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Preparing for new diseases

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TWO reports published this month are worth considering in tandem. The first, from the House of Commons Science and Technology Committee, looks at the lessons for the UK of the recent Ebola virus outbreak in West Africa, with particular reference to how science can help in emergencies.1 The second, from HealthforAnimals, which represents animal medicines manufacturers worldwide, looks at challenges and opportunities for innovation in the animal health sector.2 While one is concerned with what turned into a human health crisis, and the other is concerned mainly with animal health, there are similarities in the messages to be drawn from the two reports, especially in the context of One Health.

The Science and Technology Committee's report proffers a highly critical account of the response to the Ebola outbreak, suggesting that ‘the UK response – like the international response – was undermined by systemic delay’. It also includes a number of remarks on the importance of being prepared for disease outbreaks, some of which, from an animal health perspective, could strike a chord with those who remember lessons being learned from the inquiries into the UK foot-and-mouth disease outbreak of 2001.

Among points made in the report are that effective disease surveillance and a quick response are essential for any hope of success in containing disease outbreaks, yet, the committee suggests, in the case of Ebola, delays were evident ‘at every stage’ of the UK's response. It notes that rapid and reliable communication is integral to delivering an effective response to a disease emergency but says that ‘throughout the Ebola outbreak, we saw that systems to share advice, expertise, epidemiological and clinical data – particularly between the UK and Sierra Leone – were inadequate’. The committee recognises the ‘enormous efforts’ made by governments, universities, regulatory authorities, humanitarian agencies, pharmaceutical companies and others to ensure that clinical trials for Ebola vaccines, treatments and diagnostics were launched in ‘record time’. However, it says, ‘such efforts do not obscure the fact that the UK and other countries were not “research ready” when the outbreak began, prompting a less than optimal and uncoordinated research response.’

Worryingly, the Science and Technology Committee suggests that the Ebola disease outbreak in West Africa has highlighted structural weaknesses in the UK's capacity to absorb and withstand shocks to the system arising from emergencies. It remarks: ‘Despite hosting world leading experts in immunology, epidemiology and tropical medicine in the UK, there are currently no licensed treatments for, and vaccinations against, Ebola. This situation has arisen, in part, due to a long-term market failure to invest in interventions for rare but potentially catastrophic epidemics.’ It also expresses concern that ‘in the unlikely but possible event of a domestic disease outbreak, the UK lacks the capability to go further and manufacture enough vaccines to vaccinate UK citizens in an emergency’. It suggests that existing facilities and new plant ‘will take years to rebuild, leaving the UK in a vulnerable position’.

Lack of vaccine manufacturing capability will not just apply to Ebola, and is likely to apply to other diseases too. The committee urges the Government to encourage private sector investment in vaccine manufacturing capacity and to negotiate with manufacturers to establish pre-agreed access to capabilities that can be called on quickly in an emergency. It also recommends that the Government should ask the recently established UK Vaccine Research and Development Network (VR, August 30, 2014, vol 175, p 185) to identify actions required to address the deficiency in manufacturing capacity and investigate the feasibility of establishing investigational stockpiles of vaccines.

Concern about ‘market failure’ in the development of new medicines and vaccines is not new, having been highlighted, for example, in a report in 2014 from the Royal Pharmaceutical Society (VR, May 17, 2014, vol 174, p 488), as well as during a One Health conference in Amsterdam last year (VR, March 21, 2015, vol 176, p 292). Although much of the discussion has focused on development of products for human use, many of the arguments are no less applicable in the animal health field, as the recent report from HealthforAnimals on innovation in the animal health sector makes clear. As well as discussing vaccine development and the control of emerging zoonotic and vectorborne diseases, the report considers issues ranging from food safety and sustainability to innovation in pet health, taking a One Health approach throughout. This seems particularly appropriate in relation to new and emerging diseases, as most of the new diseases that have emerged in people in recent decades have originated in animals.

Discussing barriers to innovation, HealthforAnimals' report suggests that different sets of regulations in different countries represent one of the biggest barriers to a more efficient contribution of the animal health sector to health outcomes, and says that these need to be streamlined and harmonised. With specific reference to vaccine development, it draws attention to the potential of collaborative competition in the area of vaccine technology, but argues that this needs to be structured in such a way that companies can make a return on their investment. It also draws attention to the importance of vaccine banks, arguing that these merit greater allocation of funding.

Both of the reports published this month call for a more proactive response to emerging disease threats, which needs to be better coordinated globally. On the basis of the Science and Technology Committee's critique of the response to Ebola outbreak, it would be hard not to agree that this is necessary.

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