13 November 2018 166

Public-private partnerships in the fight against global epidemics

​The 2014-2016 Ebola outbreak in West Africa was a wake-up call to improve the world's collective defense against the threat of infectious diseases.

Between the discovery of the Ebola virus disease (EVD) in 1976 and the beginning of the epidemic in 2014, Ebola outbreaks were sporadic and only affected a small number of people in isolated communities. The 2014-2016 outbreak however resulted in more than 11,000 deaths and took several billion dollars to contain.

Lessons learned were informative to ensure better preparedness for future epidemics:

  1. Investment is needed to build resilient communities and health systems,
  2. Systems, capacities and financing mechanisms need to be developed to enable a fast and effective response, and
  3. Incentives should be created for the development of medical products for diseases that primarily affect the poor and thus have little market appeal.
    Several candidate vaccines against Ebola were in the pipeline in 2014, but none of them were ready for rollout.

Today, an investigational vaccine (rVSV-ZEBOV) - under development by the pharmaceutical company Merck - is being used under expanded access (also known as compassionate use) in the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC).

This vaccine, currently not yet licensed, was also used in the previous Ebola outbreak in DRC in May-July earlier this year.
The deployment of the rVSV vaccine in DRC was the first time a vaccine could be used as an integral part of the response to an Ebola outbreak.

What made this possible?

In 2016, Gavi (a global Vaccine Alliance bringing together public and private sectors) committed an initial $5 million toward the procurement of Merck's vaccine once it would be commercially available. As part of this 'Advance Purchase Commitment' deal, Merck agreed to ensure that a stockpile of 300,000 doses of the investigational vaccine was continuously available and rapidly deployable in case there was an outbreak before the product was licensed. This deal, the first of its kind, was designed to incentivize the rapid development of the vaccine as well as guaranteeing investigational doses are available while licensure is being pursued.

Hence, during the Ebola outbreaks in DRC this year, vaccine supplies were readily available. The UN Children Fund, the World Health Organization (WHO), and Médecins Sans Frontières (MSF) supported vaccine deployment in the field, while WHO, Gavi, and others funded the operational costs such as cold chain equipment, critical supplies, and deployment of health workers. This collaborative effort illustrates the role of public-private partnerships in helping tackle global epidemics.

In 2017, the Coalition for Epidemic Preparedness Innovations (CEPI) was created to further strengthen the world's capacity to contain future epidemics. CEPI aims to stimulate, finance and coordinate the development of affordable vaccines to prevent or contain infectious disease epidemics such as Ebola at the earliest possible stage, when development is unlikely to occur through market incentives alone. The CEPI initiative highlights that the world cannot rely on ad-hoc partnerships and the goodwill of a handful of companies to contain future epidemics, but that a strong global alliance between public and private partners is needed to create a sustainable model for epidemic vaccine development. ​


Expertise available at CMAST:

In addition to Merck's vaccine, some other Ebola candidate vaccines are in the pipeline, such as the heterologous prime-boost vaccine regimen under development by Janssen Vaccines & Prevention B.V. The safety, tolerability and immunogenicity of this vaccine regimen are being evaluated in clinical trials, several of which are conducted in the framework of the EU Innovative Medicines Initiative (IMI) Ebola+ programme (for more information: check this documentary). CMAST delivers Funding & Project Management services to these IMI Ebola+ public-private partnerships. Please do not hesitate to get in touch if you want to know more about our expertise in this field!

Ellen Hubin, Project Manager