What if effective diagnostics, vaccines and medicines to test, prevent and treat Ebola had been available at the beginning of the West Africa outbreak? The answer is easy: we could have stopped the spread of infection earlier, saved thousands of lives, and averted a large-scale social and economic crisis in the region.
Like Ebola, there are many known diseases that could become epidemic and for which we have no medical countermeasures - Zika is the most current example. To make matters worse, new viruses are emerging - such as MERS or SARS, until recently unknown to science, and against which we have no line of defence.
Since the Ebola crisis, it has been repeated numerous times that the world is unprepared to face the increasingly global nature of outbreaks and that another major epidemic is just around the corner. While traditional response measures to control transmission are still very much needed, targeted R&D for epidemic threats could be the game changer in the way we avoid crisis today and protect populations in the future.
The World Health Organization has mapped nine infectious diseases most likely to become epidemic health threats in the coming years and has created a global action plan to coordinate and accelerate R&D prior to and during epidemics to ensure that health technologies are rapidly available to save lives. The WHO R&D Blueprint, as it is called, aims to promote proactive R&D for the nine prioritised diseases before an outbreak takes place so that we are ready with the resources, the scientific evidence, the competent people and the stand-by mechanisms to enable immediate action.
The value of the Blueprint is two-fold: 1. it aims to enhance outbreak response with timely and effective R&D, and, 2. it will accelerate availability of innovative diagnostics, vaccines and medicines to the people who need them most, given that most epidemics begin in the poorest countries, where health systems are weak and people have low access to medical products. To do that, the Blueprint has already begun work on R&D roadmaps for the top nine health threats, pin-pointing the tactics, tools and networks that need to be in place for immediate activation of R&D, including clinical trial protocols, fast-track regulatory reviews and roll-out strategies as soon as safe and effective products become available. It has called for companies to make platform technologies available, and is advocating for pre-outbreak research, data sharing networks and open-access platforms for the sharing of biological samples with a number of partners.
The effort is massive, and requires funding as well as the collaboration of all countries and partners, from the affected communities to donors, from public to private research institutions, from scientists and public health specialists to social communicators. Above all, it requires that all these actors work together for the benefit of medical science and humanity.
When Ebola hit West Africa in late 2013, no health technologies were available to test, prevent or treat the disease. Outbreaks had occurred in rural East African communities for years, but they were too sporadic and isolated to provide market incentives for the pharmaceutical industry to invest in research. When Ebola appeared in Conakry, a densely populated city, the virus began to show its teeth. It spread like wildfire in Guinea, spilled across borders into several countries, most acutely in Liberia and Sierra Leone, and soon began to infect foreigners, who became potential transmission vectors when they returned to their own countries. From a local, easily contained illness, Ebola became the worry of the world, and that's when the world started acting.
Billions of dollars were spent by the international community to stop transmission of the disease and to test medical products that had been researched in academic or defence institutions but had never got anywhere close to clinical development stage. The World Health Organization stepped in to convene R&D partners, came up with specifications for appropriate diagnostics and a fast-track assessment system to ensure the new tests' quality. At the same time, it strived to coordinate the overall R&D response, advocating that the testing of vaccines and therapeutics in the affected communities followed rigorous scientific and ethical practice while remaining flexible enough to be performed with speed.
Today we have a number of effective diagnostic tests and at least one effective vaccine against Ebola, and all this in just two years. Usually, developing a vaccine can take six to 10 years. These successes unfortunately came too late for the over 11 000 people who died, but the experience showed that R&D could be accelerated, and that the international community, including the pharmaceutical industry, could step up to the plate when saving lives and stopping the global spread of a dangerous virus becomes an urgent imperative.
It is now just as imperative that the international community take action to protect our future. To avert another major crisis, to pre-empt what many commentators have called inevitable and devastating new epidemics about to happen, and to act as a true community, partners should come together under the Blueprint umbrella and collaborate openly to safeguard global health.