Future global health threats
The author is the director-general of the International Vaccine Institute, a Seoul-based international organization devoted to the discovery, development and delivery of new vaccines for global public health.
We like to think that there is certainty in numbers — 79,000 cases of Covid-19, also known as the coronavirus, and rising. 2,600 deaths, and rising. This weekend the Korean government raised the alert to its highest level, and Israel turned around a Korean jetliner. In the context of these developments, it is still hard to see where the Covid-19 epidemic will end up. Will it abate and disappear, like severe acute respiratory syndrome (SARS) did in 2003? Will it revert to a pattern of occasional outbreaks in high-risk populations, like Middle East respiratory syndrome (MERS)? Or will it adapt into the human population, and will the coronavirus’s abilities to mutate and hop between mammalian species (bats, humans, etc) create recurrent seasonal outbreaks with variations on the original Covid-19, as influenza does? Some have argued that it has become a “pandemic,” but that word, with its potential for panic or hysteria, should be used with care.
First we need to know the threat — we still don’t have complete information, but we can generalize. It is more contagious than MERS, possibly more contagious than SARS but less deadly than either and definitely less contagious than measles. Transmissible by droplets (google a picture of a sneeze) — so roughly a couple of meters around an infected person — and possibly by touching a surface where virus particles have been deposited by air or contact, Covid-19 can enter the body through the mouth, throat, lungs, nose or eyes.
Hence, the precautions — avoid the Covid-19 virus. Don’t go to China; practice good hand hygiene; and don’t touch your nose, eyes or mouth with your hands. In some places, governments recommend wearing masks. Protect others — cough into the crook of your arm, practice good hand hygiene and call your health care provider or public health authority if you have symptoms or suspect exposure to Covid-19. For governments, measures could be severe (such as quarantine on an entire city) or in varying degrees of restriction — staying at home, investigation of contacts, preventing public gatherings, testing, quarantine or hospitalization.
From SARS, MERS and avian flu to Ebola, the past 20 years should have taught us some lessons. With each, the research community is asked — when will the vaccine be ready? When we say five to 10 years, people are disappointed. Unfortunately the funding for vaccines and new drugs goes away right after media attention wanes. It means that the next time the disease appears, we are empty-handed. Vaccines and drugs take time to develop, test, manufacture and implement. These cannot be developed, as depicted on television in the space of a single episode, but they are the product of years of development — and millions of dollars. This work is done with little likelihood that the vaccine will generate billions of dollars in return on investment, and what country wants to use its money for an epidemic that may never appear again?
There is a collective solution, however, funded by countries and philanthropies to take vaccines for emerging diseases quickly from the laboratory to a stockpile so that the vaccine is available for testing or use when a new outbreak occurs. The lessons of the Ebola outbreak in West Africa led to the founding of the Coalition for Epidemic Preparedness Innovations (CEPI), which has roughly $1 billion in pledges from countries, organizations and philanthropies around the world. Staffed by experts in vaccine development, CEPI first aimed to develop vaccines against MERS, Lassa fever, the Nipah virus and a virus called Chikungunya. When Covid-19 emerged, CEPI was ready and quickly provided funding to four groups with “rapid” technologies — one group had designed a potential vaccine within three hours of seeing the virus sequence. By the early summer these vaccines may be tested on humans, and if the outbreak continues, some vaccines will be tested for efficacy. For a process that often takes a decade, it is a persuasive argument for preparedness.