R&D funding for infectious diseases needs to become less reactive, says Paul Barnsley
At the height of the west African Ebola outbreak in July 2015, the pharmaceutical company Johnson and Johnson began trialling a vaccine for the disease. One trial was originally intended to run until November 2016, but as the outbreak waned this was repeatedly pushed back until it finally concluded in July 2019.
This illustrates the catch-22 that pandemics present to policymakers. Recurring outbreaks can only be prevented through clinical research, but this can only be conducted while the disease is out of control. If non-pharmaceutical strategies such as contact tracing, isolation and social distancing reduce infections, it can be impossible for trials to distinguish statistically between infection rates in patients given a vaccine candidate and those given a placebo.
Mobilising R&D is more difficult still because the pathogens with the most pandemic potential are inherently the ones we know least about. When a novel pathogen appears or when a known pathogen acts in unexpected ways, such as the previously unknown effect of the Zika virus on unborn children, it takes time to understand its basic biology, let alone begin work on diagnostics, treatments and vaccines.
Outbreaks of an emerging infectious disease therefore present health systems with a narrow window to conduct late-stage clinical trials of vaccines and therapeutics.
Reactive funding
A report by Policy Cures Research, called Landscape of Emerging Infectious Disease R&D, shows that policy and funding can do more to adjust to this dynamic. Tracking spending between 2014 and 2018, the report shows that most funding comes in response to each outbreak, with comparatively little devoted to preparing for the next one.
Global funding for Ebola, for example, more than tripled between 2014 and 2015 as the west African outbreak took hold. Most of this came from massive investments from public organisations in the United States and multinational pharmaceutical companies. As falling case numbers made late-stage trials difficult or impossible, funding fell by around $125 million (€106m) in both 2016 and 2017.
In those years, attention switched to South America’s Zika outbreak. R&D spending on Zika went from a relative afterthought—just $6m in 2015—to $170m in 2016, peaking at $243m in 2017. As with Ebola, funding dropped sharply as the outbreak receded.
In 2018, an Ebola outbreak in the Democratic Republic of the Congo drove a rebound in funding and provided an opportunity for renewed testing. A number of treatments completed successful trials and received regulatory approval, leaving us in a stronger position for future Ebola outbreaks.
In some ways, then, the system works: a swift global response eventually led to a vaccine. But by focusing so much on each new outbreak, the global community risks constantly refighting the last war rather than preparing for the next one.
The focus on Ebola and Zika is likely to have reduced funding for research on other pathogens. Some 80 per cent of funding for basic research between 2014 and 2018 was directed to these two viruses. Tellingly, funding for coronavirus research fell in 2018, as memories of the Mers and Sars outbreaks began to fade.
Pandemic preparedness
The good news is that policymakers have taken two important steps beyond purely reactive funding. First, 2017 saw the establishment of the Coalition for Epidemic Preparedness Innovations. This pools funding from smaller public and philanthropic investors to make forward-looking commitments to R&D on epidemic diseases.
Cepi’s initial disbursements in 2018 drove a 30 per cent increase in funding for Lassa fever and bolstered funding for Mers and Nipah virus, at a time when global funding for lesser-known priority pathogens was otherwise in decline.
The second crucial step taken is increased funding to prepare for as-yet-unknown pathogens. This is exemplified by the World Health Organization’s inclusion of Disease X in its list of priorities, and Cepi’s 2019 funding for multi-disease R&D. These changes benefited platform technologies used to underpin the response to emerging pathogens, which have assisted product development in response to Covid-19.
Together, such initiatives helped to lay the foundation for the unprecedented R&D response to Covid-19. In hindsight, though, it is obvious that the cost of an uncontrollable global outbreak dwarfs any increased investments in pandemic preparedness.
There is a real risk, once this crisis passes, of forgetting hard-won lessons and reverting to a focus on the last threat, instead of increasing and diversifying our efforts to prepare for whatever the next pandemic turns out to be.
Paul Barnsley is senior analyst at Policy Cures Research, based in Sydney, Australia
This article also appeared in Research Europe