Chidi Oguamanam and Nailah Ramsoomair
In the midst of the COVID-19 pandemic, the world continues to overlook the epidemic raging on in some of the poorest regions of Africa since 2013: the Ebola outbreak. The Ebola virus is a severe disease with a death rate of up to 90% in humans. The virus was first identified in 1976 with two simultaneous outbreaks; one in the Yambuku village in the Democratic Republic of the Congo and the other in a remote area of Sudan. Along with health workers, the people most susceptible to contracting the virus are those who have direct contact with bodies during traditional burial rituals.
As of 2020, there is no dedicated treatment for the Ebola virus. While oral rehydration is used as a supportive measure for patients, the first-ever multi-drug randomised trial was conducted in 2018 during the 2018-2019 Ebola outbreak in the Democratic Republic of the Congo. Before that, in 2015, an experimental vaccine known as rVSV-ZEBOV was studied in a trial involving 11,841 people in Guinea. This trial was led by the World Health Organisation, together with Guinea’s Ministry of Health, Médecins Sans Frontières, and the Norwegian Institute of Public Health in collaboration with other international partners. While the experimental vaccine of 2015 showed up to a 100% efficacy rate in individuals, there is still no conclusive evidence that it has the capacity to protect populations through herd immunity.
It is interesting to note that the Ebola vaccine research had a start in Canada more than two decades ago with German scientist, Heinz Feldmann, studying haemorrhagic fevers in Canada’s National Microbiology Laboratory in Winnipeg. Based on this research, in the early 2000s with a majority of the funding provided by the public sector, Canadian scientists were able to get 1,000 doses of their vaccine manufactured for clinical trials. As a result, during the West Africa Ebola outbreak in 2014, Canada donated 800 doses of its experimental vaccine for use. Meanwhile, the federal government also continued to provide support for clinical trials for the vaccines to be run at the Canadian Centre for Vaccinology in Halifax.
Pharmaceutical giant, Merck, which was originally transferred the Ebola vaccine patent in 2014 for $50 million by NewLink Genetics, has only this year had its vaccine, Ervebo, approved for commercial sale by the US Food and Drug Administration and the European Medicines Agency.
In contrast, the international response to COVID-19 has been robust and consistent. This started with the WHO taking rapid measures to alert the global media of the situation happening in Wuhan, China and the severity of the virus. Following this, pharmaceutical companies globally have been developing a vaccine to COVID-19 with human trials already beginning as of May 2020.
The question then becomes: Why is there such a strong international response to the COVID-19 pandemic by governments, research labs, and pharmaceutical companies, but not towards an ongoing epidemic in Africa? In general, the international response to COVID-19 has been much swifter compared to that of Ebola. In 2015, the WHO was criticised for being too slow in responding to the Ebola outbreak. It waited five months after Guinea and Liberia had notified it of their outbreaks to declare an international public health emergency. COVID-19, comparatively, was identified on December 31, 2019, in Wuhan; on January 5, 2020, the WHO published its first Disease Outbreak News on the new virus, alerting the global media, and by January 30, 2020, the WHO had declared an international public health emergency. This was just one month after COVID-19 was first identified.
In looking at the impacts of these two outbreaks, one cannot turn a blind eye to the apparent disparities between the demographics affected by these viruses. Although there have been deaths outside of Africa due to Ebola, the majority of fatalities have been in low-income African countries such as Guinea, Sierra Leone, and Liberia. Even though the first Ebola outbreak was documented in 1976, one of the reasons why pharmaceutical companies have not jumped to produce a vaccine is likely due to the fact that there is little financial promise for major pharmaceutical companies to invest in vaccines or drugs until the viruses are a threat to countries that have consumers who can afford the medicine. There has been a huge failure on the part of what people term “big pharma” — Merck, Pfizer, GSK, and Sanofi, amongst others — to mount a response to develop a vaccine for Ebola. The World Bank even put the cost of the Ebola outbreak at more than US$32.6 billion by the end of 2015, significantly more than it would have cost to develop an effective therapy to stop the epidemic.
In contrast, there has been a swift international response by the pharmaceutical industry in regard to COVID-19. Specifically, China, the US, Germany, and the UK are leading the way in developing a vaccine for COVID-19. As of May 6, 2020, pharmaceutical giant, Pfizer, had already started human trials.
Now, the question becomes whether these vaccines to the newest global threat will be available to the most vulnerable countries, such as those living in the poorest regions of Africa, or whether there will be a repeat of the events that took place with Tamiflu in 2009 — where the wealthiest nations stockpiled drugs and vaccines?
We may be in for a patent war for the COVID-19 vaccine, with the wealthiest nations looking to control the rights to the vaccines and drugs so that their countries ultimately control distribution of the most sought-after treatment. But hope appears to be on the horizon following the just concluded WHA of the WHO where Costa Rica and Chile secured a technology pooling approach to ensure equitable access to all of COVID-19 health products reminiscent of the DOHA Declaration. Meanwhile, Africa continues to be ravaged not only by COVID-19, but also by Ebola. While we observe the lock-down measures from the comfort of our homes, this is not a reality for people living in parts of Africa. More than two-thirds of people surveyed in 20 African countries said that they would run out of food and water if they observed the 14-day lockdown measures. In Kenya, a widow was forced to cook stones for her eight children to make them believe she had food to feed them.
In the wake of this pandemic, Africa should be praised for its response to COVID-19. The continent has learned from its past experiences with Ebola (and, for that matter, HIV) to be able to prevent transmission at a very early stage. However, the continent now needs to turn its attention to its poorest regions and find a balance between reducing transmission and preventing further social and economic distress to those already living in extreme poverty.
Meanwhile, international pharmaceutical giants are being applauded for their quick discoveries to treat COVID-19 — but their corporate agendas and their failure to respond to the Ebola epidemic in Africa are ethically questionable. Where do we draw the line between scientific discovery, the pharmaceutical patenting process, free trade, and ethical considerations? Will the most vulnerable people in Africa be forgotten again in the wake of a COVID-19 discovery?
Let the thousands of deaths caused by Ebola in Africa serve as a lesson in the midst of COVID-19. The international community must come together to ensure that developing countries, which do not have the infrastructure to deal with a mass pandemic, are provided with equal access to vaccines and drugs as developed countries. Taking into account significant public funds invested across the world in the race for a COVID-19 vaccine and given the global pandemic status of the contagion, there is no alternative to a ‘global public good’ approach to a potential COVID-19 vaccine. However, Africa needs to ramp up its institutional capacity to manufacture such vaccine and other COVID-19-associated health products locally. That would be perhaps the best cost-saving and pragmatic approach under the prevailing circumstances.
· Prof. Oguamanam and Ms. Ramsoomair wrote in from the Open African Innovation Research Partnership at the University of Ottawa