New partnerships needed after Ebola's hard lessons

by J. Stephen Morrison and Chris Millard, Center for Strategic and International Studies
Tuesday, 25 April 2017 11:15 GMT

A man has his temperature taken using an infrared digital laser thermometer at the Nnamdi Azikiwe International Airport in Abuja in this 2014 archive photo. REUTERS/Afolabi Sotunde

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* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

The West African Ebola epidemic that peaked in late 2014 not only delivered a profound scare to the world, it was also a wakeup call. What had been originally viewed as localized incidents of the virus in remote Guinea quickly exploded into a regional epidemic with cases exported around the world, including to Lagos, London, Rome, Dallas, and New York.

Many factors contributed to the virus’s rapid spread—including extreme poverty, underfunded and undersupplied healthcare systems, local burial customs, and the virus' astonishing leap from the deep forests to the big coastal cities. But no less profound, it was also the absence of an effective vaccine that gravely hindered the global community’s ability to bring the outbreak to heel. And while today the epidemic has been largely contained, Ebola taught us three powerful lessons about the vital importance of vaccines.

First, not having a vaccine at the ready when a pathogen strikes creates huge vulnerabilities and imposes tremendous costs. By the time the outbreak had ended, over 28,000 cases of Ebola had been documented and more than 11,000 individuals had died worldwide, with Guinea, Liberia, and Sierra Leone accounting for over 95% of all cases.

In addition to the loss of life, the economic toll was tremendous. The World Bank estimated that those three West African countries alone experienced a combined loss of $2.2 billion in productivity in 2015. Private sector growth decreased, the tourism industry stalled, agricultural production declined, and trade slowed as restrictions were placed on the movement of people and goods across borders.

Even countries that had few to no cases of Ebola experienced economic consequences. For example, while only four cases of Ebola were documented in the United States, public hysteria and fear of widespread outbreaks caused flights to be canceled, children to be kept home from school, and travel to wane.

SCRAMBLE FOR VACCINE

Second, scrambling to accelerate vaccine development in the middle of a storm is expensive and no way to conduct business. Since Ebola was first discovered in 1976, several attempts at creating an effective vaccine had been undertaken.

As recently as 2005, scientists had developed a vaccine that conferred full immunity against the virus in monkeys, with the potential for human testing and licensing within a matter of years. Yet when Ebola struck in 2013, no such vaccine was on the market. The combination of the relatively low number of individuals affected by Ebola prior to the 2013 outbreak and the concentration of the virus among rural communities in low-income countries undermined financial incentives for pharmaceutical companies to bring an Ebola vaccine to market.

While Johnson & Johnson, Merck, and Gilead Sciences eventually entered the arena to develop an Ebola vaccine after fears of a global pandemic rose, the costs to the companies were tremendous. They invested a combined $1 billion in capital into vaccine development and diverted staff, resources, and R&D and manufacturing capacity to developing an Ebola vaccine on a crash basis. And while their efforts were ultimately successful—a vaccine licensed to Merck did pass clinical trials and regulatory hurdles late last year—there has yet to be a return on investment. The understandable private sector conclusion: never again.

Third, Ebola created a new consensus among the global health community: we have to do better. We need to innovate and act early, in new creative partnerships, to get ahead of the curve in vaccine development against dangerous pathogens. Ebola inspired seven major independent reports analyzing the international response to the outbreak.

Each landed at the same place: that the global community needs to step up when it comes to creating the basic framework for rapidly developing, testing, and bringing to market vaccines for unforeseen pathogens, particularly those that would otherwise lack financial incentives for private sector involvement.

FORGING PARTNERSHIPS

Recognizing these challenges, the formal launch of the Coalition for Epidemic Preparedness Innovations (CEPI) earlier this year is particularly promising.

By forging partnerships among governments, the private sector, foundations, regulators, and international organizations in advance of an infectious disease outbreak, CEPI hopes to create a platform for rapid epidemic vaccine development. It seeks to shuttle vaccine candidates for known pathogens through the development pipeline to create a pool of available vaccines already approved for use in humans and able to be rapidly brought to market in the event of an outbreak.

CEPI also seeks to build institutional capabilities and technical platforms between key players that can be rapidly scaled up and deployed to respond to unknown pathogenic threats when they arise in the future. And, importantly, it front-loads capital rather than trying to raise funds during a crisis, with $800 million pledged at CEPI’s launch. This work is already underway with vaccine development ongoing for MERS, Nipah virus, and Lassa fever.

Ebola was an avoidable tragedy. But out of that tragedy emerged a new consciousness of the vital centrality of vaccines as a tool for prevention and containment, and a determined consensus to change and expedite the way we go about developing vaccines for the most dangerous of pathogens. That is progress.

J. Stephen Morrison is Senior Vice President and Director, Global Health Policy Center, Center for Strategic and International Studies. Chris Millard is Program Manager and Research Associate, Global Health Policy Center, Center for Strategic and International Studies.