-
The story explores how Ebola exposes deep inequities in global vaccine politics.
-
While COVID-19 spurred rapid, lavishly funded innovation for rich nations, African outbreaks like Ebola face neglect, slow research and profit-driven delays.
-
It traces the Zaire-strain vaccine’s bioweapon origins, Gavi’s intervention, and Africa’s renewed vulnerability to the Bundibugyo strain despite new CEPI-backed trials.
Viruses are lethal and nearly impossible to conquer. If one strain of a particular virus is controlled by a vaccine, a new strain emerges, posing a bigger threat. We know this from the harrowing experience of the COVID-19 pandemic, when SARS-COV-2 ran amok and killed millions worldwide. Rich nations scrambled to find vaccines, therapies and diagnostics, and funded Big Pharma companies generously so that they can come up with life-saving solutions. Which the companies did, in an extraordinarily short time, even if it meant that they had to cut corners in the process. But for viruses that affect Africa and other less privileged regions, the vaccine trail is long and tortuous, marked by poor pointers, unexpected dead ends and delays everywhere. And so, the Ebola virus disease (EVD) is setting a new record of fatalities in the Democratic Republic of Congo or DRC,
half a century after its first recorded outbreak in 1976.
Over 5,200 confirmed cases have been reported in the central African country since May this year, notching up 2,476 related deaths (as on August 18). This outbreak is spreading faster than the health authorities can contain it and, according to the World Health Organization (WHO), is set to become the deadliest on record. The speed at which a new strain of the ebolavirus—this is now known as the group of orthoebolaviruses because many new strains have since been identified—is spreading rings alarm bells and is set to eclipse the 2014-16 outbreak that killed more than 11,000 people.
If the name of the disease and the virus have changed over time, so has the perception of the disease in the West, which earlier viewed it as a potential bioweapon terror threat. Despite the ghastly symptoms and the mortality rate of EVD, there was little interest in the disease, which continued to be neglected because there was little commercial incentive in making vaccines or drugs to fight a virus that affected relatively fewer people in a continent that suffered from more serious health problems. However, driven by fears that Ebola could be turned into a bioweapon, defence agencies in the West, notably in the US and Canada, generously funded research on vaccines and treatments to fight the disease; the programme got added impetus in the wake of the September 2001 attack on the US. More funds were ploughed into developing protection against Ebola, which they feared could be weaponised for a biological attack.
Ironically, it is this fear that allowed Africa to get a vaccine for EVD caused by the Zaire strain. The help came from an unexpected source. In 2014, ten Ebola vaccines and treatments were in various stages of research, development and clinical testing, according to experts. One of the developers, Canada’s Department of National Defence that had invested US $7 million in developing an Ebola vaccine, had allowed its research to lie dormant from 2004 because there were no commercial takers for it. The 2014 outbreak that hit a swathe of countries in Africa marked a turning point. Canada’s Public Health Agency licensed its manufacture to NewLink Genetics, and subsequently, drug giant Merck. There was, however, criticism of the agency for entering into a “sole, worldwide, revocable and royalty-bearing license” with NewLink to develop and commercialise the vaccine “for the maximum commercial return to the company and Canada”. Such a profit-driven arrangement does not put public health first, critics said.
When Merck was brought in, it tested the vaccine on close to 12,000 people in Guinea who had come into contact with someone that had shown symptoms of the disease. The efficacy was reported to be 100 per cent through a “ring strategy”, which meant that every contact of a suspected case, as well as the contacts of those contacts, received the vaccine. This created a ring of immunity around every Ebola case. But it was an emergency measure in 2015, and as the outbreak beginning to wane, there was little commercial incentive for a pharma company to take the vaccine through the various costly steps such as clinical trials to get full approval. That is when Gavi, the Vaccine Alliance, a global public-private partnership for immunisation against deadly diseases in lower-income nations, stepped in with a pre-paid commitment to buy doses of licensed vaccines as and when the vaccine becomes available. Gavi set three conditions for drug companies, the most important of which was that they maintain a stockpile of investigational doses available in case of an outbreak even before being licensed. Merck agreed to its terms and this helped several African nations fight subsequent outbreaks and stop their spread with Merck’s licensed vaccine Ervebo. It is available only for the Zaire strain and does not act against the other strains.
Now with the outbreak of the more deadly Bundibugyo strain, Africa has been once again caught in its familiar cycle of delayed responses, lack of funds and no vaccines. Because outbreaks of Bundibugyo occur less frequently, there has been practically no research on it although the mortality rate can be as high as 50 per cent. who has finally recommended that Ervebo be included in a Phase 3 clinical trial, which could be a shot in the dark since it is not known if the vaccine is efficacious against the Bundibugyo disease.
The more promising news is that the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private organisation, is funding the evaluation of three vaccines for emergency trials. The first to kick off is the University of Oxford, which is getting $8.6 million to develop a vaccine based on the same technology that it used to develop the Oxford-AstraZeneca COVID-19 vaccine. The method deploys a modified version of a chimpanzee cold virus to deliver the vaccine to the body.
The largest funding is for Moderna, which will receive $50 million for tests and trials using the flexible MRNA technology that helped the company deliver quickly on its Moderna vaccines during the COVID-19 pandemic. The third is the International aids Vaccine Initiative (IAVI) that will get $3.2 million to develop a vaccine that introduces a harmless, naturally weakened animal virus to deliver genetic instructions to the body to decode.
Good as all this sounds, there is no denying that development of vaccines can take a long time. The hope is that the new technologies and processes that helped produce vaccines rapidly during COVID-19 will deliver relief to Africa as speedily. Africa must once again wait—in hope and fear.
