Margaret Chan, the head of the World Health Organization, earlier this month lamented that doctors treating Ebola patients in West Africa are “empty-handed.” She blamed the profit-driven drug industry for leaving the poor without vaccines or treatments. It is nearly 40 years after the first signal flare of the deadly disease lit in (what was then) Zaire in the 1970s.
Now that the current outbreak of Ebola has killed more than 5,000 people, public health organizations, companies, policy makers, and philanthropies are scrambling to get experimental vaccines, diagnostics, and drugs out of the laboratory and into trials of people carrying the virus. Why did it have to get this bad before the global community took action to test these technologies in human populations and stock up supplies?
We have long known that diseases that affect small or even large numbers of the poor get less investment and research attention from industry than, for example, new painkillers and cholesterol drugs for baby boomers in the developed world. It should be no surprise that the market does not cure all of society’s ills; these failures of the marketplace were foreseeable long before Ebola became the panic virus of 2014. It was magical thinking if Chan and her colleagues imagined the industry would shift its stance on such diseases in the absence of a crisis or clear direction from public health officials and political leaders.
Ebola is a battle in a much larger war. It is only one of several emerging infectious diseases that face such market failures, where private sector interest is not enough to protect public health. The next epidemic to devastate entire families, communities, and countries might be pandemic influenza, dengue fever, or multidrug resistant tuberculosis, which infects around half a million more people each year. Like Ebola before 2014, many emerging infectious diseases have been relatively contained from going global due in part to some combination of tracking, treatments, and luck. But the viruses and bacteria responsible for isolated outbreaks adapt and evolve; strains are already emerging that are resistant to existing drugs and others have the potential to become more transmissible or deadly. Climate change, which is already underway, may also expand the range of disease-spreading bugs once confined to the tropics.
The global community can track and monitor the spread of such diseases. And we have the means as a society to spur and support the innovation required to invent and stock tools to diagnose disease, vaccines to protect the healthy, and treatments for those who fall ill. We can ensure that doctors in the next crisis are not left empty-handed. But all of this will require foresight and political will over the long term, not just in times of crisis.
What does this mean for political leaders and public health officials? It means identifying the priority diseases that are poised to most endanger public health and setting a course to tackle them with scientific and technological innovation. It means creating incentives that companies might lack. It means investing public dollars alongside private dollars in clinical trials, and taking on liabilities to ensure we can rapidly scale up supplies of vaccines. It may also require making “advanced market commitments” — guarantees that the first effective drug or vaccine a company generates for a neglected infectious disease will have a buyer. It means expediting and easing regulatory approval of experimental treatments for life-threatening diseases, as the Food and Drug Administration did in response to HIV/AIDS patients in the 1990s who demanded that even risky treatments come to market. It also requires that leaders in the global health community collaborate with private sector companies and academic researchers in partnerships. In short, it requires deal-making with the industry to yield innovations in advance, rather than hand-wringing in the aftermath. All of this requires resources, but they will be worth it compared to the high costs of responding too late to humanitarian public health disasters, while saving lives.
It should not be a revelation to the public or to policy makers that the invisible hand of the marketplace did not reach out to heal Africans suffering from Ebola. It would be delusional to assume that, when the next deadly disease spreads, we will have the innovations we need without investing resources now. The lesson from this crisis is that we have to think of infectious diseases not as house fires to be put out but as a landscape prone to going up in flames.@binajv.