Why the New Ebola Vaccine Is a Minor Miracle

Hint: It's not because of science.
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Nurse in Special Clinical Studies Unit. (Photo: NIAID/Flickr)

Nurse in Special Clinical Studies Unit. (Photo: NIAID/Flickr)

If you still have yet to shake the last tendrils of paranoia over last year's historic Ebola outbreak, you're in luck: There's a new vaccine on the market, and it's apparently very effective.

According to research published in the Lancet last week, the experimental rVSV-ZEBOV vaccine—originally developed by Merck, involving 4,000 subjects from Guinea's Ebola outbreak—resulted in an unprecedented 100-percent success rate. According to Nature, the Guinea trial tested "a ring vaccination design," a strategy "borrowed from successful smallpox eradication efforts in the 1970s," which focuses on vaccinating the immediate family and friends of a patient after they contract the deadly disease, in an effort to halt the rapid transmission of the virus throughout communities. The Los Angeles Times recently reported that the vaccine shows promise among monkeys, with a single dose protecting macaques from infection within one week. Trials will continue to determine the efficacy of the vaccine in the wider population in Guinea, as well as neighboring Gabon, which has dealt with the virus for the better part of two decades.

This is fantastic news—but not just for the discovery itself. The trials were conducted at an "unprecedented rate" in response to the global outbreak that's killed more than 11,000 people, according to the World Health Organization. "Scientists, doctors, donors and drug companies collaborated to race the vaccine through a process that usually takes more than a decade in just 12 months," the Guardian reports. "In another precedent-breaker, the trial was sponsored by the World Health Organisation because 'nobody wanted to step into this role so we took the risk,'" as WHO assistant director-general Dr. Marie-Paule Kieny told the paper. Considering that WHO chief Dr. Margaret Chan declared in April that the crisis "shook the organization to its core," and experts have pilloried the agency for its "slow" response to the emerging epidemic, the development of a potential vaccine is one hell of a turnaround.

Overall vaccines development by pharmaceutical companies has been on the decline for the last 50 years.

The lightning-fast development of a viable Ebola vaccine speaks to a larger problem that's plagued the public health world for years: Often, vaccine development can remain hamstrung by economic incentives and institutional obsolescence. Despite the fact that pharmaceutical companies like GlaxoSmithKline, Johnson & Johnson, and Mapp Biopharmaceuticals (the company behind the widely publicized Ebola treatment, ZMapp) stepped up efforts to produce vaccines in the wake of last year's global outbreak, overall vaccines development by pharmaceutical companies has been on the decline for the last 50 years. Writing in Health Affairs, pediatrician and vaccine expert Paul Offit observed that the high-profit margins of frequent-use drugs, the decline of vaccine-specific companies at the hands of mergers or acquisitions, and a glut of new regulations managing food and drug safety have conspired to make vaccine production more expensive and, in turn, less profitable. It doesn't help that, on the global level, the highest demand is centered in developing nations that simply can't afford the vaccines. "Pharmaceutical companies are businesses, not public health agencies," Offit sniffed. "They are not obligated to make vaccines."

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It’s easy to pin the blame on those dastardly drug companies, as some frustrated officials did in 2014. "A profit-driven industry does not invest in products for markets that cannot pay," Chan declared while chastising the drug industry in a regional conference in Benin last November. "[The] WHO has been trying to make this issue visible for ages. Now people can see for themselves." And besides, during the height of America's Ebolamania last October, National Institutes of Health director Francis Collins said that a "10-year slide in research support" and budget cuts wrought by the 2013 budget sequestration had crippled public health agencies' efforts to rush vaccines through clinical trials, despite ongoing research by the NIH into Ebola vaccines since 2001.

This isn't entirely true. NIH funding for Ebola has remained steady since 2010, despite congressional bickering, revealing Collins' off-the-cuff defense as little more than a nervous reaction to a threat to his agency's budget. And as Scientific American noted last July, a significant number of vaccines, funded largely by grants from the United States government, were nearing human trials when Ebola began to rear its head in West Africa. In reality, public health officials are just as vulnerable to economic incentives as the private sector pharmaceutical companies they chastise. A 2010 Royal Society examination of global vaccine development found that, paradoxically, it's highly improved domestic public health measures that actually hurt vaccine funding: By reducing the prevalence of exotic infectious diseases, the governments of advanced nations simply invest less in infectious disease control, leaving the bulk of research to resource-poor developing nations. Countries like the U.S. become, strangely enough, victims of their own public health successes.

The Ebola outbreak caught the world's most powerful public health groups with their pants down.

But even when an exotic illness arrives on U.S. shores and the private and public sector incentives are correctly aligned, development ends up mired in a miasma of bureaucratic red tap. The Food and Drug Administration's drug-approval process can take 12 years on average, with more than half that time spent on human trials to examine a drug's safety and effectiveness, as well as more than two years of FDA review. As Vox notes, those years of human testing only normally encompass five out of 1,000 possible compounds, with one finally going to market. And according to the National Institute for Allergy and Infectious Disease, the handful of government-funded vaccines development by the NIH and GlaxoSmithKline have only reached the earliest set of human trials. In March 2015, the Consortium of Universities for Global Health concluded that global vaccine development wasn't simply a matter of technology, but also a lack of  "advanced development and support of public-private partnerships," and "more efficient regulatory pathway." The Ebola outbreak, for all intents and purposes, caught the world's most powerful public health groups with their pants down.

Luckily, global health organizations are getting the message. Drug companies and health officials met in late 2014 to figure out exactly how to raise the barriers of approval without jeopardizing patient safety in a race to head off the spread of the disease. Among the solutions proposed by researchers and global public health officials in the past year: a multi-billion dollar task force designed to fast-track research and development in the face outbreaks; better communication and coordination between various national and international health agencies typically hamstrung by regulatory barriers; and the development of a brand new WHO agency, the Center for Emergency Preparedness and Response, designed to spearhead the global response to future pandemics. Outbreaks are exacerbated by a discontinuity of political and organizational interests: “Ebola spun out of control because of a lack of political leadership, will and accountability," Doctors Without Borders president Joanne Liu told health officials in May, "not because of insufficient funding, early-warning systems, coordination or medical technologies."

That the WHO was able to sponsor, facilitate, and expedite an effective Ebola vaccine isn't just a matter of scientific serendipity, but a minor miracle of public and private sector collaboration. The crisis atmosphere of Ebola media coverage played a dual role, allowing researchers to conduct trials in the middle of a real-world epidemic and inducing private and public actors to align their interests. But it would be a mistake to chalk this massive blow against Ebola to scientific brilliance: If anything, it’s a reminder of just how inefficient modern public health institutions are at addressing major crises.

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