on the list of eligible tropical diseases. Not to stem the current outbreak, but to save people from the next one. The U.S. Health and Human Services secretary has authority to add “any other infectious disease for which there is no significant market in developed nations and that disproportionately affects poor and marginalized populations.”
That’s right from the law, so yes, Ebola seems to fit the bill. But an HHS spokeswoman wrote via e-mail that adding a disease to the list requires “rule making,” which includes a period of public comment. “It is a lengthy process,” she wrote.
Put another fix on the to-do list, probably for the next FDA budget authorization in 2017: The program might need a more flexible way to respond to pathogens that don’t behave according to bureaucratic timelines. Sure, there are other mechanisms: the clinical trial cooperation I mentioned earlier, for example, or FDA’s orphan drug and fast-track designations. And the HHS division Biomedical Advanced Research and Development Authority, known as BARDA—created last decade to fund biomedical responses for public health emergencies—can move money quickly. In fact, it has: BARDA was the funding source to move ZMapp to the next level. (Those $42 million are the only BARDA funds ever allocated for Ebola, an HHS spokeswoman said.)
But there’s less funding out there for Ebola medicines than you might think. WHO doesn’t have any. The Gates Foundation, until today, had never funded any research. The NIH’s NIAID has been a big source, with $456 million from 2000 to 2013 and $91 million the previous two years alone. Much of that, of course, is for basic research. [A previous version of this story listed an incorrect NIH funding total for 2012-13. We regret the error.] The Defense Department also funds Ebola and related research, but amounts couldn’t be ascertained by press time.
Several health officials also emphasized that Ebola isn’t like the flu. A carrier can’t travel the world, spreading infection in stealth with coughs and sneezes. Ebola is relatively hard to spread, and so health officials emphasize that nonpharmaceutical measures should stop outbreaks eventually. But as we’ve seen the past couple months, “eventually” is a frightening word. So why not have all the tools available—like the incentive of the voucher program—to help prepare for the next outbreak, and the one after that, and the one after that?
