The economic impact of the catastrophic Ebola outbreak in Guinea, Liberia and Sierra Leone is now estimated to have reached more than £30 billion, drawing parallels with the SARS outbreak in 2003 in South East Asia.
The numbers infected and killed in the latest outbreak have already surpassed those affected in all previous Ebola outbreaks combined. But its true impact goes beyond morbidity and mortality numbers, says Professor Peter Piot, who co-discovered Ebola virus disease in Zaire in 1976. Indeed, much of this £30 billion figure can be attributed to so-called “aversion behaviour” – the widespread fear and precaution that has caused healthcare systems, workplaces, infrastructure and borders to collapse – with a devastating impact on economic productivity.
After the first appearance of Ebola in an urban setting, an epidemic of fear made its way to more developed nations as a global outbreak loomed and the humanitarian effects of the deadly virus on caregivers, family and health workers became evident. But Professor Melissa Leach of the Institute of Development Studies also questions the “politics of power and privilege” that saw money and resources pour in to tackle Ebola only when the risk of intercontinental spread became heightened.
Yet despite the current lack of treatment or preventive measures, Professor David Heymann of the London School of Hygiene and Tropical Medicine says early rehydration and electrolyte replacement can reduce mortality from 50%-90% to less than 30%. Nations affected by the outbreak can make significant progress in this area, as well as in administering experimental treatments such as convalescent blood plasma from Ebola patients.
The utopia is, of course, an effective vaccine for use in health workers, community workers and in ring vaccination programmes. There are currently three main candidate vaccines being developed by various collaborations: GlaxoSmithKline/US National Institutes of Health, Merck/NewLink and a J&J-led consortium. Phases II and III for these vaccines are planned to run concurrently to accelerate development but Dr Ripley Ballou, head of Ebola R&D at GlaxoSmithKline, believes even with the compressed timeline for approval it will be challenging to complete in this current outbreak.
The absence of therapeutic drugs or preventive vaccines for Ebola could be considered a market failure, but the strong motivating factors for governments to collaborate with academia, regulators and the pharmaceutical industry to drive forward R&D in this critical area is resulting in positive progess.
Already, development has accelerated through partnerships and funding. The UK’s Department for International Development has put in £1.34 million to establish a joint research fund with the Wellcome Trust, while the US Government has handed out more than $40 million to accelerate development of GSK’s and NewLink’s vaccines, and a further $24.9 million for Mapp Biopharmaceuticals’ ZMapp. Likewise, Europe’s Innovative Medicines Initiative is focusing on public-private research partnerships.
But it is a race against the clock as the number of cases in West Africa continue to fall, says Heymann, and the risk now is that vaccine protocols may be shelved until the next outbreak.
Hilary Thomas is chief medical advisor at KPMG
EFPIA and the Innovative Medicines Initiative have forged a new collaborative consortium as part of the Ebola+ programme, which will see them start off with a budget of €215 million and a programme of eight new projects, including development of a new vaccine, its production and distribution, and new diagnostics that can be used at the point of care. The eight projects will involve more than 40 global partners, mainly from Europe, Africa and North America. Full details on the projects are available at www.imi.europa.eu.
What_s in the pipeline
GlaxoSmithKline/US National Institutes of Health Chimpanzee common cold virus carrying a single Ebola protein in Phase III trials in Liberia
Merck/Public Health Agency of Canada
Livestock virus carrying a single Ebola gene in Phase II/III trials in Liberia
Johnson and Johnson/Bavarian Nordic
One jab followed by a booster jab in Phase I trials in Africa
Glycoprotein recombinant nanoparticle vaccine adjuvanted with Matrix M (Ebola GP) – two shots three weeks apart – in Phase I on healthy volunteers in Australia
Favipiravir by Fujifilm/Toyama
Antiviral drug approved in Japan for treatment of the influenza virus. Trials in Gueckedou, Guinea led by the French National Institute of Health and Medical Research (Inserm)
Brincidofovir by Chimerix
Antiviral drug that was tested in Liberia but was terminated as Ebola cases fell
ZMapp by Mapp Biopharmaceuticals
Antibody-based therapy of three monoclonal antibodies. Animal studies but has been used experimentally to treat Ebola patients in the current outbreak
Antibodies from the blood of survivors
Trials in Guinea, led by the Antwerp Institute of Tropical Medicine
This article was published in the March issue of PharmaTimes Magazine. You can read the full issue here.