This blog is part two of a two-part series on Ebola, highlighting critical challenges in global health which have hindered the ability of the world to effectively respond to this emerging health threat.
In this second blog we explore how a lack of investment in research and development (R&D) for poverty-related diseases can have devastating consequences – in the first blog we looked at how weaknesses in health systems have undermined efforts to fight the disease.
Ebola is a scary phenomenon. There are currently no treatments or vaccines specific for the disease, and general anti-viral treatments have not been found to work. It causes internal bleeding, and while patients’ bodies do eventually create an immune response to fight the virus, by this time too much damage has occurred. Death rates are around 50%.
Photo: EC/ECHO/Anouk Delafortrie
This has meant that, for the vast majority of the nearly 20,000 Ebola patients in West Africa so far, ‘treatment’ has simply been supportive, helping the patient’s body to maintain hydration and electrolyte levels; whilst trying to prevent further spread through isolation, contact tracing and proper protection from bodily fluids for those interacting with patients.
Yet over the past decade, a wide variety of potential treatments and vaccines have been explored in ‘basic’ and ‘applied’ research studies involving animals, but have then sat on the shelf gathering dust. Only very recently has high political and public interest in developed countries fast-tracked many into either small ‘phase I’ human trials, or even into use as ‘experimental treatments’ for individual patients, in partnerships between pharmaceutical and public funding bodies.
These products include antiviral drugs, blood transfusions from surviving Ebola patients, other antibiotic treatments, and vaccines using Ebola virus particles that are missing genetic materials and cannot replicate. Results have been mixed and inconclusive so far: some patients survive, but attribution is difficult; some sadly do not. Given enough products moving steadily along this ‘pipeline’ – which we have now achieved, albeit belatedly – doctors will eventually get what they need to fight Ebola.
But it will still likely take many months, and would usually would take years, as promising products pass through the final large-scale ‘phase III and IV’ trials to prove safety and efficacy before they become available to the public. The process will not be quick enough to save those facing Ebola now, and of course has already failed those who have died.
This applies not just to Ebola, but to the wider burden of infectious disease that currently causes untold disruption to both health systems and economies in low and middle income countries. As increasing trade and global integration continues, addressing the infectious diseases that affect these countries will become ever more of a global challenge.
The West Africa Ebola outbreak has so far killed just over 7,000 people during its six-month duration; in comparison, HIV/AIDS and tuberculosis (TB) both kill over 4,000 people every day. They are just two of the so-called ‘poverty-related and neglected diseases’ that kill nearly 14 million people every year and for which, as for Ebola, there are no treatments available. For others, such as for TB, the infections have become resistant to existing drugs or the treatments are painful and difficult to use and needed for long periods of time.
Despite these pressures, only 4% of all new products registered over the last decade were for poverty-related diseases. The ‘shelves’ of global health R&D are gathering huge amounts of dust. In asking what can be done to prevent another outbreak of a similar disease – or prevent the daily tragedy of HIV/AIDS or TB – we must therefore ask: how can we ensure that potential products to prevent and treat life-threatening or debilitating conditions are prioritised, funded and brought forward?
The huge under-investment that is delaying and stalling progress has been attributed to flaws in the current method of funding research and development (R&D). At the moment, companies will usually risk investing in a product only if it could generate a significant financial return. Almost by default, this is not possible for many poverty-related and neglected diseases.
However, ways round this problem are already producing strong results. The UK Government has historically been a champion of ‘Product Development Partnerships’ (PDPs), which generate partnership between the sectors, pooling donor and philanthropic funds with academic and private sector expertise and resources, and also building medical research capacity in affected countries.
PDPs have been instrumental in bringing through 37 new therapeutic products for poverty-related diseases registered over the last decade; including a UK-funded paediatric antimalarial, five new diagnostic tests for TB, and the first internal ring to prevent HIV infection in women. The Government is also exploring options to better fund R&D through public money via targeted grants, ‘milestone prizes’, and the further pooling of information and funds with other donors.
Whilst a great start, the gaps in donor finance for global health R&D are still huge – around $1 billion every year for just TB, for example. As Justine Greening said in 2013, “the development of new technologies is vital if we are to improve the health of the poorest people through better treatment and prevention”.
Ebola is just the most recent example of why the Secretary of State is right, and why the UK Government must now follow through on its leadership in investment and support for Global Health R&D.
For more information, please contact Laura Boughey, Health Advocacy Co-ordinator at RESULTS UK, at email@example.com.