The global health community keeps taking the same-old, same-old approach to tackling emerging diseases — and a massive overhaul is needed, says Sanofi’s chief scientific officer.
In an interview with STAT, Dr. Gary Nabel argued that the current global outbreak response system operates with too few resources, too little organization, and inadequate accountability. Changes are needed, he said, and that’s going to require input from government, industry, funders, and public health agencies.
Echoing concerns raised an editorial co-penned with Sanofi’s global R&D head Dr. Elias Zerhouni and published this week in Science Translational Medicine, Nabel — who previously led the government’s Vaccine Research Center — talked about whether the Zika response is doomed to follow in the footsteps of the stumbling efforts to contain SARS, Ebola, and other recent dangerous disease outbreaks. The conversation that follows has been edited and condensed.
Can the standard approaches to developing a vaccine work for something as unexpected and explosive as the current Zika outbreak?
The way vaccines are normally developed just to get a candidate would take a year. That doesn’t count the time that it might take to identify prototypes that would be likely to be successful.
That year gets you to Phase 1 [first-in-human trials]. And then once you do Phase 1 you’ve got to go off and do Phase 2 and then Phase 3. So you know, typically with a vaccine you would never get out something useful in less than five years.
Some mosquito-transmitted viruses wax and wane, triggering large outbreaks and then disappearing for a while. If a Zika vaccine isn’t ready in the next couple of years, is there a risk it won’t be pursued? After all, there was a lot of interest in a West Nile vaccine in the early 2000s, but concern subsided and the pharmaceutical industry abandoned it.
The big thing about Zika and the reason why I personally would advocate developing a vaccine — even if we can’t deploy it by the time we develop it — is what it’s doing in terms of birth defects and Guillain-Barré. It is really serious stuff. You’re talking about children that haven’t come into the world yet and their whole lives are being altered by this virus.
In the past decade or so the world has battled two brand-new diseases, SARS and MERS, as well as bird flu, pandemic flu, and an Ebola outbreak of a scale no one ever imagined was possible. Every time the crisis subsides, there are recriminations and reports and calls for the world to prepare better. Can it? Or are we destined to be constantly caught flat-footed?
We just run from one crisis to another. It’s not an optimal way to respond. Not when the stakes are so high and when so many people can either lose their lives or have their whole lives changed because of one five-day infection. That’s no way to protect the world’s population.
We have to step back and we have to say, “Is there a more systematic way to gather the intelligence that we have about these viruses, recognize where they stand in terms of the threat level, and then develop a systematic program where, when the next Ebola outbreak occurs, it’s not that we haven’t done anything since the last outbreak, that we’ve actually moved things forward?”
That’s all possible. It’s just that we have not had the collective will to do it.
The World Health Organization is trying to galvanize that kind of work. It has developed what it calls an R&D blueprint that identifies the highest priority emerging disease threats with the goal of promoting research on diagnostics, drugs, and vaccines to combat them.
The WHO is symptomatic of the problem. They have the best of intentions and they do wonderful, wonderful work. But they don’t have the capacity or the resources to really address what needs to be done. If you look at their budget, it’s meager.
It can be done. But it can’t be done through the existing structures that are now in place. We have to start thinking big. We have to start thinking about how it should be done ideally and then finding the resources to get it done.
So what do you see as the chances that there will be a Zika vaccine if changes aren’t made?
If you were running a casino in Las Vegas and you were the house and you were going to bet on the odds as the house, you’d bet against this one. There’s no question about it.
That’s why I do think if we’re going to have a chance we all — meaning the regulators, the companies, the government agencies that are involved, public health officials — we all need to put our heads together and say, “Listen, why is it taking a year? Where can we save time? Can we do trials in places where the disease is active so that we can gather at least some data that will inform us on the efficacy as we’re doing it?”
It can’t be business as usual.