Learning to prepare better for epidemics
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,” the Oxford and Cambridge educated doctor and professor at the University of London says. “That includes infections that are neglected up until they become part of an outbreak.”
Prof Krishna believes the world could have been better prepared for ebola – the first case was identified in 1976 – and a coordinated international response from governments, academics and industry to fast-track development of a vaccine could have saved many lives.
Ever since the epidemic, he has working 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 south-east Guinea in March 2014 and spread like wildfire through the nation and neighbouring Liberia and Sierra Leone, killing thousands.
There were isolated cases in the US and UK with people travelling back from the region, resulting in one death in the US.
In March last year, the World Health Organisation declared the public health emergency been had ended. There has been much soulsearching since the outbreak regarding the international community’s slow response.
By the time the first experimental vaccines started shipping to West Africa in January 2015, including from Britain’s largest drugmaker GSK, the epidemic was already out of control, having killed more than 8 000 people.
Professor Krishna says the aim should be to develop vaccines ready for emergency testing within three to four months of an outbreak being identified. “It’s really, really tight. But it’s do-able,” he says.
At the start of this year, an organisation 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 $620-million (R8.2-billion) 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 laboratory 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 organisation 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 organisation needs closer to $1billion (R13.3-billion) in its first five years to achieve its goals. He’s hopeful the US and UK governments will help it meet the shortfall.
GSK warned recently that world governments were not spending enough to prepare for future epidemics.
The FTSE 100 firm’s chief medical officer for vaccines, Thomas Breuer, told reporters last week the company had built a brand new lab outside Washington DC with capacity to work on vaccines but was lacking public funds to press ahead.
“We have to run a business so these new initiatives on potential vaccine candidates for future pandemics can only materialise if we get the funds,” he said.
GSK has nonetheless continued its work on ebola vaccine development, funded by US government agency the National Institute of Allergy and Infectious Diseases.
Positive phase two trial results for GSK’s ebola vaccine and another candidate from US giant Merck, tested in 1 500 adults, were released last week.
It’s a less encouraging picture when you turn to another epidemic, zika, the viral disease spread by mosquitos that began in Brazil in 2015 and led to children being born with unusually small heads, a condition known as microcephaly.
French drug firm Sanofi stopped working on its potential vaccine for zika last month after the US army cut funding.
While globally there are about 20 zika vaccines under development, Sanofi’s was one of the most advanced and had the clout of one of the world’s largest pharmaceutical firms behind it.
The company had come under intense political pressure to ensure there would be a fair price for the zika vaccine, including from senator Bernie Sanders, who warned President Donald Trump he was “on the brink of making a bad deal” by giving Sanofi an exclusive licence for the taxpayer-funded vaccine.
Trevor Mundel, president of the Gates Foundation’s global health division, says one of his chief concerns is the threat of a lethal global flu pandemic.
The last flu pandemic in 1918 killed 50 million to 100 million people, about 3 to 4% of the world’s population then. — The Telegraph