Ebola Outbreak – Could PPPs Be The Solution?

The Ebola outbreak in Guinea, Sierra Leone and Liberia is so out of control that governments have resorted to approaches similar to the medieval-era disease control approach last used in 1918: the “cordon sanitaire” whereby no one is allowed out of a barricade established around an infected area.

According to the World Health Organisation (WHO), the epidemic that began in Guinea in December 2013 has now become the largest, most severe and most complex outbreak of the Ebola virus disease in history and has so far resulted in more than 1,800 clinical cases and 1,000 deaths.

This desperate situation begs three questions: why is Ebola so deadly, why isn’t there a cure or vaccine for it and what can African governments do?

Sporadic nature

The lack of any licensed treatment or vaccine against Ebola is attributable to many factors; key among them the sporadic nature of the disease which has raised little interest on the part of pharmaceutical companies to invest in developing treatments or vaccines.

With the exception of the current outbreak, all previous outbreaks dating back to the first one in the Democratic Republic of Congo in 1976 have been in sparsely populated areas and have “burned themselves out”.In this regard, there has not been a market, as it were, for therapies and vaccines against Ebola.

This factor is further compounded by the fact that developing therapies for human diseases is time-consuming and expensive. For instance, analysis, innovating and bringing a new therapy or vaccine to the public market typically takes an average of 10 to 15 years and costs approximately $1 billion.

Reactive governments

Despite the fact that all 20 Ebola outbreaks in history have been in Africa, they have been resolved by the same approach: teams of foreign health specialists fly in, recruit local health workers and set up field hospitals where Ebola victims are quarantined.

African governments have so far been reactive rather than proactive – and since most of them have more elaborate armies than healthcare systems, armies are often deployed to cordon off infected areas. There has not been significant investment into biomedical research (including research into potential therapies for Ebola) by African governments.

The Ebola outbreak is, therefore, a wake-up call for African governments to focus attention on biomedical research and long-term improvement of health system infrastructures.

What can African Governments do?

While most African governments do not have substantial financial resources for biomedical research, E&K Health Consulting proposes a win-win strategy to go round this challenge. We propose the following:

1. Public private partnerships (PPPs) between African governments and pharmaceutical/biotechnological companies some of which are keen to increase and diversify their investments in Africa.

1. Investment diversification in research and development (R&D). A case in point is the recent announcement on March 31 by GlaxoSmithKline (GSK) to invest approximately 130 million pounds in R&D in Africa GSK Press release 31 march 2014. Another example is the growing investment by Novartis in capacity building for research in Africa through the Novartis Institute for Biomedical Research (NIBR) and Novartis Africa University Novartis.

1. Engaging with pharmaceutical companies and negotiating for mutually beneficial partnerships. For instance, governments can offer laboratory spaces at their public universities (most of which are not fully utilized and ill-equipped) to pharmaceutical companies at a subsidized rate (thus attracting pharma companies to set up R&D laboratory with government as opposed to leasing out expensive laboratory space in the general market). In return, governments should negotiate to have therapies and vaccines against bugs like the Ebola virus included in the research objectives of these R&D labs and for ownership of these laboratories after the PPPs lapse. Public universities should also negotiate capacity building agreements with these pharmaceutical companies whereby university staff work at these R&D labs as they are trained in biomedical specialties. In the short term pharmaceutical companies will save on R&D costs since they do not have to import all their personnel from outside Africa to work in these labs. In the long term public universities will build capacity that can continue to work on these research objectives beyond the terms of the PPPs.

The issue of ownership of intellectual property and patents will need to be negotiated too. One thing for sure, regardless of IP/ patent ownership, is that governments should push for an agreement whereby proceeds of this research (therapies and vaccines) are made available to vulnerable populations in African countries at affordable prices. Such agreements have been negotiated for previous vaccines and should therefore be feasible in future engagements.