan took issue with DRIVE’s use of the word “cure,” when they only had done animal studies. He said they were about as close to a cure for pandemics as someone who cleared a tumor in a mouse is to curing cancer.

“They don’t do a great job telling potential donors that there’s not a good chance there’s going to be an effective therapy that emerges from this,” Leigh Turner, a bioethicist at the University of Minnesota whose published on patient-run GoFundMe campaigns, told Endpoints. “It’s a common rhetorical route on crowdfunding. This is not a place where you go for risks and benefits and low likelihood.”
Perryman said he took the opposite view. He compared DRIVE to the Red Cross, providing both aid in a crisis and a way for people who might otherwise feel helpless to give back. His view was bolstered in part by donors, many of whom were connected with the University, which sent out alumni emails and reached out to specific groups about the campaign, and who told Endpoints they gave because they trusted Emory or Perryman and they didn’t care if the drug ultimately worked or not. “I didn’t give because I thought this group might have an effective treatment for Covid, I believe in what they’re doing,” Jody Cooley, a Georgia lawyer and a friend of Perryman’s, who gave $100 told Endpoints.
Laurie Zoloth, a University of Chicago ethicist, called the campaign a “clever” innovation amid a federal system that failed to address the crisis, but one that had to be fully tested. Aaron Kesselheim, a Harvard bioethicist who specializies in pharma, backed Emory. He said it’s people’s choice what charities they want to donate to, and Liotta and the university’s history with infectious diseases gave the campaign legitimacy. He took little issue with the wording.
“I feel like the pharmaceutical industry uses this kind of language a lot,” Kesselheim told Endpoints. “If there’s anybody out there — this guy’s got a fantastic track record.”
The molecular structure for EIDD-2801. If a virus uses it to build its genome, it can kill the virus by “error catastrophe”
Click on the image to see the full-sized version
“Error Catastrophe”
Just how likely or unlikely is it that EIDD-2801 will work?
For most of modern medical history, our best treatment for viruses has been to avoid them. Vaccination knocked out ravaging pathogens from smallpox to polio, while environmental interventions ended malaria in much of the developed world. Over the years, tailored drugs were developed for HIV and hepatitis but what’s remained elusive have been broad-spectrum antivirals: drugs that can treat a host of new and old viruses the way many antibiotics can treat bacterial infections.
That’s the gap DRIVE tried to fill and when Covid-19 broke out in December, there were essentially two experimental drugs that fit the bill: remdesivir, which after some early anecdotal evidence caught the hopes of much of the world, and EIDD–2801.

“This drug seems to work well,” Stanley Perlman, who has studied coronaviruses for 38 years at the University of Iowa and who was not involved in any EIDD-2801 study, told Endpoints.
The list of coronavirus researchers is short. EIDD-2801 was developed for coronaviruses at the same Vanderbilt and University of North Carolina labs that, earlier in the decade, identified remdesivir. And it operates by a similar mechanism. Both are nucleoside analogues – basically decoy versions of the molecules RNA viruses use to write their genome as they replicate. Remdesivir acts like a cap; the virus grabs it and suddenly can’t add any more molecules, its genome sealed shut. EIDD-2801 is like gunk in the works; the virus can keep adding new bases but the decoy molecule forces rampant mutations down the genome until the virus reaches what researchers call “error catastrophe.” It blows a gasket.

“Those mutations damage the RNA, they damage the viral protein, they damage the virus’ ability to infect and to grow,” Mark Denison, the Vanderbilt coronavirus researcher who helped develop both drugs, told Endpoints. “This is definitely comparable. It has similar potency and efficacy against multiple coronaviruses.”
Because the enzyme that writes the genome, RNA polymerase, is similar across many viruses, both drugs held potential to treat a long list of infections.
What has Denison, Perlman and others particularly excited is the packaging: NHC comes as a pill. That means it could be given earlier than remdesivir, which is given as a hospital infusion, and to more people, potentially even as a prophylactic for healthcare workers and those at risk. It also seems to get around the virus’ “proofreading” ability to spot and prevent copying of decoy molecules. Lastly, it showed activity against coronaviruses resistant to remdesivir, opening up the potential for combination treatments.
There are no mouse models yet for novel coronavirus. To show preclinical data that could burnish a clinical trial, DRIVE, UNC and Vanderbilt researchers tested NHC against SARS and MERS in mice, and against SARS-CoV-2, SARS, MERS and zoonotic coronaviruses in antiviral assays and human lung cell cultures. They posted their results in a preprint on March 20, and Science Translational Medicine published the study on April 6 – the first the journal has published on a potential Covid-19 drug. Immunologists raved.
The first wave of #SARSCoV2 papers was mostly case reports and fundamental virology.
I’m welcoming the second wave of well-grounded research from groups like @Baric_Lab and @DenisonLab that have been studying #MERS, #SARSCoV1, and other coronaviruses for years.
— Kira Newman, MD, PhD (@KiraNewmanMDPhD) April 8, 2020
“I implore them to continue their efforts and we need new approaches that are clinically viable (pill form),” Gene Olinger, an immunologist who has worked on coronaviruses and Ebola and principle advisor for MRIGlobal, told Endpoints in an email. “We need more antivirals in our arsenal against viruses and broad spectrum are more valuable.”

Where’d the money go?
By the time Science Translational Medicine published the study, DRIVE had licensed NHC to Ridgeback Biotherapeutics, the tiny husband-and-wife biotech that in 2018 licensed mAb114 from the NIH. Last August, that drug was one of two that beat out remdesivir in a four-arm trial against Ebola, the infection the Gilead antiviral had originally been built to treat.
At the time, DRIVE told Endpoints they would continue the crowdfunding campaign as they still needed the resources. But after the FDA approved a trial on April 7, Ridgeback CEO Wendy Holman told Endpoints she “had no knowledge” of a GoFundMe campaign and that Ridgeback “is funding the Phase I trials completely on our own.” DRIVE did not respond to subsequent requests for comment.
For all of immunologists’ excitement over NHC, many believe it could prove more effective against future outbreaks than this one. Both remdesivir and NHC suffer from a similar flaw: They’re more effective the earlier they’re given. That means by the time a patient is in severe condition – the stage at which remdesivir has been given so far – it may be too late for the antiviral to help. A pill would be easier to give early in the disease, but that approach poses problems for an infection that most people recover from and for a drug that has no prebuilt manufacturing base.
“You’d be treating 85 out of 100 people who are going to recover by themselves without any particular therapy,” Perlman said. “That becomes a huge – not waste, but a huge use of resources.”

Remdesivir, Menachery pointed out, had already cleared safety studies before the outbreak. Although the preclinical work showed no safety issues, NHC is a mutagen – a drug that causes genetic mutations – and thus could have off-target effects, Menachery said. Olinger echoed those concerns. Although Liotta said the drug “has a very good safety profile,” there’s no timeline on when NHC might clear such a trial. Meanwhile other drugs targeted for Covid-19, such as antibodies from Regeneron and Vir, are expected to be in the clinic by early summer and emergency vaccines could be available for healthcare workers by Fall.
“For future outbreaks, NHC may be an ideal drug to stockpile,” Menachery said. “However, with the remaining barriers, it is not clear if it will be useful in time to deal with Covid-19.”
It’s unclear but doubtful that the GoFundMe helped NHC reach this point. DRIVE raised only a tiny fraction of the $5 million goal and attracted no major corporate donors – although Dolly Parton did donate $1 million to Vanderbilt, where Denison houses his lab and vaccine work is underway. In early March, Roy Morejon, founder of the crowdfunding consulting agency Enventys Partners, told Endpoints that DRIVE’s campaign never looked promising. Its video tried to rouse or scare, but lacked the human interest – the sick patient facing ruinous bills – that have become the hallmark of a successful GoFundMe.

Otello Stampacchia, founder of the VC Omega Funds, took a more optimistic view for the campaign at the time, saying he had never seen anything like it, and that with the impact the virus had already had on places like his home country of Italy, a campaign could strike a chord.
“I think it’s quite possible that someone could raise tens and tens of millions on GoFundMe just because its super-topical right now,” he said.
The count, as of this writing, was $38,136 – or 00.7% of their $5 million goal. Donations have slowed to a trickle. The last one was from Anonymous for $500, adding to over $1,500 raised since they licensed the drug away on March 23.
“May God bless your efforts to speedily develop a cure,” Geraldine White wrote in a donation note two days later. She gave $100.
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