Ebola epidemic reveals gaps in research into diseases of poverty

Over 11,000 people died in the latest outbreak of the Ebola virus. [UNMEER/Flickr]

The Vaccine Alliance has announced that it will fund research into an Ebola vaccine. Without public funding, laboratories often ignore illnesses that affect the poorest patients. EURACTIV France reports.

The Ebola epidemic served as a lesson to the international community. Just days after the all-clear was declared in West Africa, the Vaccine Alliance (Gavi) announced the signature of a partnership with the pharmaceutical laboratory Merck, to accelerate research into a vaccine against the virus.

>> Read: Stylianides: We need strong bridges between humanitarian and development aid

“The suffering caused by the Ebola crisis was a wake-up call to many in the global health community,” said Seth Berkley, the executive director of Gavi. “New threats require smart solutions and our innovative financing agreement with Merck will ensure that we are ahead of the curve for future Ebola outbreaks.”

Purchasing commitment in the pipeline

The Vaccine Alliance, which is largely funded by the governments of developed countries, foundations and the private sector, concluded a $5 million purchasing commitment with Merck.

In return, the laboratory will provide 300,000 doses of the vaccine by May 2016 to deal with a potential resurgence of the epidemic, subject to the approval of the World Health Organisation (WHO).

The American laboratory could then submit a marketing authorisation request by the end of 2017.

>>Read: First Ebola vaccines shipped to Africa

The Ebola virus, or Ebola haemorrhagic fever, is a disease that affects Humans and primates, and is carried in the blood and bodily fluids of the infected animal. The ‘reservoir host’, where the virus survives between outbreaks among humans or primates, remains unknown, but is suspected to be a species of bat.

It has not yet been proved whether or not contamination by air is possible in a natural environment. Between 50 and 90% of Ebola cases in humans are fatal.

More than 11,000 dead

The incubation period generally lasts between eight and ten days, but can be anything from two to 21. No specific treatment for the virus currently exists, but experimental vaccines were tested during the recent epidemic in Liberia, one of the worst-affected countries.

In two years, the official death toll from the outbreak reached 11,315 out of 28,637 reported cases across ten countries, including Spain and the United States. According to the WHO, this figure, which may be a significant under-estimate, makes the recent epidemic more deadly than all the previous outbreaks combines, since the virus was identified in Central Africa in 1976.

The urgency to develop an Ebola vaccine is as pressing as ever, as the day after the WHO declared the epidemic over, a new case was confirmed in Sierra Leone on 15 January.

“We are at a critical point in the Ebola epidemic, passing from the treatment of cases and patients to the management of the residual risk of new infections,” said Dr Bruce Aylward, the WHO’s Special Representative for the Ebola Response. “We expect new resurgences and we should prepare for them.”

The announcement of the Gavi-Merck partnership was welcomed by Doctors Without Borders (MSF). But the NGO will remain vigilant over the final price of the vaccine, which will be a determining factor in whether it is widely used in developing countries.

Manica Balasegaram, the head of MSF’s Access Campaign, said, “We want to understand how Gavi and Merck will fix a price, especially in the long term, and we need confirmation that the final price will be close to the cost of production.”

“Given the public and philanthropic investments in the vaccine, we hope that Merck will buck the trend of the pharmaceutical companies and be as transparent as possible about contributions, the financing of R&D, development subsidies and the tariff structure of the rVSV-ZEBOV vaccine. Public donors and philanthropists should not pay twice for the research and the development of the vaccine,” he said.

Declining research into the diseases of poverty

The Ebola epidemic shed light on the shortcomings of the system of research into the illnesses that affect the poor.

In fact, the first steps towards creating an Ebola vaccine were carried out more than ten years ago. But epidemics have tended to affect only rural areas in developing countries and have always been contained, making the vaccine a low priority for the laboratories.

“Ensuring a vaccine will be available to protect people who might have missed out due to a market failure lies at the heart of what makes Gavi so important in global health,” said Dr Ngozi Okonjo-Iweala, the Chair-elect of the Gavi Board. “It is our moral duty to ensure that people do not miss out simply because of where they are born or whether they can afford to pay.”

Not an isolated example

As Bruno Rivalan from Global Health Advocate explained, Ebola is far from the only example of where financial interests have taken precedence over public health.

“Tuberculosis is another example of the failures of this research model, which ignores the diseases of the poor. In 40 years, the laboratories have placed only two new molecules on the market. So the treatment of this illness, which is very common in developing countries, is not progressing, while multidrug-resistant strains of tuberculosis are beginning to appear,” he said.

>>Read: Developing countries urged to produce TB vaccines locally

“The research and development model for diseases linked to poverty is completely broken, because it is linked to profits, and there is no specific incentive for research into diseases that affect the poor and developing countries,” Rivalan said.

This lack of economic incentive (subsidies, innovation prizes, tax deductions, purchasing guarantees, etc.) will be partly addressed by the Gavi and Merck partnership on Ebola.

But the Ebola vaccine “should be taken as a lesson about the creation of new research models on the diseases of poverty, and not as a timely solution brought about by the panic surrounding this disease,” said Rivalan. “Because if the incentives had been in place, maybe an effective vaccine would have existed before the epidemic even began.” 

More than €1 billion was pledged by member states and the European Commission to fight the Ebola crisis. The Council has appointed Humanitarian Aid Commissioner Christos Stylianides as the EU Ebola Coordinator.

Mobile laboratories, humanitarian experts, and specialists in dangerous infectious diseases have been deployed to the region.

The €280 million call for proposals, launched by Commission and the European pharmaceutical industry, is under the Innovative Medicines Initiative (IMI).

€140 million will come from Horizon 2020, the EU's framework programme for research and innovation, and €140 million from the pharmaceutical companies which are members of the European Federation of Pharmaceutical Industries and Associations (EFPIA).

The research will involve large-scale clinical trials of new vaccines in the Ebola-affected countries as well as the development of fast diagnostic tests and new approaches to manufacture and distribute vaccines. 

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