EPIDEMIC FAILURE
The Ebola outbreak in Africa claimed 11,315 lives, but will the world be prepared for the next crisis?
There were 30 smaller outbreaks and hundreds of cases before the epidemic. The warning signs were there.
Infectious diseases scientist Sanjeev Krishna knew about Ebola long before the epidemic of 2014 and 2015 that claimed 11,315 lives. “My interest has always been in neglected diseases,” says the Oxford and Cambridge educated doctor and professor at the University of London. “That includes infections that are neglected up until they become part of an outbreak.”
Krishna believes the world could have been better prepared for Ebola — the first case was identified in 1976 — and a co-ordinated international response from governments, academics and industry to fast-track development of a vaccine could have saved lives.
Since the epidemic, he has worked on potential Ebola vaccines. “Time is absolutely critical. Cases multiply fast in an outbreak and very quickly numbers become unmanageable,” he says.
The Ebola epidemic began in the bustling trading town of Gueckedou in southeast Guinea in March 2014 before spreading like wildfire through the country and its neighbours Liberia and Sierra Leone, killing thousands. There were isolated cases in the U.S. and U.K. with people travelling back from the region, resulting in one death in the U.S. In March last year, the World Health Organization declared the public health emergency had ended. There has been much soul-searching since the outbreak regarding the international community’s slow response.
While the first experimental vaccines started shipping to West Africa in January 2015, the epidemic was already out of control by then, having killed more than 8,000 people. Krishna says the aim should be to develop vaccines ready for emergency testing within three to four months of an identified outbreak.
“It’s really, really tight. But it’s do-able,” he says.
At the start of this year, an organization was launched to lead the way, the Coalition for Epidemic Preparedness Innovations (CEPI). Its mission is to bring politicians, academics, drug firms and philanthropists together to help prepare for the next epidemic.
It was launched at the World Economic Forum in Davos in January, and is backed with $776 million from the governments of Norway, Germany, Japan, Canada, Belgium and Australia and the world’s two largest health charities the Wellcome Trust and the Bill and Melinda Gates Foundation. It is working to establish the lab and distribution infrastructure and access to funds needed to rapidly develop vaccines in a crisis.
CEPI wants to be as prepared as it can be. It has identified three diseases it fears could become epidemics — Lassa fever, a viral disease in West Africa similar to Ebola; MERS, a respiratory infection that emerged in the Middle East; and Nipah, which causes inflammation of the brain and has been seen in Malaysia and Bangladesh. The organization will soon award grants to drug firms to develop and stockpile vaccines for these diseases.
“The lesson from Ebola is you can’t be complacent about diseases with epidemic potential,” says Richard Hatchett, chief executive of CEPI. “There were 30 smaller outbreaks and hundreds of cases before the epidemic. The warning signs were there.”
Being prepared comes at a cost. Hatchett believes the organization needs closer to $1.25 billion over its first five years to achieve its goals. He is hopeful the U.S. and U.K. governments will help it meet the shortfall. “We would welcome their contributions,” he says.
“Ultimately governments have a short time horizon, but once you have taken the decision the commitment has to be sustained otherwise it rapidly becomes untenable for drug firms to do this work.”
Hatchett says working closely with industry is “crucial” to prepare for future epidemics. Drug makers GSK and Merck both have seats on CEPI’s board, as do representatives from the biotech industry and India’s largest vaccine maker Serum Institute.
Given the high costs involved and uncertain commercial returns, support from philanthropic organizations like the Bill and Melinda Gates Foundation is a godsend.
Trevor Mundel, president of the Gates Foundation’s global health division, says broad collaboration between industry, governments and philanthropists is “essential.”
One of his chief concerns is the threat of a global lethal flu pandemic, saying investment needs to go into “21st century approaches” such as using genetic medicine in vaccines. “It’s clear that the world will never be prepared for a major flu pandemic until we have the technical capacity to identify a novel pathogen and produce a safe and effective vaccine in less than 12 weeks — the predicted time it would take for a fast-moving virus to reach every corner of the world,” he says.
Sir John Bell, scientist at Oxford University and author of the U.K.’s life sciences industrial strategy, agrees on the threat posed by flu, noting that the last flu pandemic in 1918 killed 50 million to 100 million people, around three to five per cent of the world’s population at the time.
“The experience of the epidemic in 1919 should give ample cause for concern about the impact of such an event globally,” he says.
While it is impossible to prepare for all potential viral outbreaks, it is clear governments, charities and industry must work more closely together to prepare as best they can.