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One of the best ways to save humanity from a global pandemic in the future is by developing infectious disease vaccines now. But research has been sluggish, partly because no one knows how much producing such vaccines would cost.
That changed last week when researchers from the Coalition for Epidemic Preparedness Innovations (CEPI) published a study in Lancet estimating the cost of developing vaccines for diseases that have the potential to escalate into global humanitarian crises.
Preventing pandemics is extremely important work: In the next two decades, experts believe, there is a reasonable probability of a pandemic that kills more than 30 million people worldwide. Compare that to the 2014 Ebola outbreak, which killed more than 11,000 people across three countries — partially because we didn’t have a vaccine at the time.
But vaccines are expensive and hard to get off the ground. According to the Lancet, “In general, vaccine development from discovery to licensure can cost billions of dollars, can take over 10 years to complete, and has an average 94% chance of failure.” It’s a risky investment not many people want to make — until, of course, there’s a deadly outbreak like in 2014. By then, it’s often already too late.
Thanks to CEPI’s research, we now know the minimum cost of developing at least one vaccine for each of the 11 diseases experts have highlighted as pandemic risks: $2.8 billion to $3.7 billion. That sounds expensive, but so are pandemics: The 2003 SARS outbreak in East Asia cost $54 billion. Moreover, if early development prevents us from experiencing another Spanish flu, which killed nearly one of out of every 20 people in 1918, then it’s actually a bargain.
It’s hard to get funding for rare diseases until there’s an epidemic
The researchers chose the pathogens based on a list the World Health Organization developed after the 2014 Ebola outbreak of the 11 pathogens that it believed were the most likely to cause severe outbreaks in the near future. The list included:
- Crimean Congo hemorrhagic fever
- chikungunya
- Ebola
- Lassa fever
- Marburg
- Middle East respiratory syndrome coronavirus
- Nipah
- Rift Valley fever
- severe acute respiratory syndrome
- severe fever with thrombocytopenia syndrome
- Zika
That list changed a bit when it was updated this year, but all of the diseases remain of “considerable epidemic preparedness importance.”
These are mostly relatively rare diseases that tend to strike poorer countries. Chikungunya occurs mostly in Africa and Asia, and while Sudan had a recent outbreak, deaths from the disease aren’t common. Lassa fever only exists in West Africa, and there have been periodic outbreaks in Nigeria for the past few years, including the worst outbreak in March that killed more than 100 people.
Rift Valley Fever doesn’t even affect humans usually. It’s a disease that primarily affects animals in sub-Saharan Africa and major outbreaks have occurred in Kenya, Somalia, and Tanzania. It’s not common, but humans can get it from mosquito bites or from handling the tissue of infected animals, and when they do, it’s deadly.
Because these diseases cause relatively few deaths (for now) and primarily strike the poor, it’s hard to get funding for them, especially the billions required for vaccine development.
But that could change. Ebola was a relatively obscure tropical disease, until it wasn’t. We also saw what happened when Zika went from obscurity to international public health concern. We don’t know what the next Ebola will be, or how bad it will be. The best thing we can do now is find a vaccine before we do.
How likely is a global pandemic? Pretty likely.
The risks of a global pandemic may seem remote but it’s no lower now than it was 100 years ago, writes Klain. While advances in modern medicine, like antibiotics, protect us from disease, other realities of modern life don’t.
“Global transportation networks can bring a virus from a remote corner of the world to one of its most populous cities in less than 24 hours. The clustering of more people into cities — especially supercities in Asia — creates fertile grounds for such diseases to spread quickly,” says Klain. Climate change also means mosquitos are reaching new populations, and growing antibiotic resistance threatens to reverse public health gains.
We’ve seen the way pandemics can spiral out of control: as with the HIV/AIDS epidemic, SARS in 2002, H1N1 flu in 2009, MERS in 2012, and Ebola in 2014.
It wasn’t until Ebola started escalating — at one point projected to infect one million people — that vaccine research kicked into gear. The public and private sector poured resources into developing the vaccine and the typically lengthy approval process was fast-tracked.
And it worked. When an outbreak struck the Democratic Republic of Congo earlier this year, vaccines were deployed to the country and were instrumental in containing the outbreak.
But a lot of people had to die before there was enough pressure to develop the vaccine.
“Had a vaccine been available earlier in the Ebola epidemic, thousands of lives might have been saved,” said Dr. Jeremy Farrar, the director of the Wellcome Trust, a global charitable foundation that funds research on Ebola after the effective vaccine was developed in 2016. “We have to get ahead of the curve and make promising diagnostics, drugs, and vaccines for diseases we know could be a threat in the future.”
Knowing the cost of developing these vaccines could help prompt an important paradigm shift: preventing pandemics before they start.
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