The last four years have seen a dramatic worldwide
rise in ethnic exceptionalism and race-baiting, especially in rich white
societies where poor, coloured people are often described as an infection or
infliction. The level of hostility is quite frightening at times. Sometimes,
reading the world news is a bit like being awash in a tide of hate mail. But
appearances can be deceptive. Behind the blaring headlines there is a
reassuring hum of cooperation and coexistence, nowhere more evident than in
public health initiatives. This is where the discord seems to vanish.
On August 16 came the news of promising results from the trials of four drugs to treat Ebola, one of the world’s deadliest epidemic diseases. Last year’s outbreak in the Democratic Republic of Congo infected 2,619 people and killed 1,823, a mortality rate of 67 per cent. The trials give cause for cheer as all four candidate drugs, Zmapp, remdesivir, REGN-EB3 and mAb114, were reported as being effective in varying degrees. In the case of the latter two there was a drop in mortality rates to 29 per cent and 34 per cent respectively. The cure rates crossed 85 per cent in both cases.
An earlier report in April of trials with Merck’s preventive Ebola vaccine (rVSV-ZEBOV-GP) mentioned a 97.5 per cent efficacy rate. More than 90,000 people were vaccinated; 71 went on to develop Ebola. Fifty-six of them developed symptoms less than 10 days after vaccination. It is believed that 10 are needed for protection to start working. The total number of deaths from this population was nine, according to the World Health Organization report.
While this is a dramatic development, the real story is one of international collaboration for more than a decade focused on just one outcome, a cure. It starts with veteran Congolese microbiologist Jean Jacques Muyembe Tamfun, who helped discover the virus in 1976. In 2005, he transfused the blood from Ebola survivors into eight sufferers. Seven survived. A year later, antibodies developed from two survivors led to the development of mAb114. The race to develop a vaccine is a narrative of international cooperation that includes big pharma, government research agencies such as the US National Institutes of Health, the CDC, and private non-profits. Among the early responders to outbreaks in DRC, Sierra Leone, Guinea, Liberia and other countries in the last two decades were hundreds of medical professionals from across the world, many in their personal capacities. It is worth noting that 10 different approaches, including a nasal spray, are being researched by the Public Health Agency of Canada, the University of Texas-Austin and the China Food and Drug Agency, among others. The Russians too have developed two vaccines for a disease that they have never known but are still willing to spend time and money to find a treatment.
For the pharmaceutical majors the profit to be made from a successful vaccine is certainly a big driver but it is also about science and the desire to cure illness. Take the Meningitis Vaccine Project under the auspices of WHO and the Seattle-based non-profit PATH. It led to the development of a vaccine called MenAfriVac by scientists at the Serum Institute of India (a private company), to be distributed across sub-Saharan Africa where over 400 million people are at risk. By 2012 over 100 million doses had been administered across the region. This is the first time a vaccine was developed for a disease found only in Africa. Moreover, it cost US50 cents a dose against $80 for previous vaccines.
The search for a malaria vaccine is a similar story of worldwide collaborations including both government agencies and pharma majors. The latest iteration to be field tested in Ghana, Kenya and Malawi is a partnership between GlaxoSmithKline and the US Walter Reed Army Institute of Research. An Indian project at the Centre for Cellular and Molecular Biology, Hyderabad also shows promise although an effective vaccine is still some distance away as the virus has a highly complex life cycle. It is also worth remembering that every campaign to eradicate malaria had a worldwide scope. It was never a partisan effort.
Collaborations like this are usually unsung and unheralded but they are the rule rather than the exception. So it is possible that we are more pragmatic than we like to believe and appreciate the worth of working together. A disease like Ebola is a killer anywhere and it makes no sense that Africa should be left alone to deal with it. When we go behind the headlines we see it is an international effort, the reason why it has seen success so quickly. We rarely read this story, however. In ordinary life teamwork is the pattern, in business, academics, especially science, even in the arts and culture, where the individual is prized over the collective. But this simple self-evident fact is forgotten amid the tantrums of partisan politics which thrives on divisions and demonologies.