It was once the domain of great adventurers, setting out on a boat or perhaps a camel that would take them into the unknown, discovering new places and continents, to perhaps never return. But travel today is as simple as a short plane trip and you are landing in a different country, culture and environment. This also means that the potential for deadly infectious diseases (pathogens) to move quickly around the planet has increased, resulting in the likelihood of infectious disease outbreaks.
The need to respond and mitigate this risk early has led to the formation of the Coalition for Epidemic Preparedness Innovations (CEPI) who are developing vaccines to known and emerging pathogens to address epidemic threats anywhere in the world.
CEPI formed as a response to the outbreak of the Ebola Virus Disease (EVD) in March 2014 in Guinea, West Africa. While the vast majority of cases were in Africa the disease did find its way to first world countries including the US.
‘Transmission of Ebola requires close and direct physical contact with infected bodily fluids. Airborne diseases like SARS and influenza can spread very quickly and easily through air droplets from coughs, sneezes and even talking,’ said CEPI consultant Nancy Lee.
‘CEPI brings together governments, philanthropy, researchers, bio-tech, manufacturers (pharmaceutical companies), front line responders from groups like Médecins Sans Frontières, WHO and UNICEF as well as regulators including the FDA in the US, EMA in Europe, and equivalent bodies in other countries like India. This facilitates an ‘end to end’ approach to develop vaccines to stop infectious disease outbreaks faster.’
While it has had its genesis in the 2014/15 Ebola outbreak CEPI was formed to respond to emerging and known pathogens including Ebola, MERS, Lassa and Nipah virus.
CEPI’s two pronged approach is to develop vaccines ‘just in time’ and ‘just in case’. ‘Just in time’ means CEPI aims to quickly coordinate a response to emerging infectious diseases, known as ‘disease X’, that could otherwise turn into an epidemic. The challenge is that developing a vaccine for these types of diseases is not commercially viable for pharmaceutical companies, and usually takes years. Yet CEPI realises that it is essential these vaccines are developed to avoid loss of lives and livelihoods.
Australia’s researchers are playing a leading role to develop vaccines ‘just in time’. CEPI has just awarded The University of Queensland (UQ) $14.7m to develop technology that will revolutionise how we respond to new outbreaks.
‘This involves developing a vaccine pipeline using new technology, so that once you identify a pathogen you can quickly respond,’ Ms Lee explained.
Professor Paul Young and Dr Keith Chappell, co-leads on this research partnership and both of the UQ School of Chemistry and Molecular Biosciences, said the new technology – known as a ‘molecular clamp’ – is designed to develop a rapid response to new epidemics and fundamentally change how we protect ourselves from common viruses.
‘With pandemic flu, Ebola and SARS we have all seen how quickly a virus can emerge and infect people around the globe and while we don’t know where the next virus and epidemic may occur, we now have technology ready to allow us to develop a vaccine and respond quickly,’ said Professor Young.
‘We are able to take relevant information from the virus genome that has been sequenced in the field and make a synthetic copy of a component of the virus in the lab that incorporates our “clamp” to produce a vaccine in record time,’ he said.
This means if there is a new outbreak of a deadly pathogen anywhere in the world, this pipeline could be used to make vaccines within weeks instead of years to potentially halt the spread and reducing untold suffering.
The risk and public good
In 1994 there was an outbreak of the Hendra virus in Brisbane. Prominent Queensland horse trainer, Vic Rail, his stable hand and most of his horses fell ill to a sudden and mysterious illness. Within several days, Mr Rail and 14 horses were dead. As a result an antibody was developed that can be administered post exposure.
In 1998, an outbreak of a new disease, now called Nipah emerged in Malaysia, resulting in the death of more than 100 people and thousands of pigs being infected which had to be killed. Nipah is related to Hendra virus. In May 2018 the Australian government supplied the antibody for Hendra to Indian health authorities after an outbreak of the Nipah virus in Kerala, in hope that it would help control the outbreak.
Similarly, CEPI’s objective is to ensure a rapid coordinated response globally to deadly disease outbreaks.
Ms Lee pointed out that the ‘reality is that one country or organisation can’t do the prevention work alone. CEPI brings together academic and private research, NGOs and governments all on the understanding they are contributing their research and development, know-how and technology into one platform that is shared globally for public good.’
‘A cornerstone of CEPI’s mission is its equitable access policy which means appropriate vaccines supported by CEPI are available to those who need them, when they need them and where they need them, regardless of ability to pay.
‘It is about having a global platform to optimise and co-ordinate international resources and expertise so that you are not developing a new platform every time you need to develop a new vaccine,’ she explained.
‘At the time of the Ebola outbreak in 2014 the pharmaceutical industry was called on to help develop therapeutics and vaccines to treat patients and protect vulnerable populations and they did, they stepped up to the plate.’
The pharmaceutical company Merck, with support of the Wellcome Trust, government of Norway and others took a potential vaccine and developed it through clinical trials in Guinea to a successful vaccine that is currently being used to control the Ebola outbreak in the Democratic Republic of Congo (DRC).
Australian government on board
CEPI is aiming to raise US$1billion by 2020 and with the backing of the Wellcome Trust and the Gates Foundation, along with various governments, they have currently raised over US$600m, yet in some ways they are a victim of their own success.
‘At first the response to CEPI was good, however, now the risk of Ebola has subsided with the development of a vaccine and there is less interest. But of the ten priority pathogens highlighted on the WHO list there were outbreaks of six in 2018 including Ebola, MERS and Nipah,’ said Ms Lee.
‘Part of the challenge is that CEPI and the international community have become better at responding to and curbing outbreaks so that they don’t become a huge humanitarian crisis. This is compounded by the fact that often outbreaks happen in places where there is little media coverage. With the immediate risk removed governments aren’t seeing the benefits of prevention or the incentive to fund preventive measures.’
But outbreaks can occur anywhere, at any time and CEPI is like an insurance policy against this risk. According to the Institute of Disease Modelling, nearly 33 million people would likely die in six months if an airborne pathogen emerged unchecked from South East Asia.
Recognising the importance of health security for the region, the Australian government came on board on Wednesday with the announcement of a further AU$4.5 million to support CEPI’s work with their investment in CEPI now at $6.5 million.
‘Australia is committed to our region’s health security and recognises the importance of supporting world-leading medical research. We are pleased to support CEPI and its important work preparing the world to fight emerging infectious diseases,’ Marise Payne, federal minister of the Department of Foreign Affairs and Trade said.
This three year contribution gives Australia a seat at the table with governments such as Norway, Japan and Germany, along with philanthropy groups supporting CEPI.