On Wednesday, November 12, HHS Secretary Sylvia Burwell and Homeland Security Secretary Jeh Johnson will appear before the Senate Appropriations Committee to testify on the government’s response to Ebola. CDC Director Dr. Thomas Frieden, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, as well as other officials from the State Department, Defense Department, USAID and the Joint Chiefs of Staff are also expected to testify.
Challenges and Incentives for Development
The companies that are working to come up with vaccines and treatments for Ebola are faced with several challenges that arise from the nature of the disease. The first difficulty is that the disease is unpredictable, so it is difficult to find people who are at high risk to test any vaccine or antibiotic (see ‘No Market’: Scientists Struggle to Make Ebola Vaccines, Treatments). Another challenge that drug companies face is the rarity of Ebola outbreaks. With the infrequency of the outbreaks and the small number of patients being impacted, it is difficult to motivate the private sector into supplying the millions of dollars necessary to research a vaccine or antibiotic.
Senators Tom Harkin (D-IA) and Lamar Alexander (R-TN) are planning to introduce a bill that would fast-track the creation of Ebola treatments by offering incentives to drug companies. The respective bipartisan leaders of the Senate HELP Committee say their bill would accelerate processing a company’s drug application for Ebola within about six months through a program called “priority review.” As an added incentive, companies would also earn a bonus voucher for another drug of their choice to receive priority review, even if it’s not meant to treat a neglected disease like Ebola. Harkin and Alexander plan to introduce their bill when Congress reconvenes for the post-election lame-duck session.
Vaccine trials- FDA weighs-in on importance of placebos
GlaxoSmithKline, in a joint effort with the US National Institutes of Health and the World Health Organization (WHO), has begun Phase 1 Safety trials in humans. The BBC News just ran an interesting article yesterday entitled Volunteering to test Ebola vaccine in Mali. Dr Samba Sow, an infectious disease epidemiologist and vaccine expert and director of Centre for Vaccine Development (CVD) in Mali, provided some good news: "We know that after two weeks they're starting to have some immune response and there are no adverse reactions."
Currently, however, trials do not involve the use placebos.
FDA officials speaking at a tropical medicine conference in New Orleans Wednesday said experimental Ebola drugs should be tested in randomized controlled trials -- a "gold standard" form of drug assessment that involves giving some ill patients a placebo. Edward Cox, director of the FDA’s Office of Antimicrobial Products, stated that “[w]hile randomized trials would be ‘challenging,’ they’re needed to understand whether or how well the medicines work.” Trials would compare “the best supportive care versus the best supportive care with a drug,” he said.
Bloomberg's coverage notes that using placebos in West Africa has created an “ethical debate pitting one of the world’s deadliest pathogens against the need to better understand exactly which drugs are most effective."
The National Institute of Health also recently announced that they were beginning human trials on a new Ebola vaccine. Human testing of this second investigational Ebola vaccine candidate is under way at the NIH’s Clinical Center in Bethesda, Maryland. Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) are conducting the early phase trial to evaluate the vaccine, called VSV-ZEBOV, for safety and its ability to generate an immune system response in healthy adults who are given two intramuscular doses, called a prime-boost strategy. The Walter Reed Army Institute of Research (WRAIR) is simultaneously testing the candidate as a single dose at its Clinical Trials Center in Silver Spring, Maryland.
Profectus BioSciences has received around $27m, and is working first on the vaccine for Ebola Zaire, the strain that has killed thousands in West Africa this year, with plans to advance it to clinical trials by June 2015. “Unlike previous investments that focused on a vaccine designed specifically for the strain of Ebola present in the outbreak, Profectus' most recent contract focuses on a vaccine that would offer more broad protection against two types of Ebola as well as the Marburg virus, which causes hemorrhagic fever similar to Ebola,” notes the Baltimore Sun. “By fall, the company plans to begin testing of what is a called a "trivalent" vaccine that would build immunity to three pathogens – Ebola Zaire, Ebola Sudan and Marburg,” according to Profectus President Jeffrey Meshulam.
Across the Atlantic, the Europe Union and pharmaceutical companies pledged yesterday to invest 280 million euros ($350 million) in Ebola research, “with the lion's share going to the testing and manufacture of potential vaccines,” Reuters reports. “The funding will go to projects backed by the Innovative Medicines Initiative (IMI), a public-private scheme jointly paid for by the European Commission and the pharmaceuticals industry.”