The late Nobel laureate Sir Peter Medawar wrote that a virus is a “piece of bad news wrapped up in protein.” That bad news is the story of the day: The first 30 MERS patients in Korea, the nurses infected with Ebola in Texas and a persistent Ebola infection in the eye of a doctor who was infected while caring for Ebola victims remind us that, in the age of the global village, neither wall, nor minefield, nor ocean suffices as a barrier.
The occurrence of Korea’s first cases of Middle East respiratory syndrome (MERS) and the Ebola epidemic in West Africa make an important point about vaccines and public health.
Each disease carries a substantial mortality rate, and neither has an approved preventive vaccine.
MERS has been known since 2012, and its cause is a virus from camels that is related to the cause of SARS.
Over 1,100 have been infected, and over 400 have died. Ebola has reportedly killed an estimated 10,000 people, but experts say the actual death toll could be much higher.
After the developed countries took notice, a multibillions-dollar effort was mounted help affected countries to control the epidemic.
Ebola vaccines moved to the forefront and testing proceeded quickly ― though the epidemic was already subsiding before the first dose of the “experimental” vaccine could be tested in the affected countries.
The process of developing a new vaccine ― showing its effectiveness at preventing infection, getting it licensed, manufactured and used ― typically takes a decade or more.
Fortunately Ebola vaccine researchers had been working, largely in obscurity, often in government laboratories, for decades. Vaccine research, particularly early vaccine research carries risk and expense.
In the case of Ebola, research on this virus itself must be carried out under the highest level of containment. The disease, until the West Africa outbreak, had not been common enough in its natural environment for investigators to do a traditional vaccine evaluation.
The Ebola virus, prior to 2014, had been lethal but sporadic, confined to pockets outside major population areas. As a result, when Ebola arose in Guinea, Sierra Leone and Liberia, there was no approved vaccine ready to deploy.
In order to have vaccines ready for future outbreaks of Ebola, MERS or the next worse thing, we have to do research and vaccine development preemptively.
This work should be funded out of a common perception of need and rational assessments of potential risk to global health.
Of the three principal funders of discovery research ― governments, foundations and major pharmaceutical companies ― the primary source of funding must be governments.
For-profit vaccine companies will find it difficult to make vaccines that are not used except in an emergency (like a new SARS or Ebola vaccine).
Governments can and do fund the production of vaccines that are not commercially viable.
For instance the U.S. government contracts with smaller companies that do not have the funding to make the vaccine themselves, and lack funding to do the clinical trials on their own.
Big companies don’t see economic value in small quantities of vaccine (say 1 million doses per year) made just for a stockpile. In these cases governments bear the risks of discovery and the burden of development.
MERS is not the herald of an impending epidemic apocalypse. However, public health, and the vaccines necessary to maintain it, is not free or easy.
Vaccines are the end result of processes that require funding and time, and vaccine development for emerging infectious diseases is best conducted in anticipation of, not in reaction to, epidemic outbreaks.
Equally important, these vaccines must be made available globally. The benefits are manifold, from the broader benefit to global public health, the creation of innovation and technical capacity at home and issues around national biodefense ― central to these is the idea that vaccines keep healthy people healthy.
The world has the scientific and medical expertise to deal with epidemic threats, but these efforts require national commitment to research, development and delivery of safe and effective vaccines.
By Jerome H. Kim
Jerome H. Kim, a medical doctor, is the director general of the International Vaccine Institute, a Seoul-based international organization devoted to the development and introduction of new vaccines for developing countries. ― Ed.
