One of the biggest nightmares for those tasked with worrying about humanity’s future is a pandemic. A fast-spreading, high-mortality pathogen that doesn’t care about national borders could bring the world to a halt in a way that even the largest natural disaster is not capable of: killing millions and hurting the world economy more than the recent Great Recession.
And, yet, despite knowing the scale of the threat we’re facing, the world is ill-prepared to prevent epidemics or deal with them once they’ve begun. That’s a realization we’ve only come to recently, thanks to the Ebola epidemic, which caused 11,000 deaths, and the current wave of Zika that is estimated to leave just as many newborns severely handicapped for the rest of their lives. Together, these two epidemics alone have already cost the world economy billions of dollars.
But it’s not all doom and gloom. We know what we need to do stop such pandemics from causing havocs: develop vaccines.
The Ebola epidemic showed that, if we have the right system in place, it’s possible to come up with new vaccines quickly. All we need to do is take the next step: create vaccines in preparation for when an outbreak strikes, rather than reacting after it begins spreading.
At the World Economic Forum in Davos, a global alliance announced today that it has secured nearly $500 million to do just that. The Coalition for Epidemic Preparedness Innovations (CEPI), created by governments and nonprofits, has identified a key gap: though the World Health Organization (WHO) knows which diseases we need to prepare for, we don’t actually have vaccines for them. CEPI aims to use the money to fill the gap that is stopping the crucial development of such vaccines.
Why doesn’t Big Pharma do it?
Pharmaceutical companies make money from helping people live better lives. They also invest more money into research and development (R&D), as a proportion of profits, than companies in any other high-tech industry. These investments often result in big losses when drugs fail in clinical trials—but when a drug succeeds, it can lead to billions of dollars in profit. So, in theory, they should be more than willing to develop and test new vaccines.
But in recent years pharma companies are getting less return on their R&D investment. Lower profits have caused some of these companies to take extreme steps, such as promoting drugs for indications they have not been approved for.
On top of that, investments in vaccines is especially risky. If there isn’t an outbreak, there is no way to recoup the cost of developing vaccines. In other words, the vaccine gap exists because there’s no real incentive for big pharmaceutical companies to work on them.
What’s up with the WHO?
Given that pharma companies are not up to task, it seems leadership on vaccine development should fall to the World Health Organization, the group charged with advancing public-health globally. But it’s not that simple.
There are two reasons why the WHO isn’t able to do the job, according to John-Arne Røttingen, CEO of CEPI: First, the WHO doesn’t have the kind of money needed to invest in vaccine development. Second, and more crucially, is a conflict of interest. The WHO is the organization that provides countries with the regulatory framework for vaccine development; they can’t also be the one to develop vaccines. It would compromise the ability of the WHO from assessing a technology, if it were also incentivized to develop its own sets of technologies.
It takes a public-private partnership to make vaccines financially viable, says Rajeev Venkayya of Takeda Pharmaceuticals, the Japan-based pharma company that is Asia’s largest. “In case of our polio vaccine, the Gates Foundation is funding all of the research and development,” he says. “That allows us to provide 50 million shots of the vaccines to low-income countries at a very affordable price.”
The long history of polio is also one of innovative drug-development frameworks. In 1938, a $26 million investment from the US government helped create the polio vaccine. The Harvard University economist Larry Summers argues that it was perhaps the best investment ever made, because it delivered a net benefit of $180 billion in cost savings for health treatments. As he writes in an op-ed for Quartz, “Now we have the opportunity to make a similarly sound investment.”
So what will CEPI actually do?
CEPI has signed a memorandum of understanding with the WHO. The alliance will rely on the expertise of the global-health body to guide their work. It’s using the WHO’s priority list to choose which diseases to pursue, and then relying on the WHO’s blueprint—which sets out how to act on priorities, share information, and develop interventions (like vaccines) in preparation for an epidemic—to drive the R&D agenda.
For CEPI that means producing “just-in-case” vaccine candidates for three diseases to start: Middle East respiratory syndrome (MERS), Lassa fever, and Nipah. (Dengue, influenza and Zika didn’t make the cut because they are already well-served by pharma companies.)
This will involve working with pharmaceutical companies to push promising candidates through animal trials and then small trials on humans. That way, if a MERS outbreak occurs, it will take only a few months to test those vaccine candidates in the last phase of a clinical trial (testing it on thousands of humans) and push them out to markets quickly if found to be safe and effective. In contrast, the fastest we’ve been able to achieve such a feat was in the case of Ebola, where we had a fully effective vaccine two years after the outbreak began.
The alliance will also work on “just-in-time” approaches to deal with unknown viruses. These will involve development of new technologies, such as DNA-constructs that allow scientists to quickly identify a virus and produce a candidate vaccine. This is not science fiction. A company called CureVac, which the Gates Foundation has invested in, is already making progress. If such technologies are successful, Røttingen says, CEPI will make them available to all pharmaceutical companies working with the alliance.
Both these approaches will require working closely with pharmaceutical companies and biotech startups, and that means having the money to incentivize them. CEPI has now raised $460 million in committed funds from the governments of Norway, Japan, Germany, and India, as well as commitments from the European Commission, the Wellcome Trust, and the Gates Foundation. It aims to raise a total of $1 billion by seeking new partners—Røttingen says CEPI is currently in talks with the US and UK governments.
With big names and plenty of money on the table, it’s no surprise that pharmaceutical companies are ready to talk new vaccines candidates. CEPI partners now include GlaxoSmithKline, Takeda, Pfizer, Johnson & Johnson, Merck, and Sanofi. The next step is for CEPI to start a competitive phase, where they’ll take funding proposals from pharmaceutical companies for development of candidate vaccines for the first three diseases.
There hasn’t been a coalition like CEPI before, so nobody knows if it will succeed. But regardless of success, the fact that the biggest health charities, pharma companies, and governments are interested in working together means we’ll finally make progress on preparing a defense against deadly pandemics. It’s never too late to buy insurance.