In 2015 a MERS outbreak in South Korea took months to get under control. Now researchers want to develop and stockpile vaccines against this and other threats. Credit: Kim Hong-Ji/REUTERS

SARS, Zika, Ebola – when some of the world’s most terrifying disease outbreaks occur, health workers often find themselves powerless. A billion-dollar initiative launched on 18 January aims to change that situation by pre-emptively developing and stockpiling vaccines to combat potential epidemic threats.

“I'm thrilled. This is only the formal launch, and to have near $500 million — and likely more — to get started is great,” says Jeremy Farrar, director of biomedical charity the Wellcome Trust in London, one of the new project’s backers.

The Coalition for Epidemic Preparedness Innovations (CEPI) launched on 18 January at the World Economic Forum in Davos, Switzerland, with an initial US$460 million of backing from Norway, Germany, Japan, the Wellcome Trust and the Bill & Melinda Gates Foundation. The organization expects to raise the full $1 billion that it needs for the next 5 years by the end of 2017, says John-Arne Røttingen, CEPI's interim chief executive. It is by far the largest vaccine development initiative ever against viruses that are potential epidemic threats.

The first targets for CEPI are vaccines against the Nipah virus and those that cause Middle East respiratory syndrome (MERS) and Lassa fever, which might be next to cause outbreaks similar in scale to SARS, Ebola or Zika.

Vaccine researchers welcome the initiative. “I’m delighted to see the launch of CEPI — it's very much needed,” says vaccine researcher Adrian Hill, director of the Jenner Institute in Oxford, UK.

CEPI is well placed to help: “This group is distinctive in being a large, very inclusive effort spanning academia, public-health agencies, large and small companies and a range of philanthropic and government funders,” says Hill.

Stocking the pipelines

The Ebola epidemic that began in December 2013 in West Africa shows the need to develop vaccines pre-emptively, says Farrar. No vaccine against Ebola was available when the outbreak started, but researchers were able to develop a safe and effective vaccine against the Zaire strain responsible in record time — just a year and a half. Making a vaccine from scratch usually takes years, or even decades.

They were able to move fast because US and Canadian researchers had already developed experimental Ebola vaccines. Researchers fighting Ebola lost valuable time, however, because the experimental vaccines, which had sat on the shelf for years, had been tested for safety in animals, but not humans.

Credit: Coalition for Epidemic Preparedness Innovations. Preliminary Business Plan 2017–2021 (CEPI, 2016).

“We had to spend what was 9–12 months getting safety data for those vaccines, and that was 9–12 months where ultimately many people lost their lives,” says Farrar.

By contrast, CEPI's planned work on MERS, Nipah and Lassa vaccines will take experimental vaccine candidates — two for each disease — through testing in humans to establish that they are safe and produce an immune response that is likely to be protective. It would then create sufficient stockpiles of promising candidates to rapidly test for efficacy, and possible use, in the event of an outbreak. For the three diseases initially targeted, CEPI aims to have stockpiles by 2021.

Market failure

CEPI intends to support research at every stage, from basic lab work to vaccine discovery and clinical trials. It also made its first call for research proposals on 18 January, and teams have until 8 March to submit preliminary proposals for grants.

“For too long, we have separated out the academic work from the next step of taking it into all that is actually required to make a vaccine,” says Farrar. There is also no market for vaccines against 'potential' epidemic threats, he notes, which explains why there is no commercial incentive to take research leads out of the lab and into clinical development.

CEPI aims to change this state of affairs by bringing together sustained long-term funding from governments and philanthropies to encourage collaboration with biotechnology companies and large vaccine makers.Industry involvement will be crucial, says Farrar. Pharmaceutical companies GlaxoSmithKline (GSK), Johnson & Johnson, Sanofi, Pfizer, Takeda and several other companies have said that they will support CEPI, but details about their involvement are still under negotiation.

CEPI is particularly keen for the United States to join, but discussions will take time given the change in administration, adds Røttingen. “Irrespective of the government, it was a bad time to engage the United States on that."