Search for Ebola vaccine hindered by research cuts

Progress towards a potential Ebola vaccine would have been faster if the international community had followed through on work begun 10 years ago when western countries were worried about terrorists using Ebola as a potential biological weapon, according to the head of the global vaccine alliance.

The claim, from Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, came as the pharmaceutical company GlaxoSmithKline (GSK) said that a vaccine to fight the west African Ebola outbreak will come “too late for this epidemic” and may not be ready in sufficient quantities until 2016.

On Thursday, Professor Peter Piot, one of the scientists who discovered the virus, warned the outbreak may not end until the world has a vaccine against the disease.

However, Dr Berkley said that – had work that was begun a decade ago been seen through – it may well have laid the groundwork for a vaccine by now.

“We have had an effort to try to make a vaccine for Ebola going on now for about 10 years,” he said.

"The two [vaccine] candidates that people are talking about now started 10 years ago. But they weren't started because of the problem in Africa, they were started because of a worry from wealthy countries about bioterrorism: that's where the money came from and that's where it went … The west's interest in and fear of biological warfare has not sustained and has changed."

Dr Berkley said that the efforts had run out of steam because “Ebola is a sporadic disease in very poor countries”, making it an unattractive market for big drug companies.

Despite GSK’s downbeat forecast, experts believe that the vaccination of frontline healthcare professionals working in west Africa, which could happen as early as January, may help the fight against Ebola.

Professor Adrian Hill, director of Oxford University’s Jenner Institute and lead investigator in the vaccine’s UK safety trial, said: “If the vaccine does provide protection against Ebola, vaccinating doctors and nurses could be very useful. It would offer them some protection – a group at very high risk – and help break the chain of transmission, which might well help end the outbreak.”

GSK is already manufacturing 10,000 doses of the vaccine, which is unprecedented ahead of any trial results. If it proves effective, which it has done in animals, there will be an urgent need to use it.

“It has always been understood that an Ebola vaccine for use across the general population would not be available for some time, but thousands of doses of the vaccine will be available early next year if current trials continue to progress well,” said Jeremy Farrar, director of the Wellcome Trust.

“That is critical: it would mean that high risk groups, especially healthcare workers, could be vaccinated within months, with a real impact on the epidemic. We also do not know how long this epidemic will last: a population-level vaccine available in 2016 could yet make an important contribution.”

Dr Berkley said the world had repeatedly failed to learn the lessons of previous epidemic outbreaks such as Sars and bird flu, and urged the international community to ensure that funding and research for such emergencies was continuously maintained.

“From a global perspective, the one thing I can promise you is that, given evolution, given the use of antibiotics, we will have epidemics of disease and antimicrobial resistance,” he said. “So the question is how do we keep a level of vigilance and work both on the ability to respond quickly when these things happen, but also, how do we make sure that we have mechanisms to create vaccines, drugs and interventions that make sense for this in an accelerated fashion?”

The current outbreak, he said, provided an opportunity to plan for the future and get serious about infectious diseases.

“We need to think about how we accelerate products and make sure we’re trying to create them,” Dr Berkley said.

“We can’t do that 100 per cent, and you could make the argument that the next disease in a few years may be a completely unknown one, which we’ll have to scramble for again. But having mechanisms for that scramble and to build knowledge will help.”

Dr Berkley said such mechanisms could not be put in place without proper and sustained funding, saying that ringfenced money for unthinkable eventualities was not unprecedented.

“The UK has nuclear submarines, one of which is always under the water, fully armed and ready to protect against a nuclear attack,” he said. “The likelihood of that nuclear attack is pretty low but, in general, taxpayers are happy to pay for the assurance of this not happening. It’s not like somebody threatens nuclear war, we move the submarine around and then we suddenly say: ‘Oh it’s calm now, let’s stand down.’ That’s not what happens. Basically, there is an understanding that the risk is very small but, for the good of society, it’s worth making a long-term investment. Why don’t we think about that for infectious diseases?”

Gavi, a public-private partnership that estimates it has immunised almost half a billion children and prevented six million deaths since its foundation in 2000, is now considering what role it can play in bringing forward a viable vaccine as quickly as possible.

As the alliance does not conduct research and development, one of the options would be using Gavi’s money to guarantee a market for an Ebola vaccine, thereby freeing up private pharmaceutical firms to conduct accelerated trials. Gavi’s board is due to consider its response in the first week of December.

Although Dr Berkley said that production of other vaccines had not yet been disrupted by the rush for a weapon against Ebola, he warned that the disease's spread through Liberia, Sierra Leone and Guinea was already having a devastating impact on efforts to tackle illnesses such as measles, diarrhoea, tetanus and pneumonia.

“We will see common things like tetanus reappear because there will be cohorts of children who won’t get tetanus vaccine and they will be exposed,” he said.

“The immunisation will not be going on because the health workers will either have been pooled to deal with Ebola or won’t be showing up at their posts because many of them have closed. The health workers who are there and trying to keep it up are doing heroic work, but it’s very hard to manage all of this, and the whole society has been disrupted as a result.”

– (Guardian service)