Lessons From The Pandemic Frontline

This guest blog post is by Jeremy Farrar, the Director of the Wellcome Trust and TEDMED 2016 Speaker. You can watch his TEDMED talk here.

Working through an epidemic of an untreatable disease is the most frightening thing I’ve ever experienced. As a doctor, there is no worse feeling than telling a patient you have no treatment, but this was exactly the degree of helplessness felt during SARS and in West Africa during the Ebola epidemic.

Thankfully, with trials now confirming the 100 per cent efficacy of the rVSV Ebola vaccine, such fears surrounding the disease are beginning to subside. We should now be able to contain Ebola – at least if we can get the vaccine to those that need it. But these positive results shouldn’t stop us from taking stock and questioning what needs to be done to prepare us for the next emerging infectious disease, whatever it may be.

The Ebola vaccine trials were of course a remarkable success, and not just because of the numbers. They showed that, by working collaboratively across international borders and sectors, we can develop and test vaccines rapidly. The global coalition that worked on the vaccine achieved in a year what would normally take decades and, uniquely, developed a vaccine within an epidemic. That is something that has never been accomplished before, and a testament to what can be done when we collaborate.

So when Ebola next reappears – and it will – we will be ready. But we must remember that we weren’t ready last time. Because we were reactive, we were far too slow, too late. Over 11,000 people died in West Africa, and the economic cost to the countries affected runs into billions of dollars.

It’s important too to remember that the partnership that delivered the vaccine – involving pharma, philanthropic organisations, governments, regulators and NGOs – was an ad-hoc one, hugely reliant on the goodwill of those involved. This way of working, while inspiring, is neither reliable nor sustainable in the long term.

The partnership’s success was also based on having Ebola vaccine candidates ready to be tried in humans at the beginning of the outbreak. For MERS, Zika and many others, there are not yet such candidates.

We must start developing tools to fight these diseases now, and set up the permanent partnerships and systems necessary to do so. Progress is being made. The WHO has drawn up a blueprint for R&D to prevent epidemics and a new global public-private coalition – CEPI – has been established to advance the development of new vaccines for epidemic diseases so that we have candidates ready to test when an outbreak occurs.

But preparedness doesn’t end with the development of vaccines. While in 2016 many were watching the Zika emergency unfold, in central Africa another great but under-reported crisis was emerging: a large outbreak of yellow fever. It began months before the alarm was raised, gathering momentum in Angola and the DRC while diagnostic tests on its first victims were still being run in foreign labs, as there were no suitable facilities close by.

Once the magnitude of the outbreak became clear, it was quickly understood that the world’s emergency stockpile of the yellow fever vaccine would be insufficient – and likewise its capacity to manufacture new doses in time. Ultimately the outbreak was contained: other countries donated their vaccine stockpiles, doses were diluted to spread coverage, and a huge immunisation campaign was implemented – all thanks to a well-coordinated collaboration between the WHO, governments, health authorities, NGOs and volunteers. But again we were lucky.

If the stories of these two outbreaks seem largely doom and gloom, they shouldn’t. They show us what amazing things we can do when we work together, against what at times may seem like long odds. And they show us that, despite what the cynics and scaremongers say, we do have the ability to prepare for and fight against emerging infectious diseases. If we don’t yet have the tools, we can make them. We have the ability to make the world a safer place.

And in showing us our shortcomings, the histories of these outbreaks show us the way forward. If we want to make the world safer, we cannot be passive bystanders. We must be proactive in the face of health challenges in order to be a step ahead, or else expose ourselves to vast risks – and the dreadful consequences that can accompany these.

In a world of denser cities, increased international travel, migration and ecological change, the ability of emerging infectious diseases to spread and cause devastation is increasing. That’s not going to change, which means we have to. We’ve shown already that we can respond effectively to epidemics. Now we need to demonstrate that we can prepare for them effectively too.