Tom Koch is adjunct professor of medical geography at the University of British Columbia. He is the author of Epidemics on the Ground (2011).
Two cheers for the Canadian Ebola vaccine. It is a stunning technical achievement. At the same time it highlights the limits of virology and modern science in addressing the evolving threat of new bacteria and viruses with potentially disastrous health consequences.
We want to think science will have a ready answer for whatever our ills, that in facing an epidemic a vaccine or treatment will be at hand. But the new vaccine was 15 years in the making and, even as the West African Ebola epidemic winds down naturally, it is still not ready for widespread licensing and distribution.
Developed by scientists at the federal National Microbiology Laboratory in Manitoba, it was licensed to a small Iowa biotechnology company, NewLink, for $205,000. Last November, NewLink licensed world rights to Merck & Co. for $50-million (U.S.) and royalties. In 2013, the federal Public Health Agency spent $887,000 (Canadian) for a German manufacturer to produce 1,500 vials of VSV-EBOV for human trials. NewLink appears to have done little to develop or promote the drug. So Canada sold the rights to what might be a "game changer" vaccine and paid the development costs required for human trials to prove its efficacy.
There are two issues. The first is the manner in which the boon of federal scientists was dissipated through the private licensing of a drug developed at the National Microbiology Laboratory. The second is the status of vaccines in a world of evolving bacterial and viral epidemics.
RVSV-ZEBOV is potentially a "game changer," as the BBC called it, if this Ebola strain is the only game in town. Alas, it is not. There are four distinct strains of Ebola, all hemorrhagic fevers in a viral family that includes the equally deadly Marburg virus. Even if this viral family were wholly conquered, there are a host of other infections out there, waiting. These include Middle East Respiratory Syndrome (MERS) and new forms of drug-resistant tuberculosis. Also there are a range of new and evolving bacterial diseases (think multidrug resistant tuberculosis) requiring new medications and, perhaps, vaccines. The sad fact is our microbial friends are evolving and we are not. Indeed, we're actively promoting their evolution and distribution.
Our microbial friends tend to be homebodies that live for generations in specific ecologies. Deforestation destroys those natural habitats, turning forests into farms and fields. To survive, bacteria and viruses evolve, migrating to burgeoning towns of densely populated, poor people. They travel as hitchhikers in the goods we sell. It has been this way since influenza evolved on poultry farms in China in 2500 B.C., spreading along old trade routes until it infected much of the then known world. Hippocrates described an outbreak in Greece around 500 B.C.
In the best of circumstances, one where an effective treatment or vaccine is available, it can take four to six months to manufacture and distribute sufficient quantities to protect an at-risk population. That is more than enough time for an epidemic to take hold. Where none is readily available it can take years to ramp up existing science until a new treatment or vaccine is developed. Virologists have been seeking an HIV/AIDS vaccine for 30 years.
The frustrating thing is we know what is needed if the worst effects of the evolutionary onslaught of new infectious diseases is to be addressed. These include, first, a well-funded, well-respected international agency capable of a first strike when new infections threaten. It took months before aggressive treatment with fluids and antibiotics were made available in West Africa. Containment protocols, if enacted early in a disease's trajectory, can halt or at least slow microbial progress.
To stop microbial incursions before they begin requires support for the development of international health infrastructures everywhere. The lack of even minimal health services in poor countries permits new epidemics to develop without attention. The poverty of peoples in the world's slums assures travelling microbes a fertile field for their evolution. In theory, the World Health Organization (WHO) is charged with this kind of global service, but prior to the 2015 epidemic it lost many of its most experienced infectious disease specialists as a result of budget cuts. And, too, its mandate for aggressive action is limited to a host government's acceptance. Non-governmental agencies (NGO), like Médecins sans Frontières and the Red Cross, try to take up the slack. But they are largely dependent on charity funding and volunteers. And so in the face of a serious disease event, NGOs are stretched beyond their limits.
One answer is to insist upon a budget sufficient to permit the WHO to fulfill its mandate and assure the broadest possible support for the aggressive address of disease events in their early stages. Another is a world-wide focus on the environmental conditions that promote bacterial and viral evolution, and steps to counteract them. This would mean a national commitment to international efforts at the United Nations, an organization. It seems federal disinterest – or uninterest – in both the global fight against viral disease and the work of its scientists explains its giveaway of this new federally developed vaccine. Rather than celebrating its discovery and sheep-herding its development, it was given away for a song. That's a failure on many counts, not the least financial.
It also underscores the focus on a view of the world that is more military than humanist. If we are willing to spend billions of dollars on "strike forces" attacking human terrorists, we should develop an at least equally focused and well-funded response to potential microbial attackers. The most serious terrorist threats are invisible, and inhuman. They're there, however, in the cities and fields of the world. By our failure to address health as an international necessity, we create opportunities for their evolution and migration. And along the way we miss opportunities for commercial benefits in the creations of the scientists Canada employs.