Vaccines have been one of the biggest success stories of modern medicine and WHO estimate that more than 5 million deaths were prevented annually between 2010 and 2015 owing to vaccinations delivered around the world. The 2014 Ebola epidemic—and more recently Zika—has highlighted the urgent need for vaccines to be developed against many known infectious diseases that threaten to become the next global outbreak. That scientists took the potential Ebola vaccines already available at the start of the outbreak and developed a working vaccine ready for clinical use in just over a year was an amazing feat, but it was still too late. The epidemic was starting to subside and many thousands of people had already died. On Jan 19, 2017, the Coalition for Epidemic Preparedness Innovation (CEPI) launched their plan to contain and manage outbreaks at an earlier stage.
CEPI was launched after the Foundation for Vaccine Research called for a global vaccine development fund to fast-track the crucial stages after vaccine discovery; these stages are often hampered by shortfalls in the funding and resources needed for large safety and efficacy studies. The incentive for pharmaceutical companies to engage is minimal when financial returns for their investment might be limited or nonexistent and many high-priority infectious diseases affect countries with the least access to funds or resources. CEPI has already sourced US$460 million in funding from the governments of Germany, Japan, and Norway, as well as the Bill and Melinda Gates Foundation and Wellcome Trust, and they hope to raise another half a billion dollars by the end of the year. This funding will allow them to partner with industry and public organisations and share the financial risks and benefits of vaccine development. CEPI aims to advance candidate vaccines up to and including phase 2 clinical trials, so if an outbreak occurs these candidates can be immediately tested in the field, dramatically reducing the time before an effective vaccine is available.
CEPI have chosen three priority diseases: MERS-CoV, Nipah, and Lassa viruses. All three viruses are zoonotic but can also pass from person to person, and none have approved vaccines. MERS causes a severe respiratory illness and is fatal in over a third of people who contract it. Most cases have been linked to countries around the Arabian Peninsula. Nipah causes a rapidly progressive illness that affects the respiratory and central nervous system, with some reports showing mortality exceeding 70% of cases. Outbreaks occur almost every year in Bangladesh. Lassa is asymptomatic in around 80% of patients but can cause a haemorrhagic fever and vomiting. It is fatal in roughly 1% of cases and is endemic in parts of west Africa. These three diseases were chosen not only on the basis of both their risk of outbreak and potential public health impact, but also the feasibility of vaccine development. All the diseases are also on the WHO research and development blueprint list that was updated this week in Geneva.
At the 140th WHO executive board meeting in Geneva in January, Director-General Margaret Chan discussed the importance of remaining alert to existing and evolving infectious diseases. The slow international response to the Ebola outbreak had received widespread criticism and WHO were blamed for the delay in declaring a public health emergency. It was only when foreign health-care workers and visitors to west Africa developed Ebola that public interest seemed to rise. Sadly, this narrative is also echoed in vaccine availability. Although most of the knowledge required to develop vaccines for diseases such as Ebola and Zika are obtained in the developing world, those countries are not always given priority access. A crucial part of the ethos of CEPI is to make sure the vaccines it helps to generate are available to all those who need them. They plan to negotiate global access agreements with vaccine developers to encourage affordability and availability in low-income countries as well as to support the infrastructure needed for vaccine preparedness within countries most at risk of an epidemic.
As Margaret Chan ends her last term as Director-General of WHO, she has called for greater equity in the delivery of health care. It is short sighted for high-income countries to offer support for epidemics only when the threat reaches their own shores. International collaboration between scientists and policymakers in preparing for potential epidemics through vaccine development will not only save many thousands of lives but also help to prevent an outbreak becoming a pandemic. The development of new organisations such as CEPI and the ongoing work of groups like the vaccine alliance Gavi give us hope that in these politically uncertain times we can still work together towards globally beneficial goals.
For more on the WHO estimate of deaths prevented by vaccines see http://www.who.int/immunization/documents/general/WHO_Mission_VIsion_Immunization_Vaccines_2015_2030.pdf
For more on the Coalition for Epidemic Preparedness Innovation see http://cepi.net/
For the Foundation for Vaccine Research's call for global vaccine development see N Engl J Med 2015; 373: 297–300
For more on CEPI's priority diseases see http://cepi.net/resources#Priority-diseases
For the WHO research and development blueprint list see http://www.who.int/csr/research-and-development/2017_priority_disease_list_review_short_summary_25Jan.pdf?ua=1
For more on the late development of public interest see https://www.nytimes.com/2015/08/15/opinion/the-ebola-vaccine-we-needed.html?_r=1
For more on the need for priority access to vaccines see https://www.nytimes.com/2016/12/28/opinion/a-zika-vaccine-but-for-whom.html?_r=0
For more on Margaret Chan's call for equity in health-care delivery see http://www.voanews.com/a/all-people-rich-and-poor-entitled-to-good-health-care-who-says/3687978.html
For more on the vaccine alliance Gavi see http://www.gavi.org
© 2017 Garo/Phanie/Science Photo Library