Ten percent of the world’s children aren’t meeting basic global vaccination standards. New data from the World Health Organization (WHO) and UNICEF estimates that in 2016, nearly 12.9 million infants did not receive any vaccinations. This includes the first dose of the DTP vaccine, which is considered to be an essential vaccination for children.

DTP is the three-round vaccination that protects against diphtheria, tetanus, and pertussis, commonly known as whooping cough. According to a release from WHO and UNICEF, this immunization is “one of the most successful and cost-effective public health interventions,” preventing 2-3 million deaths annually.

The data shows that in 130 of 194 WHO member states, at least 90 percent of infants received their full course of vaccinations at the national level. Additionally, 6.6 million infants failed to complete all three doses of the DTP immunization series after receiving their first dose.

Jean-Marie Okwo-Bele, director of immunization, vaccines and biologicals at WHO, said in the release that lack of vaccination can indicate overall health of children in a region.

“These children most likely have also not received any of the other basic health services,” Okwo-Bele said. “If we are to raise the bar on global immunization coverage, health services must reach the unreached. Every contact with the health system must be seen as an opportunity to immunize.”

Getting to 90 Percent

While 86 percent of children received their routine vaccinations in 2016, WHO’s goal is to vaccinate 90 percent of children globally. The number has remained at about 86 percent since 2010, and the new data shows there has not been any improvement in the last year.

This 90 percent coverage target is part of the agency’s Global Vaccine Action Plan, which was endorsed in May 2012 by WHO member states. To meet this goal, WHO says, “an estimated 10 million additional infants need to be vaccinated in 64 countries, if all countries are to achieve at least 90% coverage.”

Immunization Barriers

Vaccinating these additional 10 million children has proven difficult due to politics and location. Eight countries failed to vaccinate at least 50 percent of their infants against DTP. Most of these nations are war-torn countries like South Sudan and Syria, where conflict has resulted in the destruction of hospitals and health centers, making it difficult for vaccinations to reach many areas.

Unsurprisingly, poverty was also shown to impact how well a country’s children were vaccinated. According to the data, poor, urban populations are most at-risk of being under-immunized. This is a global problem, but particularly in “rapidly growing slums in Africa and Asia,” the release reads.

Robin Nandy, chief of immunizations at UNICEF, said in the release that immunization is “one of the most pro-equity” public health interventions.

“Bringing life-saving vaccines to the poorest communities, women and children must be considered a top priority in all contexts,” Nandy said.

Still, foreign aid and other factors have given some nations the ability to break through the poverty obstacle. Okwo-Bele told NPR that poor countries, like Tanzania, have improved their DTP vaccination rates because of their prioritization of immunizations as a national issue.

“[Tanzania] has had the political will to make immunizations a priority, and with foreign health aid, has built a well-organized system to deliver vaccines where needed, with trusted community health workers and reliable refrigeration for vaccines,” according to NPR.

UNICEF and WHO are continuing to research the impact of economic inequality on vaccination.

Avery Anapol

Avery Anapol is a blogger and freelancer for Law Street Media. She holds a BA in journalism and mass communication from the George Washington University. When she’s not writing, Avery enjoys traveling, reading fiction, cooking, and waking up early. Contact Avery at Staff@LawStreetMedia.com.

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Robert F. Kennedy Jr. said Tuesday that President-elect Donald Trump has asked him to head a panel  that reviews the safety of vaccines. Kennedy is the nephew of President John F. Kennedy and a well-known vaccine skeptic. This news has worried vaccine experts and health workers, as they believe that the president creating such a panel could strengthen vaccine opponents’ beliefs that vaccines cause autism.

“President-elect Trump has some doubts about the current vaccine policy, and he has questions about it,” Kennedy said on Tuesday. Trump’s spokeswoman Hope Hicks later said that Trump is considering forming a committee on autism, but that nothing is certain yet. Kennedy has previously spoken out against vaccinating children, calling it a “holocaust.” In 2015, he spoke at the screening of a film that claimed a link between autism and vaccines, and said:

They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone. This is a holocaust, what this is doing to our country.

JUST IN: Vaccine skeptic Robert Kennedy says he accepted Trump’s offer to chair panel on vaccine safety. https://t.co/BwuF0sJ2pv pic.twitter.com/17k85oXk8p

— Reuters Politics (@ReutersPolitics) January 10, 2017

The conspiracy theory that vaccines cause autism in children is believed to have its origin in a British study that was published in 1998. That study specifically named the vaccine against measles, mumps and rubella, MMR, as the villain. That study has been debunked. But in recent years, there have been some serious outbreaks of measles since some parents have declined to vaccinate their children.

Appointing RFK Jr. to head vaccine safety panel is like appointing David Duke to head panel on race relations. Disgusting & irresponsible.

— Seth Mnookin (@sethmnookin) January 10, 2017

Kennedy wrote an article on the subject in 2005 for the Rolling Stone magazine, in which he argued that the government is covering up the connections between autism and thimerosal, a preservative that used to be an ingredient in vaccines. But there is no evidence for that theory, and thimerosal was never used in MMR vaccines. The article was later deleted because of factual errors.

This theory has been debunked several times, and vaccine experts warn that delaying vaccinating children poses a real danger. Infectious disease expert at the University of Chicago Pritzker School of Medicine, Dr. Daniel Johnson, said that there are many systems constantly overseeing and reviewing the safety of vaccines, so it would be a waste of taxpayer money to create one more. He said denying vaccines could lead to “increased harm, illness and potentially death” from diseases that would easily be prevented by a shot.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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Christmas Prison Break: Six Inmates Escape Through the Toilet

Early Christmas morning, six inmates at a Tennessee jail made a run for it and escaped through a broken toilet. Police captured five of them pretty quickly, but one is still on the loose. David Wayne Frazier is considered the most dangerous escapee and was imprisoned for aggravated robbery and possession of a weapon.

The unusual escape was made possible by a water leak behind a toilet that had damaged the surrounding concrete wall and bolts. The men were able to simply remove the toilet and crawl out through the hole in the wall, according to the Cocke County Sheriff’s office. At least the men got a little bit of freedom on Christmas.

They were able to unscrew and remove the toilet’s bolts, exposing a hole big enough for them to wiggle through https://t.co/oiK4LzvgoA

— New York Post (@nypost) December 26, 2016

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

The post RantCrush Top 5: December 27, 2016 appeared first on Law Street.

It was probably only a matter of time, but vaccination has officially become a political issue. The particular hot topic at the moment is the vaccination of measles. Despite the fact that the virus had been declared “eliminated” from the United States in 2000, there have been approximately 100 cases recently stemming from outbreaks at Disney theme parks–particularly Disneyland in California. Public health officials are encouraging parents to make sure that their children get vaccinated. But that doesn’t mean that it’s not becoming a political conversation–while some politicians like President Barack Obama have encouraged parents to get their children vaccinated, others, like New Jersey Governor Chris Christie have continued to emphasize that it’s an individual choice to be made by parents.

There are plenty of reasons why children don’t get vaccinated–for an in-depth look, check out our issues brief on the topic–but at the most simplistic level, they can get sorted into two camps. The first group are children whose parents choose not to vaccinate them, whether it be because of religious beliefs, concerns about the side effects of vaccines, or whatever other personal reason. The other group is children who physically can’t be vaccinated, usually because they have some sort of allergy to the vaccines, or some illness or condition that would it make it unsafe to be vaccinated. This also includes children who are too young to receive the vaccine–although that’s obviously only a temporary situation. Basically since the measles vaccine became mainstream, those who actually can’t be vaccinated are protected, because those around them can’t get or spread the disease. Unfortunately, as fewer people are vaccinated, that becomes less true, and the spread of measles becomes a legitimate concern.

That being said, it’s not illegal to not vaccinate your child in most places–some states, such as California, are pretty generous when it comes to granting exceptions. Particularly under fire right now are the loopholes that California allows when it comes to its exemption laws, which do require that parents wishing to forego the vaccines undergo “counseling” and get signatures from healthcare professionals. According to Mercury News, those parameters aren’t actually that strict, because:

Counseling can be given by naturopaths, who practice alternative medicine and typically oppose vaccination.

In addition:

People who oppose vaccination because of religious beliefs can skip counseling, a policy change that Gov. Jerry Brown instituted when he signed the updated law.

This has led to a concerning number people in California being unvaccinated–in 2014, 2.5 percent of kindergartners had vaccine exemptions. That doesn’t sound like that many out of context, but that’s pretty much one unvaccinated kid for every other classroom. Children and teens who are unvaccinated are being sent home from school, and there’s a real worry that measles could continue to spread among the unvaccinated population, much of which is clustered into specific schools and neighborhoods.

The CDC put out a statement a few days ago urging any Americans who aren’t vaccinated to do so as soon as possible. President Barack Obama echoed the CDC’s comments on the Today show. However, New Jersey Governor Chris Christie came under fire for a statement he made in response that said that the government should “balance” government and parent interests when it comes to vaccines, saying:

Mary Pat and I have had our children vaccinated and we think that it’s an important part of being sure we protect their health and the public health. I also understand that parents need to have some measure of choice in things as well, so that’s the balance that the government has to decide.

Christie has since clarified that statement, releasing a statement as follows:

The Governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated. At the same time different states require different degrees of vaccination, which is why he was calling for balance in which ones government should mandate.

Obviously this is a clear example of a big difference between Democrats and Republicans–a federal approach vs. a more state-based one is certainly open for debate. That being said, it’s important that our elected officials stay strong and and stand together in encouraging all Americans who are able to get vaccinated or vaccinate their children to do so. There’s a time for politics, but now, with this topic, isn’t it.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Start saving up your sick days. The Centers for Disease Control and Prevention (CDC) says that the upcoming flu season could be severe. The agency expects influenza A (H3N2) to dominate this year. H3N2 causes more hospitalizations and deaths than other flu types and has mutated since this year’s vaccine was created. Is it time for a quarantine? Probably not. But even if you’re vaccinated, you could be purchasing more tissues than usual from now until March as flu season peaks. I’ll break down what you need to know below.

How bad will it be?

Here’s some perspective: last year’s vaccine was only about 50-55 percent effective and experts estimate we won’t even reach those levels this year.

Here’s why

• Ninety-one percent of recent samples are influenza A (H3N2), an influenza (flu) subtype that typically causes more hospitalizations and deaths than other subtypes. (Don’t worry, I’ll explain subtypes later!)

• Over half of these samples don’t match this year’s vaccine because they’re drift variants; they’ve “drifted” to become structurally different from the H3N2 virus used to create this year’s vaccine. The drift could make this season’s vaccine less potent but it’s certainly not useless. In past flu seasons where influenza A (H3N2) drifted, vaccines were about 40 percent effective in stopping the virus. The vaccine still protects against other flu subtypes that haven’t drifted, like influenza A (H1N1) a.k.a the “swine flu.”

So, what is the flu anyway?

The flu we’re talking about should not be confused with the stomach flu, which is really just slang for gastroenteritis. It’s also not a blanket term for any ailment. You only have the flu if you’ve been infected with the flu virus.

A true flu is a viral infection that preys on your nose, throat, and lungs. The flu sees these mucous membranes as ideal ports of entry. Even innocently rubbing your eyes invites the flu into your body. Once the flu gets in, it causes an infection that leaves your respiratory system hampered and makes you feel generally miserable–sneezing, coughing, weak, and sluggish.

This video from Health 360 explains the flu virus and how it invades your body.

Flu Mechanics

Google a picture of a flu virus and you’ll see a circle covered in spikes, kind of like a balding koosh ball. Just like the koosh ball’s rubber fingers make the toy easier to catch, the flu virus’ spikes make the infection easier to catch. The flu virus would be nothing without its spikes.

The viral protein hemagglutinin (H) makes up most of the virus’ spikes. Hemagglutinin causes red blood cells to stick together (hema is heme molecules found in red blood and agglutinate means to stick together). Hemagglutinin enables the virus to attach to a host cell. Viruses can only spread if they hijack a host cell and replicate within it, so you can see why hemagglutinin’s role in host cell attachment is of the utmost importance…to a virus.

The viral protein neuraminidase (N) makes up the rest of the virus’ spikes. After the virus has infected a host cell and replicated itself, neuraminidase (N) allows the replicated virus to escape the host and infect other cells.

So hemagglutinin (H) assists in infecting the host cell and neuraminidase (N) helps the replicated virus proliferate. They work together to infiltrate as many immune systems as possible. Different subtypes of these viral proteins–Hs and Ns–are behind all of the confusing names for different flu viruses like H3N2, H1N1, etc. Let’s end that confusion once and for all.

H?N?: Naming flu types and subtypes

Three types of flu affect humans: A, B, and C.

• Influenza A: Infects both animals and humans and is usually responsible for large epidemics because of its ability to change.
• Influenza B: Infects only humans and is typically less severe than influenza A.
• Influenza C: Infects humans but is the least severe of all the types.

The ABC’s are the least of your worries in understanding flu names. Naming the flu gets complicated when we look at all of the subtypes of the viral proteins (spikes), hemagglutinin (H), and neuraminidase (N) that we just learned about above.

There are 16 possible subtypes of H and nine subtypes of N that can recombine to form 144 different subtypes of the flu virus that are named based on which H and N subtypes they contain. The influenza A virus dominating this year is named H3N2 because it has the viral protein subtypes H3 and N2 decorating its surface.

Viral proteins also come into play when we’re looking at how this year’s vaccine ended up being mismatched with this year’s dominant flu. Even among the 144 different subtypes, something called antigenic drift can cause different strains to form. The drift changes the structure of the viral proteins H and N to be different enough to befuddle your immune system, but not different enough for separate classification.

For example, this year’s dominant strain of influenza A (H3N2) drifted antigenically from the strain used to create the vaccine. So even if you’re vaccinated, your immune system might respond differently if you’re exposed to the newly drifted virus.

The Drifts and Shifts of the Flu

The flu virus has a sneaky habit of changing and tricking the immune system into letting it pass. The change happens through antigenic drift or antigenic shift. The preceding “antigenic” refers to antigens, which trigger your immune response. So the drifts and shifts produce a virus strain with altered antigens that your immune system will respond to differently. The antigens in this case are the viral proteins H and N. Your immune system responds to the shape of H and N subtypes you were vaccinated with. If those shapes change enough, you could have a problem.

Antigenic Drift

Antigenic drift happens when small changes naturally accumulate over time as a virus copies itself. At first, the drifted virus will be antigenically similar enough that a vaccinated immune system can recognize it. But small changes can compound over time so the shapes of the proteins drift enough that even a vaccinated immune system can’t recognize the drifted virus.

Think of a close friend getting a radically different haircut. She’s the same person, but at first glance you might not realize it because she looks completely different. If a virus drifts enough to create an antigenically different strain, the immune system might not be able to recognize and bind to the new shape of the viral proteins.

The flu drifts adeptly so we need to create a new vaccine every year. Drift is also why you’ll probably get the flu more than once in your life.

Antigenic Shift

An antigenic shift causes fast changes that make completely new H and N viral proteins. The virus is so altered that humans have no immunity to it, even if they were vaccinated. This happens when viruses shift from animal populations to infect humans.

Antigenic shift occurs rarely, but it can be devastating. Pandemics and epidemics like the 2009 H1N1 flu pandemic often happen when a flu virus shifts suddenly. Flu viruses usually shift to humans from domestic pigs and poultry. Don’t worry, this year’s dominant influenza A (H3N2) has only drifted not shifted.

Making a Vaccine

Since it takes so long to develop the vaccine, experts have to pick the virus strain they’ll use months in advance. There’s always a good chance the virus will drift in the interim as it has this year.

Private companies make flu vaccines but are subject to FDA safety and efficacy requirements. The FDA has approved three flu vaccines: egg-based, cell-based, and recombinant flu vaccines. The processes vary, but here are the basic steps:

• The CDC or other Influenza Collaborating Center provides the vaccine manufacturer with the vaccine viruses chosen.
• The viruses replicate in a controlled environment.
• The viruses are extracted from their growth host (eggs or cells).
• The manufacturer kills the virus and purifies the viral antigen to produce a vaccine that will not make people who take it sick.
• The manufacturer tests the vaccine before it goes to market.

Historyofvaccines.org has a great animated walk-through of the process. Check it out here.

Then what?

When you get your vaccine–the flu shot–it kind of tricks your body. Immunity builds when you’re exposed to a pathogen, such as a virus. In most cases you have to get sick to build this immunity. When your immune system fights off a virus once, it keeps a memory of the virus in case it returns.

A vaccination gives you the benefits of exposure and immunity building without making you suffer through the actual illness by exposing you to a harmless version of a pathogen. It won’t make you sick, but your immune system responds like a feisty dog that barks at anyone who knocks on your door. The overprotectiveness eventually pays off. If a harmful version of the virus tries to take you down, your immune system will have an immune memory to use in the fight.

That sounds OK, why doesn’t everyone do it?

There’s just something inherently scary and untrustworthy about getting injections. People come up with many fears and excuses for not getting vaccinated. Take a look at the video below.

And the list continues with NPR’s 32 Myths About The Flu Vaccine You Don’t Need To Fear. The good news? Most fears and excuses for not getting vaccinated are unfounded. The bad news? People don’t care if their fears are unsubstantiated.

Researchers have found that foiling flu vaccine myths doesn’t increase a skeptic’s intent to get a vaccine. It actually reduces it. The study suggests that explaining the facts about vaccines might remind people of why they were fearful of getting them in the first place or even give them new information to worry about. This only solidifies their anti-vaccination stance.

So what are we doing about this flu mess?

The CDC maintains that a flu shot is still the best way to protect yourself, but it also urges doctors to prescribe antivirals to people coming in with flu-like symptoms or those at high risk such as children, pregnant women, and adults 65 and older. Antivirals work best within 48 hours of flu symptom appearance, so most doctors will not wait for a positive test to prescribe them.

Is antiviral resistance a problem?

With doctors prescribing medication without lab test confirmation of the ailment, you might be wondering if antiviral resistance is a concern. Yes, it’s actually an inherent problem since the rapid replication process of viruses leads to mutations that can evade antivirals as well as immune systems and vaccines. Some strains of influenza have already become resistant to drugs that have been on the market for a while like oseltamivir, amantadine,  and rimantadine.

What are the benefits?

Results from past flu seasons and the 2009 H1N1 flu pandemic show that these drugs can reduce potentially devastating effects of influenza. Clinical trials and observation show reductions in symptoms, complications, and deaths from influenza with antiviral use.

All Things Considered, It’s Not So Bad

With its fast and unpredictable changes and complicated subtypes, the flu presents a formidable enemy for modern medicine. Flu shots and antivirals aren’t the perfect weapons, but they’re more effective than entering the battle unarmed. So how bad is this flu season going to be? Probably worse than last year’s, but a pandemic doesn’t seem likely.

Resources

Primary

CDC: Early Data Suggest Potentially Severe Flu Season

CDC: Health Advisory Regarding the Potential for Circulation of Drifted Influenza A (H3N2) Viruses

CDC: Types of Influenza Virus

CDC: How the Flu Virus Can Change: “Drift” and “Shift”

CDC: How Influenza (Flu) Vaccines Are Made

NIH: New Vaccine Technologies

Additional

Mayo Clinic: Influenza Treatments and Drugs

Synapse: “Flu” – Recombinant Genes on the Loose!

Science Daily: Correcting Myths About the Flu Vaccine: Effective?

Virology: Structure of Influenza Virus

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Are We in for a Bad Flu Season? appeared first on Law Street.

The recent Ebola outbreak is plaguing thousands across West Africa with illness and even death. In the modern age of science, it seems incomprehensible that there is not yet a vaccine for Ebola. Though the virus is an urgent health concern, pharmaceutical companies have few incentives to develop drugs to combat the disease. Read on to learn what happens when economic incentives do not align with public health needs, and what better solutions may exist for drug development.

What is the status of the Ebola outbreak and vaccine?

Ebola virus disease is characterized by fever, intense weakness, and muscle pain, leading to more severe symptoms. Ebola was initially transmitted by animals and is now spreading between humans through contact with bodily fluids. The outbreak was first detected in Guinea, by which time it had already spread to Liberia, Sierra Leone, Senegal, and Nigeria. A separate outbreak occurred in the Democratic Republic of Congo, which is believed to be unrelated to the outbreak in West Africa. The virus has primarily infected villages where there is extreme poverty and insufficient medical care to combat the spread of the virus.

Statistics

Mortality rates for the Ebola virus are well over 50 percent. Since March, Ebola has killed more than 1,500 people, making it the deadliest outbreak of the virus in human history. The World Health Organization estimates that the Ebola outbreak could affect 20,000 within the next nine months, and that roughly half a billion dollars is needed to stop the spread. Watch the video below for more information on the outbreak:

Vaccines

Ebola first appeared in 1976, yet nearly 40 years later no approved vaccination exists. In part this is due to the nature of the virus. Since incidents of Ebola are rare and occur in remote villages, it is difficult for scientists to effectively obtain samples and study the disease. Scientists cannot predict when an Ebola outbreak will occur, and even during a typical outbreak there are rarely enough people for a vaccine trial.

Since the outbreak, scientists are furiously working on an Ebola vaccine, and requests for approval are being fast-tracked. In the United States, the National Institutes of Health partnered with GlaxoSmithKline to develop a vaccine. The potential vaccine tested very well on primates, but the trial on humans only began on September 1. Initial data from the trial will not be available until late 2014. A number of other prototype vaccines are being worked on across the world.

Other Treatments

ZMapp was the experimental drug given to two Americans who contracted Ebola this year. While vaccines are designed to prevent future infections, ZMapp was designed to treat an existing Ebola infection. Both Americans who took the drug recovered, but the company that manufactured ZMapp has exhausted its supply.

What is the drug development process like?

Developing a new drug or vaccine is an extremely long process due to stringent regulation. Candidates for a new drug to treat a disease range anywhere from 5,000 to 10,000 chemical compounds. Of these compounds, roughly 250 will show promise enough to warrant further tests on mice or other animals. On average, ten of these will then qualify for tests on humans. Since certain outbreaks, such as Ebola, do not lend themselves to have vaccines ethically tested on humans, the United States does provide a way for the drugs to be approved on animal tests alone.

Pre-clinical and clinical development for a new drug takes between 12 to 15 years, though the Ebola vaccine should come much sooner. Pre-clinical development includes testing the various chemical entities and meeting all regulations for use. Three sets of clinical trials are then conducted on humans. Clinical phases include trials on healthy humans to test for the safety of the drug. Testing then moves to those who are ill to see if the treatment is successful. If successful, the drug is submitted for further approval by the Food and Drug Administration. Other countries have similar regulatory bodies to the FDA. Internationally, the World Health Organization oversees which drugs can be used to combat a crisis like Ebola. Learn more details about the development process by watching the video below:

The problem is not that scientists lack the capability to create an Ebola vaccine, but rather that the economics of drug development do not entice companies to develop such a vaccine. Pharmaceutical companies estimate the cost of the entire process of developing a new drug to range from hundreds of millions to billions of dollars. Many times the drugs are not successful, in which case the companies have spent a huge amount of money and have no profit-making product. A Forbes analysis estimates that 95 percent of experimental drugs tested ultimately fail. Only one in five that reach the clinical trial phase are approved.

Given the low rate of success for potential drugs and the huge amounts of money that can be spent on research and development of drugs, cost plays a huge factor. In the United States, basic discovery research is funded primarily by government and philanthropic organizations. Development in later stages is funded mostly by pharmaceutical companies or venture capitalists.

Why do some see funding as a problem?

Funding for areas that support public health is a tricky issue. Since pharmaceutical companies are looking to make a profit, they have an incentive to make drugs that a large number of people will take and be on for a long time. Most research and development for these companies target diseases that affect wealthy people in primarily Western countries.

Targeting wealthier clients leads to a severe underinvestment in certain kinds of drugs. Diseases of poverty cannot compete for investment from financial companies looking for big return. Ebola infects relatively few and primarily affects the poor. Ebola is similar to diseases like malaria and tuberculosis, which kill two million people each year but still receive little attention from pharmaceutical companies. Watch the video below for more on the economics of drug development:

Neglected Tropical Diseases, a set of 17 diseases including Dengue Fever and Chagas Disease, affect more than one billion people each year and kill half a million. Most of these diseases could be completely eradicated, but the drugs are not widely available. One study found that of the more than 1,500 drugs that came to market between 1975 and 2004, only ten were aimed at these diseases.

Even though developing countries may experience an outbreak of a disease, the demand for new drugs is limited. In rural villages in Africa, many reject clinical drugs for diseases such as Malaria and Tuberculosis. Instead, they favor spiritual healers and herbal remedies.

What is being done to promote drug research of neglected diseases?

The Office of Orphan Products Development (OOPD) in the FDA was designed to advance development of products that could be used to diagnose or treat rare diseases affecting fewer than 200,000 people. Orphan diseases do not traditionally receive much attention from pharmaceutical companies. The program provides a tax credit of up to 50 percent for research and development of drugs for rare diseases. When these drugs do become available, however, there is still no guarantee that patients will be able to afford them.

Since 1983 the OOPD program successfully enabled the development and marketing of more than 400 drugs and products. In the ten years prior, only ten of these products came to the market. Learn more about the OOPD with the video below:

Additionally, in 2007 the FDA created a voucher program to encourage research for neglected diseases. If a company receives approval for a drug for neglected diseases, it will receive a priority review voucher to speed up the review time for another application. Only four of these vouchers have been awarded so far.

Are there better ways to fund drug research?

Some argue that researching very rare diseases is not worth the time, and that instead research should be focused on more prevalent diseases. Companies will naturally invest in research for the most pressing concerns that offer the greatest opportunity for profit. Drug development for rare diseases should not be encouraged since the diseases occur so infrequently. Others argue research for rare diseases is essential to public health. The case of Ebola shows that even rare diseases can have a disastrous world impact.

Bioterrorism

Beyond public health, knowledge about the workings of any serious virus or disease is important to combat threats of bioterrorism. Concerns of bioterrorism are what led to Ebola research in the past. Serious threats of bioterrorism force the government to partner with research institutions to learn more about rare diseases. In March, the University of Texas and three other organizations received $26 million from the National Institutes of Health to find a cure for Ebola and the Marburg virus in case they were ever used for a bioterrorist attack. Other groups partnered with the Department of Defense to find an injectable drug treatment for Ebola.

Prizes

Prizes and grants are seen as ways to incentivize companies to develop drugs for diseases they might otherwise ignore. Financial incentives would encourage speedy development for an Ebola vaccine. The World Health Organization has looked into building a prize fund, where a centralized fund would reward drug manufacturers for reaching certain research goals. These tactics are more cost effective for the government, since they only have to pay if the product actually works. By creating grants for specific drugs, the government can pull research into neglected areas. Most prizes and grants, however, are not offered until a severe outbreak occurs, by which time many people are already in need of drugs.

Partnerships

Others point to room for greater partnerships between various entities for drug development. The greatest area for partnerships is between development groups and pharmaceutical companies. For instance, if a company pays to research and develop a product, the government could pay the company for the right to the product and could then promote the product itself without worrying about profit. In another case, GlaxoSmithKline and Save the Children arranged for someone from the charity to be on GSK’s research and development board, so the groups can share expertise and resources.

The Ebola outbreak indicates areas in which our current drug development model is lacking. People are dying because no Ebola vaccine exists. When pharmaceutical companies search only for profits, drugs for rare diseases go neglected. By expanding partnerships and offering greater prizes and financial incentives, the government can encourage drug research for these otherwise neglected diseases.

Resources

Primary

WHO: Ebola Virus Disease

FDA: Developing Products for Rare Diseases

CDC: Experimental Treatments and Vaccines for Ebola

Additional 

CNN: Ebola Outbreak: Is it Time to Test Experimental Vaccines?

Vector: De-risking Drug Development

Guardian: Funding Drug Development for Diseases of Poverty

Reuters: Scant Funds, Rare Outbreaks Leave Ebola Drug Pipeline Slim

Explorable: Research Grant Funding

Vox: We Have the Science to Build an Ebola Vaccine

American Society for Microbiology: Ebola Virus Pathogenesis

NBC: No Market: Scientists Struggle to Make Ebola Vaccines

Wall Street Journal: Two Start-Ups Aim to Change Economics of Vaccine Production

NPR: Would a Prize Help Speed Up Development of Ebola Treatments?

Harvard Global Health Review: Funding Orphan Drugs

LA Times: U.S. Speeds Up Human Clinical Trials

Washington Post: Why the Drug Industry Hasn’t Come Up with an Ebola Cure

New Yorker: Ebolanomics

Alexandra Stembaugh

Alexandra Stembaugh graduated from the University of Notre Dame studying Economics and English. She plans to go on to law school in the future. Her interests include economic policy, criminal justice, and political dramas. Contact Alexandra at staff@LawStreetMedia.com.

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