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

The child's symptoms begin

with mild fever, headache, muscle pains,

followed by vomiting and diarrhea,

then bleeding from the mouth,

nose, and gums.

Death follows in the form of organ failure

from low blood pressure.

Sounds familiar?

If you're thinking this is Ebola,

actually in this case it's not.

It's an extreme form of dengue fever,

a mosquito-born disease which also does
not have effective therapy or a vaccine

and kills 22,000 people each year.

That is actually twice
the number of people

that have been killed by Ebola

in the nearly four decades
that we've known about it.

As for measles, so much
in the news recently,

the death toll is actually tenfold higher.

Yet for the last year,

it has been Ebola that has stolen
all of the headlines and the fear.

Clearly, there is something
deeply rooted about it,

something which scares us
and fascinates us

more than other diseases.

But what is it exactly?

Well, it's hard to acquire Ebola,

but if you do, the risk
of a horrible death is high.

Why?

Because right now, we don't have any
effective therapy or vaccine available.

And so that's the clue.

We may have it someday.

So we rightfully fear Ebola

because it doesn't kill
as many people as other diseases.

In fact, it's much less transmissible
than viruses such as flu or measles.

We fear Ebola because of the fact
that it kills us and we can't treat it.

We fear the certain inevitability
that comes with an Ebola.

Ebola has this inevitability
that seems to defy modern medical science.

But wait a second, why is that?

We've known about Ebola since 1976.

We've known what it's capable of.

We've had ample opportunity to study it
in the 24 outbreaks that have occurred.

And in fact, we've actually had
vaccine candidates available now

for more than a decade.

Why is that those vaccines are just
going into clinical trials now?

This goes to the fundamental problem
we have with vaccine development

for infectious diseases.

It goes something like this:

the people most at risk for these diseases

are also the ones least able
to pay for vaccines.

This leaves little in the way
of market incentives

for manufacturers to develop vaccines

unless there's large numbers of people
who are at risk in wealthy countries.

It's simply too commercially risky.

As for Ebola, there is absolutely
no market at all,

so the only reason we have two vaccines
in late stage clinical trials now

is actually because
of a somewhat misguided fear.

Ebola was relatively ignored

until September 11 and the anthrax attacks

when all of a sudden,
people perceived Ebola

as potentially a bioterrorism weapon.

Why is it that the Ebola vaccine
wasn't fully developed at this point?

Well partially, because
it was really difficult

or thought to be difficult
to weaponize the virus,

but mainly because of the financial risk

in developing it,

and this is really the point.

The sad reality is, we develop vaccines
not based upon the risk

the pathogen poses to people,

but on how economically risky it is
to develop these vaccines.

Vaccine development
is expensive and complicated.

It can cost hundreds of millions of dollars
to take even a well-known antigen

and turn it into a viable vaccine.

Fortunately for diseases like Ebola,

there are things we can do
to remove some of these barriers.

The first is to recognize
when there's a complete market failure.

In that case, if we want vaccines,

we have to provide incentives

or some type of subsidy.

We also need to do a better job

at being able to figure out which
are the diseases that most threaten us.

By creating capabilities within countries,

we then create the ability
for those countries to create

epidemiologic and laboratory networks

which are capable of collecting
and categorizing these pathogens.

The data from that then can be used

to understand the geographic
and genetic diversity,

which then can be used
to help us understand

how these are being changed
immunologically

and what type of reactions they promote.

So these are the things that can be done,

but to do this, if we want to deal
with a complete market failure,

we have to change the way we view
and prevent infectious diseases.

We have to stop waiting
until we see evidence

of a disease becoming a global threat

before we consider it as one.

So for Ebola,

the paranoid fear of an infectious disease

followed by a few cases
transported to wealthy countries

led the global community to come together,

and with the work
of dedicated vaccine companies,

we now have these

two Ebola vaccines in efficacy trials

in the Ebola countries.

(Applause)

And a pipeline of vaccines
that are following behind.

Every year, we spend billions of dollars

keeping a fleet of nuclear submarines
permanently patrolling the oceans

to protect us from a threat

that almost certainly will never happen,

and yet we spend virtually nothing

to prevent something as tangible

and evolutionary certain
as epidemic infectious diseases.

And make no mistake about it,
it's not a question of if but when.

These bugs are going to continue to evolve

and they're going to threaten the world,

and vaccines are our best defense.

So if we want to be able to prevent
epidemics like Ebola,

we need to take on the risk
of investing in vaccine development

and in stockpile creation,

and we need to view this then

as the ultimate deterrent:

something we make sure is available,

but at the same time praying
we never have to use it.

Thank you.

(Applause)