Category Archives: Ebola

Ebola – the search for a vaccine

LONDON, 27 January 2015 – 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.

“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.

Médecins Sans Frontières 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 have 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.”

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 percent protection? 80 percent? Or only 50 percent? 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.”

[Courtesy of IRIN]

Liberia: Ebola Hits Family – Personal Stories

International news reports about Liberia leave the impression of overwhelming irrationality in response to the Ebola crisis. It’s true that fear has provoked unfortunate incidents. But many Liberians are working hard and courageously – despite the lack of an international response that would supply the equipment and medical help to stem the virus.

Ebola hit close to home – hard – this month. Two members of my church – one a nun and the other a social worker who had been under 21-day quarantine and observation – both died.

My cousin Enid, an emergency nurse with the health ministry, was under surveillance as well, after coming into contact with an Ebola patient. She was assigned to Kakata, a densely populated trading town in Margibi County, where several health workers had already died and health facilities didn’t have enough personal protective supplies. Our family was worried about her.

Now, she, too, has died. On her Facebook page a few weeks ago, she posted, “Ebola has hit Margibi again. More health workers are being affected this round 2 and some are even dying. Oh God have mercy.” Our family and friends will remember that she caught the virus trying to save others. Rest In Peace, Enid.

But personal losses aren’t stopping Liberians from trying to help ourselves and each other. Whatever you hear about the situation, you should know that people may be frightened, but most of us are working hard to stop the virus.

Ebola has become a household word. When the first case was reported in the northern Lofa area in late March, the chief medical officer, Dr. Bernice Dahn, warned that “the disease is reported to be spreading along the border” Liberia shares with Guinea and Sierra Leone.

Almost every Liberian citizen now knows what Ebola is. Many believe that the virus is real and are taking preventive measures, while others are in denial. But these people who are denying the existence of the Ebola virus in the country still follow the preventive measures, which baffles me.

“I don’t understand some Liberians”, said one of my friends, Derek Berlic. When I asked him why, he said, “Some people go around saying that the virus isn’t real, but yet still they join us and wash their hands and use sanitizers as frequently as those of us that believe that the virus is real.” He said it pleases him when he sees these individuals taking preventive measures, because it signals that somewhere in these people minds, they believe the virus is real, even if they don’t want to admit it.

Most churches have joined the fight against Ebola by carrying on awareness campaigns, talking about it during sermons and placing buckets of water at entrances of the church buildings for members to wash their hands before entering for service. Both Christian and Muslim religious leaders have called on all Liberians to pray for the country – and, at the same time, to take their own preventive measures.

Supermarkets, shops and other business centers are following suit. The three mobile phone companies in Liberia have been using SMS to sensitive their subscribers by sending daily text messages about the virus. Across cities and towns, Liberians have organized themselves in various communities and are promoting awareness.

It seems that almost every Liberian has now become his or her ‘brother’s keeper’ by carrying on sensitization in taxis, clubs, and market places – wherever they find themselves. On Facebook, many Liberians have made their profile pictures Ebola related and their statuses feature awareness messages on a daily basis. Liberian groups on Facebook discuss the situation.

Liberians in the diaspora have organized themselves into mini-groups to send aid, such as gloves and other personal protective equipment, back home to fight this deadly disease. The Liberian ambassador in Washington DC, Jeremiah Sulunteh, announced that the embassy had established an account for those who want to donate.

The alarmingly high death rate from the Ebola virus among health workers has left citizens wondering how they will get medical care for many common illnesses, which can be deadly also, such as malaria. Bodies of suspected Ebola victims being left in the streets or in houses adds to the anxiety.

In this situation, it’s hard to prevent suspicion and misinformation. There were stories of some individuals going around putting dangerous chemicals such as formaldehyde in wells in various communities. The result is that Liberians had to worry about poisonous chemicals being put into water sources as well as about the Ebola virus; but Police Director Col. Chris Massaqoui has since denounced the rumor. He said the police found no evidence that the stories were true.

The president of Liberia, Madam Ellen Johnson Sirleaf, has addressed the nation multiple times, including announcing a three-month state of emergency. She said, “Under the State of Emergency, the Government will institute extraordinary measures, including, if need be, the suspension of certain rights and privileges.”

The government has passed a regulation for only three persons to sit in the back of a taxi to avoid close contact, but even at that, one can’t possibly avoid touching or rubbing against other passengers. On a daily basis, securing transport is a rush-and-fighting thing, which involves considerable contact with other people who are also trying to get a taxi or bus. In my case, the trip to work usually takes two different commercial vehicles. So movement from place to place has become worrisome. Still, people have no choice but to do it.

And there are positive things every Liberian can do. So this is how I spent my weekend. With the organization Girls As Partners, I managed to reach out to ten different churches in the Gardnersville area of Monrovia, giving them buckets, chlorine and soap so their members could adhere to one of the Ebola preventive measures – washing hands. We also gave out leaflets containing facts about Ebola and its prevention.

We’re in the rainy season now, and we had to walk through small rivers to get to some churches, but it was really fun reaching out to others. Would you believe someone was brave enough to ask me whether I had a political motive for doing this? Nevertheless, I say let’s all be our brothers’ and sisters’ keepers and kick Ebola out of Liberia!

[Courtesy AllAfrica News]