In late 2002, the first few patients contracted SARS, a respiratory disease that often leads to death, in China. Within weeks, thousands were ill, and the virus was spreading rapidly across the world. The first pandemic of the new millennium threatened the lives of many thousands, and despite heavy efforts, a vaccine took long to be developed.
More recently, Ebola swept across West Africa and killed thousands, building the threat of a new global epidemic. Microsoft founder Bill Gates has, through the Bill and Melinda Gates Foundation, set up The Coalition for Epidemic Preparedness Innovations (CEPI), to streamline efforts at containing pandemics and developing vaccines in order to protect global health.
Mr. Gates presented the new organization at the World Economic Forum in Davos, Switzerland.
CEPI’s goal is to drastically cut the time from outbreak to vaccine in order to limit the spread and minimize the death toll. Besides the Bill & Melinda Gates foundation, founding members of CEPI include the Wellcome Trust as well as the governments of Germany, Norway, Japan and India. Private sector firms are expected to join the initiative. The organization will need up to $500 million by 2022 to research vaccines against diseases like Lassa fever or MERS, but also to develop a new platform that helps in building new vaccines when unknown viruses hit. Developing a serum costs between $50 million and $250 million.
Mr. Gates spoke to Handelsblatt about the threat of global pandemics, what CEPI will deliver and how the German government and start-ups figure into the mix.
Mr. Gates, your foundation has been active in fighting some of the biggest diseases in human history over the past decades. In your opinion, how close are we to the outbreak of a new pandemic?
Ever since the black plague in the Middle Ages, epidemics have been threatening us. The fact that people mix more, they travel more, means that the rate of spread of a respiratorily transmitted human infection would be quite rapid. I gave a TED talk where I showed a simulation of what a flu epidemic would be like. And here at Davos, in addition to the CEPI announcement, we’ll use the example of Ebola to show that if a vaccine had been available after 30 weeks, it would have provided a modest benefit; after 22 weeks, more of a benefit; and after 6 weeks, a pretty dramatic benefit. If you take a flu, which is over 100 times bigger if it happens to be quite fatal, then you can show a huge difference if you get the vaccine fairly quickly.
If you had to guess, which epidemic will be the biggest threat to humanity in the future?
The most likely is an unknown one we haven’t seen before. The one we know we have to be worried about is the flu, because it can mutate into forms that both spread a lot and are fatal. So far, since 1917, we’ve seen varieties that spread a lot and varieties that are fatal. Fortunately, we have not seen a variety that combines what was combined in the so-called Spanish Flu epidemic.
Is the world prepared for such an epidemic?
For war, you keep paying your defense budget and you hope you don’t go to war. But with something like a pandemic, the question is who’s responsible, particularly because it will most likely start in a poorer country and then have an impact on all countries. For things like drug approval and allocating resources, we don’t have institutions that bundle that responsibility. The World Health Organization is there to gather information, but they’re not even funded to finance the actual surveillance networks themselves.
What will CEPI contribute?
There’s been a lot of talk about how the resources for the new vaccine should be accessed. In this case, we’re most likely talking about natural epidemics - that’s the focus of CEPI. When I’m next in Germany for the Munich Security Conference, we’ll talk about bio-terrorism in addition to natural epidemics as another threat you want to defend against.
What are the organization’s main tasks?
We’re engaged with private sector research groups looking at both which vaccines we should be working on now and new ways to create vaccines. You can never predict where an epidemic may come up, but there are some pathogens like MERS, the Middle East Respiratory Syndrome, and some others, where we’re talking about what we should be working on now. That’s one strand. And then the other is RNA/DNA, that’s sort of the broad, new approach that may allow you to come up with a new vaccine literally in a period of months instead of a period of years. So the CEPI discussion is: should we make some specific vaccines, and should we pay for those that advance these new platforms that would be valuable not only for the particular construct – like a MERS vaccine – but also for something new that comes along and surprises us.
CEPI really looks at what happened with Ebola and Zika and says: let’s try and get ahead of that. Let’s also make sure we’re understanding emergency use, which regulator do you go through, where do you need indemnification, how do you coordinate these things, what about the manufacturing capacity, and so on.
What is Germany’s role in the project?
Germany has shown a real interest in this, both because of its importance for the world and because German scientists and German companies may play a significant role in this. One of the four or five companies that work aggressively with these new platforms is Curevac that our foundation has given some grants and investments to. That’s one of the more promising activities with which you could make vaccines not only more quickly but also less expensively.
How much money is involved?
The specific announcement is $460 million. We think of it as a bit higher than that, because Germany has only just come in with its first one-year commitment, which is $10 million, and the other countries and partners are coming in with closer to $100 million or even $125 million. Our commitment is $20 million each year over a five-year period, so a $100-million commitment. I think Japan and Norway are closer to $125 million each. India may make some contribution, but the financial piece won’t be large. They are part of the overall consortium, which we’re glad to see. And that’s just the initial list.
The United States is notably absent from that list.
The U.S. in terms of biological research is by far the biggest spender, as big as everybody else put together. I expect the new administration will formulate its strategy on how they will get those groups working together over the next year. I think they’ll be pleased that CEPI is up and running. And they’ll figure out how their work – either in parallel or directly connected – can be complimentary.
Historically, the U.S. has thought about a global flu epidemic and made some investments. I don’t think any country has done as much as we’d like to see though.
Have you talked to Donald Trump about this?
I did have a meeting with him where I talked about innovation and new vaccines as one area where I thought investments are important, be it for things like HIV or the kind of preparedness we’re talking about here. But people are being appointed now and budget priorities are getting set, and then we’ll have a clearer view. But in the area of medical innovation and defending everyone against these things, the U.S. will definitely be in there in a very strong role in some way. But they’re not formally part of the CEPI launch.
What is your vision for the organization?
The dream is for CEPI to be part of an overall ecosystem. Such that if an Ebola-like epidemic came along – or, God forbid, an epidemic that’s much faster spreading, like a flu epidemic – there would be clarity about how are you going to get the data, how the regulator is going to look at the development process, how you are going to find the manufacturing capacity, how quickly you can turn this around and get it out to protect the citizens and the medical workers, so that you can stop the epidemic before it exponentially gets out of control. That’s the goal: to lower the response time.
Thomas Jahn is Handelsblatt's New York correspondent. To contact the author: [email protected]