With South America's Zika outbreak declared a health emergency, the Medical Research Council's Dr Jonathan Pearce explains how pharma, healthcare and governments can prepare for disease crises and tackle them quickly
The rapid spread of the Zika virus in Central and South America and its association with an increase in the number of babies born with small heads, or microcephaly, led the World Health Organization to declare an international public health emergency on 1 February. With this crisis following so soon after last year's Ebola outbreak, the public is more aware than ever of the difficulties in addressing sudden and unprecedented health situations.
Several organisations are working to ensure that governments and healthcare industries around the world are as prepared as they can be to tackle outbreaks quickly when they arise. In the UK, a key player is the Medical Research Council (MRC), which recently announced a £1 million Rapid Response initiative to fund immediate research into the Zika virus.
"There's a critical need to quickly collect robust evidence for decision-making on Zika," says Dr Jonathan Pearce, the MRC's head of infections and immunology. "Our Rapid Response initiative is seeking short-term proposals that will provide novel, critical and timely insights into the nature of the risks posed by Zika, as well as potential avenues for its management or prevention."
He highlights the most important areas of research to help tackle the current outbreak. "An important question initially is whether there really is an association with microcephaly. While Zika has been known since the middle of the last century, it has only given rise to very mild symptoms to date, so getting a good handle on whether that is a true association is critical."
More questions flow from this initial one, he says. "If it is indeed happening, why are we seeing it now? Was microcephaly masked before? Has the virus changed since its emergence in Africa or is there something about the population that's different? It could be genetic, or it could be environmental."
Diagnosis is critical, says Dr Pearce. "80 percent of those with Zika disease don't show any symptoms, which makes it very hard to track its progress. It's really important that we get better tools that enable us to identify those people that have it. We also need to start looking at whether there are therapeutic or vaccine approaches that might play a role. We all recognise that the development of a vaccine takes a lot of effort, a lot of time, and a lot of money to get it into and through clinical trials and regulatory approaches," he says.
The search for a vaccine
Pearce points to the lack of vaccines in late-stage development as a notable problem during the Ebola crisis, leading the MRC to support clinical trials for potential vaccines. One originated from the Jenner Institute in Oxford and was being taken forward by GSK, while a second came from the Public Health Agency of Canada and was developed by NewLink Genetics and Merck.
The MRC and other organisations are working to improve the speed of the development of emergency inoculations in the future, but Pearce. "We've committed £5 million towards the UK Vaccines R&D Network, an initiative that brings together experts from across academia and industry to develop a list of high-priority, emergent threats, with the goal of developing an arsenal of vaccines against them, so that we're in a better position than we were with Ebola."
This arsenal will be deployed against the "known unknowns", he says, but the MRC is also looking at what needs to be known in the event of an unknown threat. "What is the list of questions and what are the capabilities that we would need to be able to deploy in order to rapidly get on top of such situations. We're bringing together all the research funders to agree on a list of what those might look like."
One key question is, 'Are there existing vaccines targeting a similar type of virus?' he says. "Zika belongs to a family of viruses, including dengue, against which we have already developed vaccines. Companies involved in the development of vaccines against that family of viruses are actively evaluating whether they could switch their existing platform and capacity to address Zika."
Pearce stresses the importance of everyone involved being as open with their data as possible. "We want to work together to best effect rather than to duplicate effort," he says. "We would like the researchers we support to release their data as soon as it becomes available. There have been concerns in the past that people hold back data, perhaps because of what they might perceive as commercial or publication opportunities. Being open with the data after the fact is not as helpful as coming forward with it to help the whole community understand the developing challenge."
Although much of the MRC's work is in the academic space, Pearce is keen to emphasise the importance of its partnerships with the pharma industry in addressing emergent diseases.
"We recognise that a number of these diseases lack a commercial opportunity, but we also absolutely recognise the expertise and experience in the development and deployment of therapies and vaccines of our pharma partners. An industrial partner can really help an academic group understand what the downstream challenges are likely to be so they don't design in issues that will handicap the project as it moves further down the development path," he says.
"As such, we actively encourage and support work with industry across all of our funding schemes. In the Zika Rapid Response initiative we very much welcome applications if they were to come in with an industrial partner."
The MRC also has more permanent partnerships with industry that can help in outbreak situations. "One of our key roles is to give thought to the UK research environment's strategic and capability needs," says Pearce. "We've launched a couple of partnerships in the last few years, one with AstraZeneca to establish a centre for lead discovery in Cambridge that will provide academics with access to the company's molecule compound library. We have a similar relationship with UCB, utilising their antibody screening capabilities to rapidly take forward innovative target opportunities emergent out of academia.
"It's those kinds of capacity opportunities that can then be brought to bear in an outbreak rather than waiting for the problem to emerge and then having to come up with the solution," he says.
Although emergent diseases will, by their nature, always be unpredictable, there are clearly many steps that governments, healthcare and pharma can take to help ensure everyone in the system is as prepared as possible for an emergency.