Collective defense against threats
In December, the World Health Organization (WHO) released a list of priority pathogens for research and development. And it’s probably not surprising that the list doesn’t have many recognizable names.
Ebola, Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) are on the list. HIV/AIDS and tuberculosis are considered to have sufficient governmental research funding. But Congo-Crimean hemorrhagic fever, Nipah virus (NiV), Lassa fever and Rift Valley fever (RVF)?
Chikungunya, the Zika virus and severe fever and thrombocytopenia syndrome (SFTS) round out the list, endorsed as “serious” but not as priorities.
As with many epidemic threats, we cannot say with certainty when an outbreak will occur, but we can say with some likelihood that it will (someday) occur. The experts picked these viruses as likely causes of severe epidemic outbreaks in the near future and, critically, there are no vaccines or medicines available. With the exception of SFTS, none are typically found in or near Korea - that virus has caused deaths in China and in the Koreas.
We learned from the 2014 Ebola epidemic and are trying not to repeat the mistakes made during the SARS outbreak, which came and went in 2003, and is still without a vaccine or effective treatment.
Ebola vaccines were not ready (despite decades of work) in 2014, and despite being on the radar since 1976, even our understanding of the way the disease develops after infection and how the human body’s defense (immune) system responds to and controls (or fails to control) the virus was limited.
Billions of dollars were pledged during the Ebola outbreak - the health and social infrastructure in the affected countries were decimated- and billions of dollars were lost during the MERS outbreak in Korea. These are expensive lessons - paid in deaths, disruption and economic loss.
The new list of dangerous diseases identifies the viruses to highlight the need for research and development, but does not itself offer funding to do the necessary work. This will likely fall on governments in developed economies - the burden of these diseases do not create the economic incentive that would spur investment by a major pharmaceutical company. This is, perhaps, where a more directed approach to research and development might be helpful.
What companies do best is to move systematically through a process of discovery, through development and, finally, to licensing. Universities traditionally do well with discovery, but less well with the steps beyond. In the United States, for specific pathogens like avian influenza or MERS, a different kind of government agency helps to move vaccines and other biomedical products from the discovery “incubator.” This organization, known as the Biomedical Advanced Research and Development Authority (Barda), takes great ideas and turns them into products, tests them and ultimately makes them available for the public good. It does this not by becoming a public pharmaceutical company but by using funding to help other groups get products in the development process.
Probably not every country needs a Barda, but a collective defense against these priority pathogens might be helpful, though the difficulties in coordinating different countries’ priorities can be daunting. The World Health Assembly requested the development of a blueprint for accelerating research and development in epidemics, where there are no known preventive or curative measures.
The WHO is drafting that blueprint now. Key points include identifying the priority pathogens (a key first step), identifying gaps in research and development, coordination among stakeholders, monitoring and evaluating preparedness, and exploring funding options.
Individually, countries like Korea would benefit from a Barda-like approach to particular pathogens as these might enhance both preparedness and spur Korean biotechnology efforts. Prioritizing the threats posed by the WHO is the first step. Collaboration with Barda or other similarly focused entities might help with resource constraints by avoiding redundancy and would complement and potentially accelerate key development milestones. Lastly, working with the WHO to develop and actuate the blueprint would enhance Korea’s preparedness for future outbreaks.
The development of new preventive and therapeutic interventions requires funding and the burden of coordination, the cost of success - and we have seen firsthand the cost of failure.
*The author is director general of the International Vaccine Institute.
by Jerome Kim, M.D.