Being prepared for emergencies is a long, hard grind


By Amesh Adalja



As America prepares for a new presidential administration, a major victory was just announced in the world of medical science that provides a reminder of the importance of the under-celebrated workhorse of dramatic outbreak stories: preparedness.

Toward the end of last year, an Ebola vaccine developed by a group of scientists was proven to be 100 percent effective during a trial in West Africa. Consequently, the inoculation quickly achieved fast-track status from the U.S. Food and Drug Administration. The next time the world confronts Ebola, one of the most terrifying viruses in history, we will be in a much better position to save lives.

Ebola remains a potential global public health threat. Thus, as a new presidential administration is about to take office, it is important not to draw the wrong lesson from the Ebola vaccine experience, or to take it for granted, either.

The scientists who developed the vaccine achieved a major scientific advancement that will change the face of Ebola forever, but this victory also underscores the value of preparedness. After all, the development of vaccines is not measured in weeks or months or even a year. It is a rigorous process that proceeds from test tubes, to animal models, to multiple phases of human trials — typically over a period of many years. No vaccine magically appears before the credits roll, as is often the case in blockbuster films.

The virus killed more than 11,000 people in 2014, and terrorized countless others as it ripped through parts of West Africa, eventually traveling to the United States. Naturally, then, the world is cheering the spectacular vaccine results, which were so swift and dramatic — almost as if plucked from a Hollywood movie script. However, it would be a mistake to believe that the path to success for this vaccine began in 2014, when the disease entered American hospitals and homes, or that it represents a typical battle in the war that is being fought every day against emerging infectious diseases.

Ebola was a well-characterized biological weapons threat for which a robust effort to produce a vaccine had been underway for more than a decade by the time the disease surfaced in the United States in 2014 — the vaccine had even been used in a human years before the West African outbreak. Over time, it had been studied by experts who gained a deep base of knowledge about the vaccine and its potential promise. By 2014, the vaccine, developed by Merck and New Link Genetics, was ready for larger human trials, which the West African outbreak provided.

By their very definition, emerging infectious diseases defy expectations — just look at the global proliferation of the Zika or West Nile viruses. Without predictability, the ability to make vaccines, anti-infectives, and diagnostic tests is challenging, because the development process is always intensified and completed after a disease outbreak crosses an infection threshold high enough to spur action. It is usually only then that the race to combat the disease begins in earnest, by marshaling the requisite will to begin the long processes of developing new products and screening existing compounds, all while trying to anticipate what the next pandemic may be.

In many situations, any pharmaceutical relief may occur too late or not at all. During the 2009 H1N1 influenza pandemic, for instance, the development of vaccines progressed at almost unprecedented speed against a well-characterized threat and benefited from years of preparation for pandemic flu. Yet the efforts still resulted in a vaccine that was available only after the epidemic had peaked.

All this is a reminder that the business of preparing for unknown infectious disease threats is not really a business at all. In many cases, it is very akin to gambling over which threats to prepare for and which to ignore. This arduous process requires resources and continual support from policy makers, even in the midst of changing administrations and other global crises. The gamble is worth it though, because the stakes couldn’t be higher: If left unprepared, the cascading effects of an unrestrained outbreak can lead to mass suffering, mass death, economic calamity and failed states.

For this reason, the complete development of the Ebola vaccine is best understood not as an overnight success but as the capstone to more than a decade of work. This new administration will undoubtedly face either an emerging infectious disease outbreak of its own, a biological weapons threat or both. Our experience with Ebola emphasizes that it is essential to understand the vital need to prepare for these threats before they materialize. Then, when a threat is recognized, employing adequate resources to advance vaccine, diagnostic and treatment development is the only path to potential success.

Repeating the success of the Ebola vaccine story is only possible if leaders make preparedness a priority, which puts us in a far better position when an emergency strikes. There is always a risk of being surprised by unknown pathogens, but if we take the threat of emerging infectious diseases seriously, and value the scientists who fight them, victories like the one against Ebola are possible.

By Amesh Adalja

Amesh Adalja is a board-certified infectious disease physician at the Center for Health Security at the University of Pittsburgh. He blogs at www.trackingzebra.com and can be followed on Twitter @AmeshAA. He wrote this for The Philadelphia Inquirer.

Amesh Adalja is a board-certified infectious disease physician at the Center for Health Security at the University of Pittsburgh. He blogs at www.trackingzebra.com and can be followed on Twitter @AmeshAA. He wrote this for The Philadelphia Inquirer.

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