CEPI will fund researchers to test vaccines against these three diseases in mice and monkeys. It will run early trials in humans to show that the vaccines are safe, and that they correctly educate the immune system. And it will plan the final large-scale trials that will run during an outbreak to see if the vaccines actually work. Such trials involve a morass of logistics, ethical approvals, and legal arrangements. “The Ebola outbreak showed that this can happen very quickly,” says Lee. “Legal agreements that could take years were agreed in months. But if things can be agreed ahead of time, it would speed things up even more.”
That agreement is vital: In an outbreak, bureaucracy costs time and lives. By agreeing on pathways for getting their vaccines approved, manufactured, and distributed, CEPI’s goal is to ensure that there are as few obstacles as possible between their vaccines and someone’s arm. When an epidemic hits, health workers can be given a ready-made product, which they know is safe and probably effective, and deploy it according to a ready-made plan.
Speaking of Ebola, CEPI will also be working with the American pharmaceutical company Merck to get the rVSV vaccine through regulatory approval, so that it’s ready for the next outbreak. And it will fund the development of more Ebola vaccines, since rVSV only works against one of the several dangerous strains. “The vaccine was a turning point for global health, but we haven’t finished the job,” says Farrar.
He has even bigger ambitions for CEPI. “My dream would be that 10 to 20 years from now, we have a vaccine for every one of the 37 infections on Mark Woolhouse’s list,” he says. “That won’t be possible for everything, but Ebola showed that there are many infections for which a vaccine is eminently makeable.”
Trevor Mundel, the president of the Global Health Division at the Bill & Melinda Gates Foundation, thinks that dream’s within reach. In creating vaccines for MERS, Nipah, and Lassa fever, he believes that CEPI will push techniques that could be used to rapidly make vaccines for any number of viral diseases—including ones we don’t expect.
A new class of vaccines, known as RNA vaccines, can help with that. Most current vaccines work by presenting the immune system with dead microbes, weakened microbes, or bits of microbes. The Ebola rVSV vaccine, for example, was created by genetically engineering a different virus to make an Ebola protein. When you inject someone with that virus, their immune system can study the protein and prepare defenses against an actual Ebola infection.
But proteins are made using instructions encoded in a molecule called RNA. So instead of injecting someone with the Ebola protein, you could instead give them the RNA instructions and get their own cells to make the protein. In this way, you’re transforming the patient’s own body into a vaccine factory.