| A
packed train in Hamburg, a medical student fresh off the plane from
Rwanda, a tiny mountainous nation dealing with its first outbreak of a
deadly hemorrhagic fever, and now the prospect that a disease that can
kill up to 88% of those it infects could be about to spread in Europe. That's not the opening script of some b-grade horror film. It’s the news out of Germany and Rwanda this week. The patient in fact tested negative but the momentary panic focused attention on the outbreak of Ebola-like Marburg virus in Rwanda, where it has already killed 11, with 36 confirmed infected. There
are no approved vaccines to prevent Marburg, nor are there any
therapies authorized to treat the disease. Changing that presents a
strange conundrum. No one wants an outbreak of a rare and deadly
disease. But those outbreaks could help actually test whether vaccines
and drugs work against the virus. Mark Feinberg, the chief executive officer of IAVI,
a non-profit vaccine and antibody drug developer, knows better than
most how crucial it is to respond quickly when outbreaks occur. He used
to work at Merck,
where he helped lead efforts to get a vaccine for Ebola virus on the
ground during the 2014-2016 outbreak. Those trials supported the first
approval of an Ebola shot. This time, potential drugs from Mapp Biopharmaceutical and Sabin Vaccine Institute,
which has an experimental vaccine, could be tested in Rwanda. Both
companies have said they’re in discussions with the Rwandan
government or other partners involved in getting the products on the
ground. But it’s
not an easy task. Clinical trials usually take months to set up and
years to complete. How do you do that for an outbreak that could be over
imminently? For
Ebola, studies were initially started in Liberia and Sierra Leone but
public health responses brought infections under control, meaning it
wasn't possible to do an efficacy trial, says Feinberg. In
Guinea, the researchers used a different approach — ring vaccination,
which showed that the vaccine worked at preventing Ebola. But it was
“only because the outbreak continued at a sufficiently high level in
Guinea that it was possible to generate those data,” he says. It’s also about developers being ready to ferry their product to the heart of the outbreak within days of it starting. For
example, IAVI has a Marburg vaccine and while it is going to start
manufacturing doses this week, it currently doesn’t have vaccines
available for testing in humans. “Ideally
the funding agencies that support work in this area would not only
support the product development efforts, but there would be stockpiles
of the vaccines available so that in the case an outbreak arises, they
could be rapidly deployed and evaluated,” says Feinberg. The
problem? This relies on limited funding from government agencies or
other global health organizations. “There’s not really current interest
on the part of multinational pharmaceutical companies or the
biotechnology companies, for the most part, to invest in these areas.” While
Feinberg is confident that Rwanda has the public health resources to
respond swiftly to the outbreak, the same can't be said for all nearby
countries like the Democratic Republic of the Congo. “If the outbreak
extends to the DRC or maybe even came from the DRC, the situation could
change significantly in the coming days and weeks,” he says. — Ashleigh Furlong |