A keyhole view of the next pandemic

I’ve been following the Ebola outbreak in central Africa, which has just surpassed 2,000 reported deaths and 4,381 confirmed cases. (The real numbers are likely higher due to underdetection.) What’s surprising about the Ebola outbreak is that we actually have an Ebola vaccine, but it was developed and tested against the Ebola Zaire virus during the 2014–2016 outbreak, while this outbreak is caused by Ebola Bundibugyo virus. The two viruses have similarities and some laboratory and animal data suggested there may be cross-protection, although the evidence is still unclear.1 But until last week, the WHO hadn’t decided to test that vaccine in this outbreak; the focus was on developing and testing new Bundibugyo-specific vaccines and antivirals instead.

In a recent STAT opinion piece, Krutika Kuppalli and Placide Mbala argue that pandemic preparedness shouldn’t be so narrow. Rather than focusing so narrowly on each virus, we should invest in broad-spectrum diagnostics, vaccines, and treatments, and should have tested the effects of the Zaire vaccine on Bundibugyo earlier; I agree.

Interestingly, the Ebola Zaire vaccine came about through innovative trials and coordination. It was developed through funding by BARDA and the DoD, tested using ring vaccination trials led by the WHO, incentivized through an advance market commitment, and stockpiled by Gavi, WHO, UNICEF and the Red Cross for future outbreaks. That stockpile has been useful in the years since then to contain outbreaks of Ebola Zaire quickly. But now that a larger, harder to contain outbreak has arrived, we’ve lost expertise and funding to tackle it, and we don’t know if the existing Ebola vaccine protects against this virus too. We could be doing a lot better.