A Day Late, A Dollar Short: What The U.S. (And The World) Still Aren't Getting About Zika

News cycles and vaccine development cycles are never in sync. While pandemic-inspired headlines may dominate the news for weeks or months, it takes years to develop a new vaccine.
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While Zika cases in Puerto Rico, and now the continental United States, have risen into the thousands, and Zika-related miscarriages and birth defects continue to climb, Congress is still treating Zika like an opportunity to score political points rather than a full-blown medical emergency. Funding to fight the virus is running out, and Congress just failed to approve more funds before their summer break--leaving Americans unprotected right as the mosquito season is peaking and the threat is highest.

There are at least two things wrong with this picture. The first is obvious. Zika poses an imminent threat to public health that demands immediate action, starting with congressional approval of funding to combat the disease.

The second is that once again, the international response to a health crisis is driven mostly by headlines when we should be developing vaccines and other approaches that would prevent many highly infectious diseases from becoming pandemics in the first place.

The fact is that news cycles and vaccine development cycles are never in sync. While pandemic-inspired headlines may dominate the news for weeks or months, it takes years to develop a new vaccine. Remember Ebola? In 2014, it was front page news as deaths climbed into the thousands. That prompted a massive effort to find a vaccine. Two years later, not a single Ebola vaccine has received regulatory approval.

Now, with the immediate threat of Ebola behind us and attention focused on Zika, we are scrambling once again without the benefit of a coherent strategy or integrated approach.

This pattern of shifting priorities and lost time recurs with dismaying regularity. Instead of responding only when an outbreak becomes front page news, we need a long-term program that focuses the capabilities of governments, intergovernmental institutions, the private sector, academia, and nonprofits on development of vaccines for infectious diseases with pandemic potential.

The good news is that there are examples of multisector programs that have delivered lifesaving vaccines. After meningitis killed more than 25,000 people across sub-Saharan Africa in 1996, the World Health Organization (WHO) and partners from the private and public sectors developed a vaccine for less than 50 cents per dose that has nearly eliminated a disease that once regularly killed thousands across the African meningitis belt.

And in the United States, the Biomedical Advanced Research and Development Authority (BARDA)--which supports the work of the private sector and academic researchers to respond to national health emergencies--has overseen the development of more than a dozen vaccines and treatments since 2011.

The success of BARDA and the meningitis vaccine--and the inefficient global response to Ebola--make clear that long-term funding and coordination of research and development are essential. Because the most urgently needed vaccines often don't have a commercially viable market, funding will need to come from governments and foundations that have a history of supporting global health initiatives.

Such funding should be used to accelerate development of vaccines for the diseases already identified by WHO as most likely to cause severe outbreaks in the future. It should cover private-sector investments in developing vaccines that are unlikely to generate a profit. Working with pharmaceutical companies in emerging markets that have lower operating expenses and a better understanding of local markets can reduce costs and expand global health capacity. This approach helped make it possible to develop a vaccine for meningitis for one-tenth the typical cost.

In addition to creating the mechanism to support a "just in case" approach to pandemic preparedness, we also need to be ready with a "just in time" response when outbreaks occur. This should build on frameworks for rapid regulatory review developed by WHO and the Food and Drug Administration, and include clear rules for speeding vaccine candidates from the trial stage to manufacture and distribution.

Following the poorly coordinated response to Ebola, a number of review panels studied the problem and issued sensible reports. But Zika makes clear that we're no better prepared than we were two years ago. As an urgent matter of national and international security, governments and WHO must join with pharmaceutical companies, academic institutions, and nonprofits to establish a well-funded and well-coordinated public-private partnership program to prepare for the future disease outbreaks that are certain to strike.

It won't be cheap to fund or easy to manage. But failure to do so now will certainly carry a significantly higher cost in the future. In our complex and often insecure world, this step toward improving global health security is an essential investment.

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