Global Health

Zika Surprised Us. It Shouldn’t Have.

September 27, 2016  • J. Joseph Kim

No one likes surprises – especially the medical community. But there was alarm across health organizations around the world in 2003 when the SARS virus killed 10% of those infected. We witnessed similar shock in 2009 when a known strain of swine flu killed almost 20,000 people. Then again in 2014 an Ebola outbreak jolted the medical community, taking more than 11,000 lives over an 18-month period. Move to 2015, when one businessman infected with Middle East Respiratory Syndrome led to the deaths of nearly 40 people in South Korea and almost paralyzed the country for a better part of a year.

Time and time again, governments, the medical community and the general public are caught off guard by these surprise viral outbreaks.

Medical and scientific experts understand the biology of virus evolution and know that new virus types are going to emerge. We know it only takes a single switch of a gene for an “unknown” virus to jump from animals to humans like the 2009 “bird flu” epidemic. With the number of people traveling via air every day and worldwide events such as the Olympics and World Cup bringing together thousands of people from all corners of the world, a single infection can become a pandemic more rapidly than at any time in world history.

We know that this year’s “surprise” is Zika. As a global society with the means and the knowledge to create new vaccines, we should no longer be caught off guard by emerging viral outbreaks. A global vaccine development fund bringing in support from governments and a wide variety of other sources coupled with the best minds of the vaccine world could better prepare us for the next viral outbreak. But first, we must tackle Zika.

Since the Zika virus has rung this year’s medical alarm, let’s take a brief look at how it emerged. Remember that a genetic mutation in a virus that only affects animals can cause it to jump to humans, creating a seemingly new virus that the medical community has never before seen. And then remember that the Zika virus was first identified in Uganda in 1947 in a monkey. Next, according to Oxford researchers, the Zika virus could have been introduced to Brazil during the 2013 Confederations Cup, a soccer tournament featuring a team from Tahiti — which suffered a Zika epidemic earlier that year. A single mosquito biting a Zika-infected individual may have set this series of events in motion.

Sounds like a movie script, doesn’t it? But it’s science fact, not science fiction. And it’s a movie scientists have seen before. To fight Zika, we didn’t start from scratch. We have learned many lessons from other related diseases and pandemics that we can apply to the current Zika epidemic. Lessons come from, of course, malaria – but also yellow fever, chikungunya, and dengue fever. Like Zika, all of these are in the same Flavivirus family or are spread by the same type of mosquitos.

To fight against Zika and other viruses, we have the funds and knowledge from historical outbreaks, and we have vaccine scientists spread across industry, government and academia to better prepare us for these surprises. In my opinion, the path to preparedness begins by supporting the creation and maintenance of a global vaccine fund first described last year by three vaccine pioneers and led by Stanley Plotkin, who played a pivotal role in the development of several world-changing vaccines against rubella, rabies and rotavirus.

Drs. Plotkin, Adel Mahmoud and Jeremy Farrar* observed that vaccines against emerging viral threats are not available because we as a society have not been willing to invest in the costly and complex development process that is required not to have a vaccine ready for market, but merely to reach the testing stage. In this phase, vaccines are tested against a variety of infections to prove their safety and immunogenicity. In the clinical development world, we call this period the “valley of death.” That is, the early development process necessary to move a vaccine from the lab bench through Phase I trials (the first human testing stage). After successfully completing this process, the vaccines can be handed to larger pharmaceuticals partners to fund the necessary large-scale trials with government support or special incentives. Seed money to launch this global fund could come from government, the pharmaceutical industry and non-traditional sources such as insurance companies and even the travel or hospitality industries.

In the past, industry, especially publicly traded entities, has been unable to commit to developing vaccines for Ebola, West Nile virus and MERS. Consider that the development of just one new vaccine requires a capital investment of $500 million to $1 billion.

To create this global vaccine fund, look at the cost/benefit ratio. Dr. Plotkin and many other visionaries see the need for at least $2 billion to kickstart a global fund to address the top emerging viral threats before they become epidemics. That’s a lot of money – except when you consider that the cost of the emergency response to mitigate the recent Ebola outbreak is estimated at $8 billion. To fight Dengue fever in 2013 alone cost Indonesia $2.2 billion and cost Brazil $1.2 billion. These numbers will be far below the economic and medical costs we’ll see once the official Zika response is tallied.

This global vaccine fund could ensure we never again see the tragic loss of health workers infected while caring for Ebola patients or innocent children born with Zika-related microcephaly. We have the necessary tools to create such a fund. We need the conviction and support to make it happen. From what we have all witnessed – do we really need any more motivation?

Dr. J. Joseph Kim, is an entrepreneur, immunologist, and health policy leader, who is CEO of Inovio, a biotechnology company developing novel DNA-based immunotherapies for cancers and challenging infectious diseases. His company was the first to create a Zika vaccine, first into human testing and expects to be the first with Zika clinical results. Kim is a Fellow of the inaugural class of the Aspen Institute’s Health Innovators Fellowship and a member of the Aspen Global Leadership Network. As a Health Innovator Fellow, he is working with his team to develop a vision of tomorrow’s healthcare system.

*Plotkin SA, Mahmoud AA, Farrar J. Establishing a Global Vaccine-Development Fund. N Engl J Med. 2015 Jul 23;373(4):297-300.