The outbreak of the Ebola virus in West Africa in 2014 set the world’s nerves on edge. At the height of the epidemic, as the numbers of dead seemed to be rising exponentially, fears rose that this virus could be the “big one”, the one that breaks loose of its quarantine and goes global. Thankfully that didn’t happen – although nearly 12,000 people lost their lives, the outbreak was largely contained in Liberia, Sierra Leona and Guinea. And now that Ebola has resurfaced in a secluded region in the Democratic Republic of Congo, claiming four lives and infecting several dozen, the world is jittery again. But is there really cause for concern?
The DRC is battling with its eight Ebola outbreak and there are no signs for far that the virus could spread out of control. In fact, what made the West notice the 2014 outbreak was that it appeared in densely populated regions of the continent, with strong trade and travel connections to Europe and the US. Indeed, despite being known since 1977, when a Belgian scientist identified the virus in the DRC, almost no research was directed towards it – that is, until Western countries started admitting Ebola patients in their hospitals. Now, a plethora of vaccines and treatments are in development, and the World Health Organization is ready to start trials in the affected Bas-Uélé region and nip the virus in the bud.
This new Ebola outbreak provides the first real-world scenario in which to test a vaccine developed by pharmaceutical giant Merck. Initially touted as a major breakthrough after early trials seemed to result in a 100 percent success rate, that claim has recently been thrown into question following a report by the US National Academy of Medicine. The panel of scientists tasked with peer reviewing the trial that had been conducted in Guinea disputed the methodology used, concluding that the vaccine’s effectiveness “could in reality be quite low”. Since the vaccine has yet to receive the World Health Organization’s regulatory approval, the findings are significant.
Nevertheless, the Global Alliance for Vaccine and Immunization, known as Gavi, announced last week that it was making 300,000 emergency doses of Merck’s vaccine available in case of a large-scale outbreak in DRC. And it’s not the only one in the pipeline. Apart from Merck, GlaxoSmithKline, Johnson & Johnson and the Russian government have also developed vaccines that have shown promise during animal testing and are now progressing to human trials (GSK and Johnson & Johnson) or awaiting market approval (in Russia’s case)
Welcome as this rush to find a vaccine for Ebola is, it does underline a depressing truth: for Big Pharma, it only became profitable to do so once the virus began to threaten rich Western countries. GlaxoSmithKline may dispute this and point to an altruistic desire to do good behind their decision to develop a loss-making vaccine against Ebola. But overall, the tendency for pharma companies to favor developing expensive drugs for lifestyle diseases that predominantly affect rich Western countries is undeniable.
According to James Surowiecki writing in The New Yorker a study by the WHO found that “of the more than fifteen hundred drugs that came to market between 1975 and 2004 just ten were targeted [tropical] maladies” like Dengue fever or Chagas disease which kill more than half a million people a year. While Surowiecki recommends incentivizing drug makers to focus more on these forgotten diseases by offering prizes for breakthroughs, others are looking to see whether people living in regions most affected by these diseases can be empowered through training and investment to lead the charge against them.
A report by McKinsey showed that Africa’s pharma industry grew from just $4.7 billion in 2003 to over $20 billion in 2013 and is estimated that by 2020 it will be worth somewhere between $40 and $65 billion. By fostering research and development of the drugs needed to combating diseases closer to where they are needed most, patients may stand a better chance of benefitting. This will require sustained investment in both human capital in the form of researchers, specialists, practitioners and nurses as well as the physical infrastructure required to get medicines to patients.
And progress is slowly being made. For example, Rusal, an aluminum company, invested $10 million in Guinea to open a microbiological research center trial, which helped trial an Ebola vaccine. More than 300 pharmaceutical companies have manufacturing sites in Africa, many of which rely on local companies and employ local researchers. Initiatives like H3Africa, which funds the work of African scientists researching the genomic and environmental causes of health issues affecting the continent, are leading the way in providing local responses to local issues. Mobile phone technology has allowed Africans overcome poor travel infrastructure by enabling them to access services more quickly online, a model which is now being adopted by the pharmaceutical industry. In Sudan, for example, some 27,000 health workers use a mobile system called mTrac to report on medicine stocks around the country. In Kenya, pharmacists send surveys to patients by text message and use the results to draw a map of what medicines are needed where and then distribute them accordingly.
While DRC’s new Ebola outbreak may be hogging the limelight for now, we should not lose track of the fact that if the West is really serious about improving Sub-Saharan Africa’s access to healthcare, building on the ground infrastructure should be paramount. Otherwise, as epidemics keep happening and people keep dying, that “big one” will only be a matter of when not if.
Photo: A child waits outside a medical clinic as part of Western Accord 2012 in Thies, Senegal, June 10, 2012. Photo by Sarah Mattison.