07:52
TED2015

Seth Berkley: The troubling reason why vaccines are made too late ... if they’re made at all

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It seems like we wait for a disastrous disease outbreak before we get serious about making a vaccine for it. Seth Berkley lays out the market realities and unbalanced risks behind why we aren't making vaccines for the world's biggest diseases.

- Vaccine visionary
Epidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world. Full bio

The child's symptoms begin
00:13
with mild fever, headache, muscle pains,
00:15
followed by vomiting and diarrhea,
00:18
then bleeding from the mouth,
nose and gums.
00:21
Death follows in the form of organ failure
from low blood pressure.
00:25
Sounds familiar?
00:31
If you're thinking this is Ebola,
00:33
actually, in this case, it's not.
00:36
It's an extreme form of dengue fever,
a mosquito-born disease
00:38
which also does not have
an effective therapy or a vaccine,
00:43
and kills 22,000 people each year.
00:48
That is actually twice
the number of people
00:52
that have been killed by Ebola
00:54
in the nearly four decades
that we've known about it.
00:56
As for measles, so much
in the news recently,
01:00
the death toll is actually tenfold higher.
01:04
Yet for the last year,
01:09
it has been Ebola that has stolen
all of the headlines and the fear.
01:11
Clearly, there is something
deeply rooted about it,
01:17
something which scares us
and fascinates us
01:19
more than other diseases.
01:22
But what is it, exactly?
01:24
Well, it's hard to acquire Ebola,
01:27
but if you do, the risk
of a horrible death is high.
01:29
Why?
01:33
Because right now, we don't have any
effective therapy or vaccine available.
01:34
And so, that's the clue.
01:40
We may have it someday.
01:43
So we rightfully fear Ebola,
01:45
because it doesn't kill
as many people as other diseases.
01:48
In fact, it's much less transmissible
than viruses such as flu or measles.
01:53
We fear Ebola because of the fact
that it kills us and we can't treat it.
01:59
We fear the certain inevitability
that comes with Ebola.
02:05
Ebola has this inevitability
that seems to defy modern medical science.
02:08
But wait a second, why is that?
02:14
We've known about Ebola since 1976.
02:16
We've known what it's capable of.
02:20
We've had ample opportunity to study it
02:22
in the 24 outbreaks that have occurred.
02:24
And in fact, we've actually had
vaccine candidates available now
02:27
for more than a decade.
02:31
Why is that those vaccines
are just going into clinical trials now?
02:33
This goes to the fundamental
problem we have
02:38
with vaccine development
for infectious diseases.
02:41
It goes something like this:
02:45
The people most at risk for these diseases
02:47
are also the ones least able
to pay for vaccines.
02:50
This leaves little in the way
of market incentives
02:55
for manufacturers to develop vaccines,
02:59
unless there are large numbers of people
who are at risk in wealthy countries.
03:02
It's simply too commercially risky.
03:07
As for Ebola, there is absolutely
no market at all,
03:11
so the only reason we have two vaccines
in late-stage clinical trials now,
03:15
is actually because
of a somewhat misguided fear.
03:21
Ebola was relatively ignored
03:24
until September 11
and the anthrax attacks,
03:27
when all of a sudden,
people perceived Ebola
03:32
as, potentially, a bioterrorism weapon.
03:34
Why is it that the Ebola vaccine
wasn't fully developed at this point?
03:37
Well, partially, because
it was really difficult --
03:42
or thought to be difficult --
to weaponize the virus,
03:44
but mainly because
of the financial risk in developing it.
03:47
And this is really the point.
03:53
The sad reality is, we develop vaccines
03:55
not based upon the risk
the pathogen poses to people,
03:58
but on how economically risky it is
to develop these vaccines.
04:02
Vaccine development
is expensive and complicated.
04:06
It can cost hundreds
of millions of dollars
04:09
to take even a well-known antigen
and turn it into a viable vaccine.
04:11
Fortunately for diseases like Ebola,
04:17
there are things we can do
to remove some of these barriers.
04:19
The first is to recognize
when there's a complete market failure.
04:23
In that case, if we want vaccines,
04:27
we have to provide incentives
or some type of subsidy.
04:30
We also need to do a better job
at being able to figure out
04:36
which are the diseases
that most threaten us.
04:40
By creating capabilities within countries,
we then create the ability
04:43
for those countries to create
epidemiological and laboratory networks
04:48
which are capable of collecting
and categorizing these pathogens.
04:52
The data from that then can be used
04:58
to understand the geographic
and genetic diversity,
05:00
which then can be used
to help us understand
05:03
how these are being changed
immunologically,
05:06
and what type of reactions they promote.
05:10
So these are the things that can be done,
05:13
but to do this, if we want to deal
with a complete market failure,
05:15
we have to change the way
we view and prevent infectious diseases.
05:19
We have to stop waiting
until we see evidence
05:24
of a disease becoming a global threat
before we consider it as one.
05:28
So, for Ebola,
05:34
the paranoid fear
of an infectious disease,
05:36
followed by a few cases
transported to wealthy countries,
05:40
led the global community to come together,
05:45
and with the work
of dedicated vaccine companies,
05:48
we now have these:
05:51
Two Ebola vaccines in efficacy trials
in the Ebola countries --
05:54
(Applause)
06:00
and a pipeline of vaccines
that are following behind.
06:06
Every year, we spend billions of dollars,
06:10
keeping a fleet of nuclear submarines
permanently patrolling the oceans
06:13
to protect us from a threat
that almost certainly will never happen.
06:18
And yet, we spend virtually nothing
06:23
to prevent something as tangible
and evolutionarily certain
06:26
as epidemic infectious diseases.
06:31
And make no mistake about it --
it's not a question of "if," but "when."
06:35
These bugs are going to continue to evolve
06:38
and they're going to threaten the world.
06:41
And vaccines are our best defense.
06:44
So if we want to be able to prevent
epidemics like Ebola,
06:47
we need to take on the risk
of investing in vaccine development
06:51
and in stockpile creation.
06:55
And we need to view this, then,
as the ultimate deterrent --
06:58
something we make sure is available,
07:02
but at the same time,
praying we never have to use it.
07:05
Thank you.
07:09
(Applause)
07:10

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About the Speaker:

Seth Berkley - Vaccine visionary
Epidemiologist Seth Berkley is leading the charge to make sure vaccines are available to everyone, including those living in the developing world.

Why you should listen

Seth Berkley is an epidemiologist and the CEO of Gavi, the Vaccine Alliance, the global health organization protecting lives by improving access to vaccines in developing countries. Seth joined Gavi in 2011 in a period of rapid acceleration of Gavi’s programs. Now, with more than half a billion children immunized, he is leading Gavi’s efforts to reach a further 300 million children in the next five years and build sustainability into country immunization programs. Prior to Gavi, he spearheaded the development of vaccines for HIV as founder and CEO of the International AIDS Vaccine Initiative.

More profile about the speaker
Seth Berkley | Speaker | TED.com