Washington state has reported nearly 300 cases of mumps this winter and experts predict this may be the state’s worst flu season in years, a stark reminder of how dangerous even familiar viruses can be. While the Ebola and Zika outbreaks have dominated the headlines in recent years, they are part of a paradigm we have seen for centuries. Any time a highly transmissible pathogen is introduced into a susceptible population, there is the potential for substantial detrimental health outcomes.
We don’t have to go back to the Bubonic Plague to understand the consequences. European settlers transmitted the smallpox virus to Native Americans, who had no immunity, with devastating consequences. The global influenza pandemic of 1918 swept from city to city around the world, killing at least 25 million people. Since HIV/AIDs burst into the world, 78 million people have contracted the virus and 39 million of them have died.
While the paradigm is unchanged, it’s moving at a seemingly faster pace as more people travel and climate change accelerates. Researchers estimate that there are some one million viruses out there that we haven’t identified, a scary thought.
IDRI recently brought together global health leaders from the Bill & Melinda Gates Foundation and Sanofi Pasteur for a panel discussion on emerging infectious diseases that addressed the risks of refocusing limited resources to combat the latest emerging disease. We all understand the importance of moving quickly to fight newly emerging threats like the Zika virus. But those of us working in global health also worry about losing our focus on such age-old killers as HIV/AIDS, malaria, and tuberculosis. Let us not forget that more people die every day from these three diseases than the 11,300 people who died from Ebola during the 2014-16 outbreak in West Africa.
Perhaps unexpectedly, the panel concluded that diverting vaccine research dollars to emerging diseases like Zika or Ebola is not necessarily detrimental. It brings a laser focus to the issues of vaccine development in general, which helps the entire field. Responding to newly emerging diseases help us not only focus on how to develop a vaccine but also how to implement it, how to deliver it, and how to help the affected communities use it. These are important lessons as we work on developing long-term, more complex vaccines for TB or malaria.
For example, the need to rapidly evaluate and implement a candidate vaccine for Ebola led to the development of a novel vaccine testing strategy, the stepped-wedge trial design, that may be used for other diseases as well. Additionally, the time needed to achieve regulatory approval for this approach was significantly shortened compared to the typical vaccine development as key agencies met under intense pressure to address this outbreak. Thus even though money was redirected from existing projects to developing an Ebola vaccine, the long-term benefits to the entire field are significant.
Another positive impact of intense focus on a newly emerging disease is a new level of collaboration. Academics who normally compete became more willing to share information about the antibodies, therapies, and diagnostics they had been working on in relative isolation. We saw the collaborative sharing of reagents and unpublished data, and all antibody sequences were published live rather than waiting for the prestige of publishing an article in a prominent scientific journal, which may have required months to years of peer review and revision before being made available to the broader research community. Certainly the peer review system is essential for proper vetting of scientific findings, but in this case the rapidity of sharing information with others who were positioned to make an impact on the outbreak outweighed the risks associated with not following this tried-and-true approach.
We’ve also built better partnerships between academics and the pharmaceutical industry. Academics realized they have to embrace the product development departments of the multinational drug companies because they are the only ones who can translate scientific findings into products that could have impact. On the flip side, many of these companies embrace the moral imperative of addressing these global health crises, even without an apparent benefit to their bottom line. These shifts have now left an imprint on the field, as academics are more open to this idea to advance the other vaccine candidates they are developing in their own labs, with industrial partners willing to respond to the public health need.
Finally, we were reminded how crucial it is to listen to the community we are trying to serve. Once healthcare workers in West Africa understood that people didn’t bring their sick family members to healthcare facilities because they wouldn’t be able to care for them, education began on how not to put themselves at risk of Ebola by caring for the afflicted at home. Scientists are currently trying to put forward a mosquito that blocks the transmission of Zika and dengue fever, but if we cannot make a case to the communities that are affected that this is a good idea, then we may have no right to conduct this effort in their environment.
Any success for a vaccine is success for vaccines at large. Still, the world would be a much healthier place if the same sense of urgency to stop Ebola and Zika could be applied to HIV/AIDS, TB, malaria, pneumonia, and diarrhea—scourges we have been battling for decades.
