#Ebola

The Ebola epidemic in Western Africa has finally come to a conclusive end, with no further suspected cases since the end of November 2015. According to the World Health Organization, the outbreak has been responsible for over 11,300 deaths, which – while a devastating number – is actually far fewer than the projected 1 million plus deaths that were predicted from various epidemiological models had the disease become airborne (1,2). Through the collaborative efforts of the people of Liberia, Guinea, and Sierra Leone; country governments; international aid organizations; healthcare providers; and public health experts, the epidemic was eventually controlled, with only a minority of cases spreading outside of West Africa.

During the past two years, a number of vaccines have been researched and tested to control the epidemic in what was an unprecedented interest in a relatively low-impact global health emergency. By comparison, in 2015 alone, there were 438,000 deaths from malaria — and yet we didn’t see nearly the same level amount of research and development toward a malaria vaccine... 

Why did Ebola receive the level of attention from pharmaceutical companies that it did, and what can this teach us about the landscape of pharmaceutical incentives in global health? The Ebola virus is no new player in the world of infectious disease epidemics — it was discovered in 1976, and there have been over 30 outbreaks around the world since then. So why did the latest outbreak receive so much attention? Notably, as well as being the largest outbreak to date, this was one of first with cases outside of Africa — and as quickly as the disease spread, so too did news of it through social media outlets, creating an Ebola panic — and subsequently significant public and private interest in developing a vaccine.

However, if a vaccine were to be tested and ready for deployment, who would pay for it? As of 2012, over 40 percent of the population of Guinea lived on under $1.25 per day, so the affordability of a novel Ebola vaccine is unrealistic in this market. Even without a robust market in Africa, several pharmaceutical companies continued developing and investing in an Ebola cure because of the potential markets in the West where Ebola quickly developed into the next plague in the public imagination. These markets were created largely through fear, with social media playing a central role.

Pharmaceutical incentives for diseases affecting poorer nations should not hang on the threads of social media trends. The need to improve health outcomes for the developing world, and for pharmaceutical companies to create profits to sustain their businesses are two forces that are traditionally seen as being at odds with one another. It is imperative that we find an intelligent approach that can achieve both. A number of potential yet somewhat patchwork solutions have been tried or are in development, including priority review vouchers, advanced market commitments, and compulsory licensing. But in my view a truly revolutionary proposal is the Health Impact Fund (http://healthimpactfund.org/), which would reward pharmaceutical innovation by the potential and/or actual health impact of an intervention, with consideration being given towards the number of people benefiting. This would take the place of traditional patenting, and would be most relevant for diseases that primarily affect poorer nations.

Rethinking how we incentivize the development of drugs and vaccines is critical, because it will allow the global scientific community to investigate solutions to future ‘Ebolas’ before they become social media hashtags – and before they selectively kill the world’s most vulnerable.