Dynamics Enabling the Ebola Vaccine Program

by tuftsigl
Jan 25

Kai-Moritz Keller, MALD ’16 The Fletcher School Capstone Research: Dynamics enabling the Ebola vaccine program.  Kai’s received a Hamlin Research Scholarship from the IGL to support his research.

Before my final semester at Fletcher starts, as I prepare to return to the whirlwind activity of campus, I use the brief respite to reflect on the past winter break – a busy and rewarding past few weeks. With the help of the IGL, I traveled to Europe to conduct research for my capstone, which will examine the dynamics and processes that enabled the rapid vaccine development in response to the 2014 Ebola crisis in West Africa. Throughout my studies at Fletcher I have focused on public-private partnerships in the Global Health realm, and the Ebola vaccine program has been a prime, shining example of how joint efforts between the scientific community, government and regulatory bodies, as well as the industry, can generate transformative health outcomes. The Ebola vaccine program is particularly intriguing because the actors involved pulled off an initially vastly successful project with remarkable speed. Development processes that usually took years were accomplished in months. What were the drivers that enabled this? Who played what role and what actors featured most prominently? What are the key takeaways to be applied in future outbreaks of neglected infectious disease? Over the winter break, I pondered these questions and discussed them with representatives from IO’s like the WHO, private companies like GSK, and international funding mechanisms like GAVI. I traveled through the UK, Germany, the Benelux and Switzerland, gathering insights and perspectives – and ever more questions. In fact, I concluded my travels with more questions than I started out with.

Following a day of meetings in Geneva, I continued on to London early this week to try to gain a more granular understanding of the UK’s role in the vaccine development effort. My extremely engaging discussions with representatives of the Welcome Trust and with the UK Chief Medical Officer Dame Sally Davies at the Ministry of Health, left me with plenty of food for thought. I am grappling with the question of whether the seemingly overwhelmingly successful effort to pull industry, government agencies, regulators and the scientific community together was the deliberate result of a system that was set up in a way that made collaboration the only possible outcome – or whether it was due to mere luck or chance. On the surface, both perspectives are compelling. We got lucky in many ways: At the time of the outbreak, promising vaccine research was already underway; the scientific community was staffed with individuals who appreciated the disastrous developments in West Africa early while international coordinating mechanisms largely adopted a wait-and-see attitude; decision makers within major pharmaceutical companies did a good job of listening to their scientists and dedicating significant resources in preparation for a potential escalation; and one of the Ebola-affected countries happened to be a member of the Commonwealth, which triggered a response from the UK, a country that happened to dedicate a relatively high proportion of its resources to development and scientific research. Perhaps next time, the stars won’t align as they did here, and a response would take much longer to emerge.

Not so, argue government representatives with confidence that the various actors required to enable the response would have come together anyway . Maybe not as quickly, they admit, but the ensuing response and outcome would’ve been very similar. They believe that the process did not hinge on certain individuals but reflected robust processes that are already in place both on national and international levels.

Regardless of whether the outcome hinged on luck or robust systems, first evaluations of the vaccine effort indicate that there is plenty of work ahead for the global health community as it endeavors to make sure that the response to the next neglected infectious disease outbreak will be similarly successful. The 2014/2015 outbreak ended up being defeated without a vaccine intervention and much quicker than initially expected. As a consequence, vaccine trials took substantially longer and are still ongoing. A program that seemed extraordinarily promising at the outset might turn out to be a crushing disappointment. As the disease is gone, so is the urgent need for a vaccine. Donors have turned their attention elsewhere; to date, not a single dose of vaccine has been procured. Given this scenario – will the industry stem similar efforts in a future, similar outbreak? What financing mechanism might be more robust than the ones currently in place? How should the setup and role of the WHO evolve in order to coordinate more efficiently in the future? How can we overcome national structures and limitations in order to avoid duplication of efforts, in the pursuit of the highest attainable health outcome? So many questions…and four months until my capstone is due!

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