By Dan Stinchcomb, Ph.D.
SVP, Vaccine Development and Viral Diseases
One of the biggest new headlines in 2016 was about the Zika virus, which grabbed attention all around the world. As this year moves to a close, Zika remains top of mind as it should because we are not done with this disease … and, even if we were, there would likely be another infectious disease lined up to take Zika’s place in the spotlight.
While the incidence of disease is going down in some places like Brazil, the virus is on the rise in the U.S. and other countries and continues to spread (with new transmission in Singapore and the Virgin Islands). Here in the US, we have seen our first cases of Zika-associated birth defects in infants born by mothers that were infected during travel and the number of cases are growing daily. We’ve also seen the first U.S.-based transmission of Zika in Florida and the number of cases there increase Even as we battle this current epidemic, we must also stay vigilant about taking what we’ve learned to prepare for the next contagion.
It’s not easy to predict the next disease. We can misjudge the potential risk and get complacent, even when we know the virus and how it can be spread to humans. Biology always finds a way to throw us a curveball.
Ebola was a virus we thought we knew well since its discovery in 1976. Outbreaks remained isolated and of low impact because of rapid and effective quarantine and health care for infected individuals. But in 2014, an outbreak exploded due to a breakdown in health infrastructure in western Africa. All of us – scientists, public health officials, the medical community and even the World Health Organization – were unprepared for the increase in magnitude of Ebola worldwide. And the threat remains; even with the reduction in cases, Ebola continues to infect and kill in unanticipated locations. As an example, since the first outbreak in 2014, Liberia has been declared virus free four times. What we thought was a virus easily contained by modern medical practices turned out to be able to devastate multiple countries in a few months’ time.
Similarly, virologists have known about Zika since 1947, and even after an outbreak in the Pacific Islands in 2007 we remained unconcerned due to its mild clinical effects. However, as Zika inevitably spread first in Polynesia and then in Brazil, we found surprisingly that the virus could cause neurological damage. A rise in the number of cases of paralysis and Guillain-Barre syndrome followed the Zika outbreak in the French Polynesia. And then frighteningly as the number of infections accelerated in Brazil, we found the virus could cause birth defects (such as microcephaly) after infecting pregnant women. What we thought was a benign mosquito borne virus, turned out to have devastating personal consequences for women in infected countries and even travelers to those regions.
The essence of prevention is better preparation. The global health community needs to put procedures and guidelines in place for everything from global policy making to protective measures in local clinics.
As a biologist with decades of experience in product development, I believe that preemptive research and product development is one of the most important steps we can take. To prepare for the next Zika we need smart, nimble development of candidate vaccines. Pharmaceutical companies normally don’t invest in developing therapeutics or vaccines unless they know there is a market to pay for them. We need a better way to get our best scientists working on these interventions in the absence of existing markets.
Well before there is a crisis, we must develop a shortlist of ominous diseases that are candidates to break beyond their current borders. We then need to advance potential products from the bench into clinical testing, through to phase 2. This is where researchers demonstrate safety in affected populations and multiple age groups, and get an indication of whether the vaccine or drug would have the desired effect. Currently there are no stockpiles of phase 2 candidates for these potential pathogens, and no money for them either.
Our governments and public health institutions need to approve and support long-term funding that allows companies and research institutes the opportunity to take their best candidate vaccines into human clinical trials. We have to break from the habit of funding from crisis to crisis, as when money jumped from Ebola to Zika, even though the threat of Ebola and the need for a safe and effective vaccine still persists. We saw the same pattern with HIV, SARS and pandemic flu.
We don’t know when or where the next crisis will occur. Certainly regions of Asia, Central and South America or Africa are considered potential hotbeds for infectious diseases. New diseases have the greatest opportunity to establish a foothold and spread rapidly where people in search of economic opportunities move to create supercities. With high-density populations living in tropical climates with poor sanitation and public health infrastructure, often close to mosquito or wildlife reservoirs, there is always the risk of new disease strains emerging. And with the rise in global travel we have seen firsthand how rapidly disease outbreaks can spread. The dissemination of Zika is only the latest example following in the footsteps of chikungunya, H1N1 pandemic influenza, SARS, dengue and HIV.
We worry rightly about the threat of global terrorist organizations, but global infectious diseases kill and maim more year after year. The next few years will be crucial for developing better policies and preparations to reduce the impact of global epidemics. Even if we succeed in developing and funding work on vaccines, therapeutics and diagnostics for high-risk threats, there will always be surprises. But that shouldn’t stop us from trying to anticipate the next deadly virus and advancing the science to be better prepared.