The Ebola epidemic that broke out in 2014 might be a blip in most people's memories now, but for those directly involved in managing the crisis it remains a harrowing reminder of how unprepared the world is to protect itself from sudden outbreaks. Hence the formation of the Coalition for Epidemic Preparedness Innovations (CEPI), which formally launched at the 2017 World Economic Conference in Davos this week.
A global coalition to create new vaccines for emerging infectious diseases, CEPI has so far raised US$460 million – nearly half of its US$1 billion target for the first five years – from the governments of Germany, Japan and Norway, as well as the Bill & Melinda Gates Foundation and the Wellcome Trust. India, one of the coalition founders, is in the midst of finalizing its financial commitment.
CEPI's goal is to build up a bank of new vaccines to protect against emerging viral diseases for which there is currently no cure. Pathogens such as the Zika virus and Ebola are not part of this plan as there is already a substantial amount of R&D taking place in these areas. Its first three targets are MERS, a respiratory virus that was first identified in Saudi Arabia in 2012 and is now present in 27 countries, including the US; Lassa fever, an acute viral illness endemic to parts of West Africa, including Nigeria, Liberia and Ghana; and the Nipah virus, which seemingly arose out of nowhere in Malaysia in 1998 and nearly caused the collapse of the country's pig farming industry. Its more severe symptoms include breathing problems, seizures, inflammation of the brain and in fatal cases, coma and death. All three are on the WHO's list of priority pathogens, can be transmitted from animals to humans and have the potential to flare up into deadly epidemics.
The plan is to develop two vaccine candidates for each of these viruses before an epidemic breaks out, a lesson that was learned the hard way during the 2014 Ebola crisis. While there were actually several promising vaccine candidates developed by such organizations as the US army and National Institutes of Health, they had only been tested on animals and it was not until there was an outbreak with a rising death toll that pharmaceutical companies and organizations were spurred into action to develop a vaccine in just a year and a half, a record considering that it can take 10 to 15 years before a drug is made available to the public. Creating a vaccine is a lengthy and expensive process, the costs of which, for companies that have their eye on the bottom line, do not always justify the end, especially if it is targeted at a potential threat that might or might not rear its head at all.
For proponents like Jeremy Farrar, director of London-based biomedical charity The Wellcome Trust, the time has come to put short-term commercial interests aside and look at the bigger picture. "We know from Ebola, Zika and SARS that epidemics are among the significant threats we face to life, health and prosperity. Vaccines can protect us, but we've done too little to develop them as an insurance policy. CEPI is our chance to learn the lessons of recent tragedies, and outsmart epidemics with new vaccine defences."
Peter Piot, a CEPI co-chair who was involved in one of the Ebola post-mortem reports, is even more pointed in his criticism of the current R&D process. "The current R&D system is not fit for purpose to produce vaccines and therapeutics where we have no market incentives and have high uncertainty where the next epidemic will be," he said during last year's World Economic Forum meeting, when discussions were held on how the next Ebola epidemic could be prevented.
CEPI has already made its first call for proposals to target the three aforementioned viruses and is expected to announce its first grants in the middle of this year. It has also received pledges of support from pharmaceutical companies such as GlaxoSmithKline, Johnson & Johnson, Sanofi, Pfizer and Takeda, who have promised to keep the prices of these drugs affordable. The industry partners, on their part, also hope that CEPI will in turn work with regulators to speed-up or streamline the approval process for these vaccines. "Getting to a vaccine in a very short time frame is challenging scientifically", said executive vice president of Johnson & Johnson during a call with reporters at this year's World Economic Forum. "We can do our part to fund not-for-profit vaccines, but it's important that we have collaboration."
On another note, it will be interesting to see if its founders can persuade the US to join. Early news reports have stated that the country will be providing subject expertise rather than funding, though this might not be conclusive. Nature reports that CEPI is "particularly keen" for the United States to join and that further discussions are a possibility, though this will take time given the change in administration, according to interim CEO John-Arne Røttingen.
In any case, this is a bold and ambitious move and CEPI has its work cut out. For a start, there's the question of how it plans to mitigate the bureaucracy that has long plagued clinical trials, and then there's also the risk of lawsuits that might arise from drugs gone awry. In the grand scheme of things, however, these are minor bugbears compared to the crippling effect that an unknown epidemic could have on economies and societies – one estimate puts the short-term economic costs that SARS had on affected countries at US$80 billion – and its founders know it.
Bill Gates, whose foundation will donate US$100 million over the next five years, has previously said that he fears a pandemic disease more than nuclear war or killer asteroids. Without R&D in vaccines, societies will be ill-equipped to face the next threat.
"The ability to rapidly develop and deliver vaccines when new 'unknown' diseases emerge offers our best hope to outpace outbreaks, save lives and avert disastrous economic consequences," he says.
In the video below, members of the coalition talk about the importance of taking immediate action on potential epidemic threats.