For me, science is about asking not how the world is, but what it could be – asking what if.
Almost six years ago, and just a few months after I joined Wellcome as Director, a two-year-old boy died in a remote Guinean village. His death was the first in an Ebola epidemic which took more than 11,000 lives in less than two years in West Africa. It remains the world’s largest Ebola epidemic.
As 2019 draws to a close, it is in eastern provinces of the Democratic Republic of the Congo (DRC) that Ebola has been devastating communities – for 18 months, in what is now the world’s second largest outbreak.
It is not coincidence that the two largest Ebola epidemics have occurred in the last five years. This is the world we now live in, and it is this world we need to be prepared for. Each death is a tragedy, and healthcare teams face a constant threat of violence as they try to stop Ebola.
Nonetheless, something is now different – something National Geographic last week hailed among the greatest scientific achievements of the decade.
Ebola is now a disease which can be diagnosed, prevented and cured.
The toll in DRC is more than 2,200 deaths and continues to rise. But, since last August, more than 250,000 people in DRC have been protected by Ebola vaccination and, with development of diagnostics and treatments, there are over 1,000 Ebola survivors.
These advances have not, in fact, taken 10 years, but just a little over five. They are achievements made because in 2014 we dared to ask ‘what if’. What if we could make sure research was at the heart of every epidemic response?
There were many who doubted it would be possible.
Epidemics are among our greatest health threats, and they strike quickly. How could vaccine or treatment studies be contemplated, when they take years and require complex ethical and regulatory systems quite unsuited to the speed needed in outbreak responses? And, though a threat to us all wherever we live, epidemics often strike first in regions with the most fragile of health systems.
Despite these considerable challenges, there were researchers, governments, the World Health Organzation (WHO), aid agencies, charities, industry and funders, including Wellcome, willing to come together.
It is thanks to collaborations that in November the European Medicines Agency (EMA) approved licensure of the Merck Ebola Vaccine (Ervebo); that, earlier this year, trials of four potential treatments have identified that two significantly increase the chances of living after being infected with Ebola; and that responders now have detailed information to help them to understand and navigate the complex local contexts in which they are working.
And finally, in Rwanda, Uganda and the DRC trials of a second, complementary, preventative vaccine, from Johnson & Johnson, are underway.
Photographs taken at the beginning of December, capturing hopeful scenes of health leaders from DRC and Rwanda leading a community celebration to launch trials for a second vaccine, go a long way to encapsulating the remarkable progress.
But front of mind too is the experience of almost a year ago, when I joined Dr Tedros, Director-General of the WHO, in a visit to the affected communities in DRC. I hope to return to the region soon.
The security situation in this complex region was then – and remains – febrile. Healthcare teams are, again, under attack and the ongoing Ebola response, which was looking to have stabilised, is again under threat. There is no end to this Ebola epidemic if the violence continues. Healthcare workers must not be a target.
Our thoughts stay with all those brave and dedicated teams putting their lives at risk to protect others.
We must ensure the benefits of this research, the diagnostic tests, the vaccines, the life-saving drugs and the social science work, are available, accessible and affordable to everyone who needs them independent of their ability to pay.
And we must bring the same commitment to conducting research in every epidemic.
Only by doing so can we bring hope and turn these terrifying deadly diseases into something we can prevent, treat and no longer fear.
It is right too, however, that we reflect on what has been achieved, remember that progress is possible, that we can come together to make the world a better place.
Since 2014 Wellcome has provided more than £41m to ensure, in partnership with others, that the world can respond to Ebola. This includes funding for development of vaccines, treatments, diagnostics and social science research.
Through partnership we expand our remit and reach. Recent funding was through the Joint Initiative on Research for Epidemic Preparedness and Response, a partnership with the UK Department for International Development (DFID).
We were also one of the founding partners and provided £80m for the Coalition for Epidemic Preparedness Innovation (CEPI), a global partnership to support development of vaccines to prevent epidemics.