The world is once again on the brink of a deadly pandemic, with the ongoing Ebola outbreak in the Democratic Republic of the Congo posing a grave threat. As the global health community scrambles to contain the spread, one organization stands out as a beacon of hope: the Coalition for Epidemic Preparedness Innovations (CEPI). CEPI, a pandemic-busting alliance of government bodies, scientific outfits, and civil organizations, has poured $87 million into three possible weapons against the disease, a shot in the arm for three Bundibugyo vaccine candidates in early stages of development. This is a scattergun strategy that paid dividends during the last pandemic, with CEPI investing in 14 vaccine candidates, of which seven got to some form of licensure during the COVID-19 pandemic. CEPI has become a cornerstone of the world's response to deadly new pathogens, financing science aimed at crafting new countermeasures to emerging diseases in a pandemic-prone world. It also runs disease control war games with laboratories and governments, setting a University of Queensland lab the challenge of crafting a vaccine for a bloody, deadly virus spread by the pygmy rice rat in 150 days. Some practice drills have proved eerily prescient, with a real-life outbreak of Marburg, a haemorrhagic fever, occurring in Rwanda at the same time as a CEPI exercise involving the Rwandan government. The government leapt into action, launching contact tracing and door-to-door surveillance while calling in CEPI and its partners to find a vaccine candidate. CEPI is facilitating ways to overlap stages of vaccine development, streamlining the process so that if a vaccine succeeds, it can be released as soon as possible. This approach does risk burning cash if a candidate falls over, but CEPI believes that the world should pay a premium to get something that works. The world has no answer to Bundibugyo, even though it is so deadly and devastating, partly because it is too rare to guarantee market return for developers. CEPI has committed $87 million in "push" funding to get new vaccine candidates tested, while Gavi, the Vaccine Alliance, has cleared $US40 million ($57 million) in "pull" funding to build production capability even before a vaccine is guaranteed to work. CEPI has tipped $US50 million into preclinical testing and clinical trials for a Moderna Bundibugyo ebolavirus vaccine candidate, while manufacturing enough doses so that large-scale phase 2 and 3 trials can launch immediately if phase 1 succeeds. CEPI is also fast-tracking a third vaccine option with $US8.6 million based on the University of Oxford’s ChAdOx1 platform, which harnesses a weakened virus that causes the common cold in chimpanzees to deliver small, harmless fragments of another disease – in this case, Bundibugyo ebolavirus – and spark immunity. CEPI is advocating for $US2.5 billion in funding for CEPI 3.0, a five-year pandemic preparedness plan aimed at making treatments to combat entire viral families rather than individual pathogens. Before the next globe-crippling illness – "disease X" – strikes, CEPI wants the world able to craft and distribute new vaccines within 100 days. That kind of speed would have saved about 8 million lives during the COVID-19 pandemic. "It’s about speed, safety, and scale to save lives," Halton says. "That’s what we’re trying to do." Personally, I think that CEPI's efforts are a testament to the power of international collaboration and innovation in the face of a global health crisis. What makes this particularly fascinating is that CEPI's approach is not just about developing vaccines, but also about streamlining the process so that they can be released as soon as possible. In my opinion, this is a crucial aspect of pandemic preparedness, as it can mean the difference between life and death for millions of people. From my perspective, CEPI's work is a shining example of how we can come together as a global community to tackle some of the world's most pressing challenges. One thing that immediately stands out is that CEPI's approach is not without its risks. By investing in multiple vaccine candidates, CEPI is taking a scattergun strategy that could burn cash if a candidate falls over. However, this approach is necessary to ensure that we have a robust and diverse set of options to combat emerging diseases. What many people don't realize is that CEPI's work is not just about developing vaccines, but also about building a robust and resilient global health system that can respond quickly and effectively to new threats. If you take a step back and think about it, it's clear that CEPI's efforts are a crucial part of the global effort to prepare for and respond to pandemics. This raises a deeper question: what can we learn from CEPI's approach that can be applied to other global health challenges? A detail that I find especially interesting is that CEPI's "push-pull" strategy is designed to smooth the financial risks that developers take on by testing new vaccines, while ensuring safe and effective treatments get to the front lines as soon as possible. What this really suggests is that we need to rethink our approach to global health funding and investment, focusing on building a robust and resilient system that can respond quickly and effectively to new threats. In conclusion, CEPI's efforts to combat the Ebola outbreak are a testament to the power of international collaboration and innovation in the face of a global health crisis. By streamlining the vaccine development process and taking a scattergun approach, CEPI is helping to ensure that we have a robust and diverse set of options to combat emerging diseases. This is a crucial aspect of pandemic preparedness, and it's one that we should all be supporting.
