Too often, after an epidemic of a new or re-emerging disease, the story is the same. Formal review committees lay out lessons for how the world can be better prepared the next time, but as the flurry of media and political attention fades, little comes of them.
It is therefore heartening that, in the wake of the horrific 2014 Ebola epidemic in West Africa, research funders and scientists have come together to address a major failing in preparedness: the fact that, although there is a long list of pathogens known to have at least the potential to cause major epidemics, approved vaccines exist for almost none of them.
For example, the coronavirus that causes deadly Middle East respiratory syndrome (MERS) was discovered in Saudi Arabia back in 2012, but there has been no serious effort to develop a vaccine against it. The virus’s spread between people seems limited to those in close contact, and yet it ticks many of the boxes for an agent that could cause a pandemic were it to evolve to spread more easily between people. Similarly, an epidemic of severe acute respiratory syndrome (SARS) in 2003 caused global havoc, with a pandemic narrowly being averted by drastic public-health measures. But more than a decade later there is still no vaccine.
In fact, in a paper published last December in Emerging Infectious Diseases, scientists identified 37 viruses (including some you may never have heard of, such as Bwamba, Oropouche, Junin and o’nyong-nyong) that so far have caused only limited outbreaks in humans, but which seem to fit the bill as potential epidemic threats (M. E. J. Woolhouse et al. Emerg. Infect. Dis. http://doi.org/bxnk; 2016).
For too long, the world has fatalistically acquiesced to a status quo in which, because there is no market for vaccines against pathogens that might never cause a major problem, there is no substantial investment in developing vaccines against them. Clearly, private companies cannot be expected to invest on their own. But it is incumbent on governments to invest, and thus address this market failure, in partnership with pharma.
It is therefore encouraging that there is now a solid plan to do just that: the Coalition for Epidemic Preparedness Innovations (CEPI), launched on 18 January at the World Economic Forum in Davos, Switzerland, aims to develop and take through early clinical trials vaccines against potential threats. It already has enough cash to work on three — MERS, Nipah-virus infection and Lassa fever.
Some US$200 million of CEPI’s initial $460-million funding comes from just two donors, the Wellcome Trust and the Bill & Melinda Gates Foundation, with the rest coming from the governments of Norway, Germany and Japan. Budget and election cycles in several other countries have delayed further contributions, but it is crucial that more countries come on board, allowing CEPI to take on additional targets. Some nations may wish to wait, and it is only right that CEPI should prove its worth, but there seem few reasons that it should not succeed.
The difficulty of developing vaccines against HIV, tuberculosis and malaria must not cloud expectations. As researchers point out, most pathogens don’t have the vast sequence diversity and mutability of HIV, the TB bacterium’s high transmissibility and ability to lie dormant, or the malaria parasite’s cunning evasion of the immune system by generating alternative surface proteins. Making vaccines against many of the viruses on the most-wanted list should not be a huge challenge.
CEPI comes at an exciting time in vaccine research. There’s a move away from a single-vaccine approach for any one disease, to developing vaccine backbones for use against multiple infections. This promises to greatly speed up vaccine development — and perhaps even to allow rapid development of vaccines against previously unknown viruses.
At a time when short-termism and shortsightedness are rife, and political rhetoric often prevails over action, CEPI’s founders are offering vision and foresight — it’s an insurance policy that more governments, including the United States, would be well advised to back.
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