February
2015
EBOLANOMICS:
THE SEARCH FOR A VACCINE
After
years of ignoring the disease, pharmaceutical companies are racing
to produce an effective vaccine for Ebola, using plenty of public
money. Now questions are being raised about ethics and accountability.
By
Elizabeth Blunt
LONDON (IRIN) -- When Ebola hit West Africa last year, it was a disease
with no sign of a vaccine or cure. To those affected that may have
been an indication that the wider world didn't care about them or
the diseases that affected them, but in truth there has simply been
no incentive for anyone to develop these therapies. Yet now pharmaceutical
companies are racing to produce an effective vaccine, and on 23 January
the British company GlaxoSmithKline shipped the first 300 doses of
its candidate to Liberia to start phase II trials.
At an event in the UK Houses of Parliament to discuss
the economics of developing such vaccines, Jon Pender, a vice president
of GSK, said he had been surprised, in the circumstances, that companies
had any possible candidates at all on their shelves which could be
developed and tested. He challenged suggestions that this was just
because Ebola epidemics happened in poor countries where there was
little scope for profit.
A
recent priority
“That isn't the reason why we don't have vaccines for
Ebola. The reason we don't have a vaccine is because it wasn't a priority
for anyone, and there are understandable reasons for that.... The
number of people affected each year was very small and the overall
disease burden, in comparison to other disease like malaria or HIV,
is tiny. The fact is that in the forty years that we have known about
Ebola, including the present outbreak, there have been about 24,000
known cases. There are that many cases of malaria every hour.”
Now, clearly, it has become a priority. So if it isn't
just about money, how do you persuade the pharmaceutical industry
to work on a normally obscure disease like Ebola? Adrian Thomas is
a vice-president at Janssen Pharmaceutical Companies, which is also
now working to get an Ebola vaccine to market. He says, “The first
question is, what is the strength of the science? The second thing
is to what extent there is a reward for innovation or a willingness
to risk-share. And the third is, will we actually reach people? I
think we have to understand what are the clear priorities for global
health...
“Some companies do it for the reputation, others do it
for the science or for alternative incentives. Other companies do
it for direct financial reward, and I think you have to understand
what are the different incentives that are necessary across that spectrum.”
Profit may not be everything, but the companies are not
setting out to lose money. In this case they have been incentivized
with public money – American, Canadian or European – to pay development
costs, and assurances from the global vaccine alliance GAVI that there
will be a market for any successful vaccine they produce, with up
to $300 million available to pay for it.
Blank cheques
Médecins Sans Frontières (MSF) has been campaigning on
the high and rising price of vaccines and the lack of transparency
in the pharmaceutical industry, and earlier this month it published
a new edition of its campaign
document, the Right Shot.
Rohit Malpani is director of policy and analysis for MSF's
Vaccine Access Campaign. He told IRIN that despite substantial sums
of public money poured into the development of an Ebola vaccine, very
little was being demanded of the companies in return. “These vaccines
are being developed with full public funding,” he says, “compensating
the manufacturers for whatever investments they have to make, and
for the cost of the clinical trials. Yet at this stage it is very
non-transparent what the costs of development are, and not clear what
guarantees there are about the outcomes and how they will ensure affordability.
Governments are just writing them blank cheques.”
MSF welcomes the fact that GAVI has earmarked money to
buy any successful vaccine, since that sends a signal to the manufacturers
that there is a market, but thinks that GAVI should also be more demanding.
Malpani says, “We are still not sure at what price it will be sold
to GAVI. MSF would prefer that it is sold at or near cost. And if
any cost is not covered by public funding, it's better for that to
be compensated directly, rather than through higher prices for the
vaccine. The idea would be to de-link the cost of development from
the final price.”
GAVI negotiates lower prices for the vaccines it buys
for developing countries, but it is likely that the US or European
governments will also want to stockpile some of these vaccines for
their own use, and they are likely to pay more. Malpani says MSF accepts
that, but remarks that “if these countries have already paid for the
development, it does seem inappropriate that they should pay all over
again through high prices.”
MSF is certainly not against the development of Ebola
vaccines, and intends to take part in some of the phase II clinical
trials, probably at its facilities in Guinea. Julien Potet, their
policy advisor on vaccines, says that planning the trial has been
"a bit of a moving target".
“Cases are declining a lot, and to demonstrate a protective
effect is more difficult in a setting where there are limited or no
cases. But we hope to vaccinate two groups - health workers because
they are particularly exposed to the virus, and also to ring-vaccinate
people who have been in contact or have a case in their neighbourhood.
This is the plan today, but of course it could change.”
Panic has led to a lot of short cuts
Others working on the response to the epidemic have more
reservations about the vaccine programme. Mukesh Kapila, professor
of global health at Manchester University, has just returned from
West Africa. He found the affected countries alive with all kinds
of stories and rumours, and he worries that time isn't being taken
to prepare people for the idea of the vaccine trials. “I am afraid
they are going to think, 'Oh, all these companies are coming to test
some half-baked vaccines on black people here in Africa'. And the
impact might be to put off people at risk from coming to get help,
because they think, 'Oh God, I'm going to be vaccinated'. When we
do these trials for antibody response, it's important that we do them
on white people as well as black people, partly because it is important
scientifically, but also because it's important for public perception.”
More widely, Kapila thinks the rush for a vaccine may
be counter-productive. “The panic associated with this epidemic has
led to a lot of short cuts, with people rushing through the early
phases so that human trials can start quickly. Everything may be fine,
but we still don't know how effective the vaccines are going to be.
Are they going to give 90% protection? 80%? Or only 50%? That wouldn't
be enough."
Kapila told IRIN: “People are expecting a vaccine to be
the solution to this epidemic and it can't be. A vaccine is no substitute
for the laborious public health measures of identifying index cases,
tracing and isolating contacts. By looking to a Promised Land where
a vaccine is going to come and solve all our problems, we risk undermining
these more important public health efforts. A huge amount of public
money is going into vaccines. Once we have started we might as well
finish, but I am sceptical whether it is a useful effort, on either
public health or social and economic grounds.” – Third World
Network Features.
-ends-
The above article is reproduced from IRIN, an independent non-profit
news and information service, 27 January 2015.
When
reproducing this feature, please credit Third World Network Features
and (if applicable) the cooperating magazine or agency involved in
the article, and give the byline. Please send us cuttings. And
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