Date Published: September 24, 2015
Publisher: Public Library of Science
Author(s): Peter J. Hotez, Shaden Kamhawi. http://doi.org/10.1371/journal.pntd.0003852
Partial Text: War and the ensuing health system breakdowns in the Islamic State (IS)–occupied Syria and Iraq significantly increase the risk of a new wave of infectious disease epidemics in the Middle East and North Africa (MENA). Proactive engagement to enable health system capacity and resilience—including expanding immunization programs and building biotechnology capacity for vaccines that specifically target diseases in the region—would help minimize the impact if and when outbreaks occur. A program of vaccine science diplomacy with selected countries in the MENA region could help to avert an international public health crisis possibly similar in scope and magnitude to the 2014 Ebola virus outbreak in West Africa.
A comparable situation associated with poverty and conflict may now be unfolding in the MENA. Our previous analysis showed a surprisingly high burden of NTDs disproportionately affecting an estimated 65 million people who live in extreme poverty in this region . Shown in Table 1 is a reassessment of the NTD burden in the MENA based on newly released World Health Organization (WHO) and other estimates [5–13]. In total, approximately 50 million people in the MENA suffer from an NTD.
When Ebola virus emerged in West Africa in 2014, the global health community was slow in mounting a coordinated international response. To avoid a repeat, is there a possibility of mobilizing resources now in order to combat the NTDs and other emerging infections that will surely arise in the MENA? Anticipatory action plans could include expansion of public health emergency preparedness through the United States—launched Global Health Security Agenda (GHSA) in partnership with the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE) . Launched in February 2014, the GHSA has an overarching mission to prevent and reduce the likelihood of infectious disease outbreaks by detecting threats early and providing for rapid and multisectoral responses . GHSA also furthers progress towards full implementation of WHO International Health Regulations 2005 (IHR).
But what if diseases emerge across the MENA region for which vaccines and other countermeasures have not yet been developed? Given that a number of diseases might be primarily of regional instead of global importance, it is unlikely they will be targeted for vaccine development by the multinational pharmaceutical companies. We saw this situation previously when Ebola virus vaccines were not available throughout all of 2014, and these vaccines are only now entering phase 1 trials, more than a year after the epidemic ignited in West Africa.
According to former US Secretary of State Henry Kissinger, “science and technology are the governing concepts of our age” and ones that are replacing nationalism as a major “leitmotif” of the 21st century . While pockets of science and technology have advanced in the MENA region, overall vaccine biotechnology has lagged. In terms of manufacturers that produce vaccines accessible for developing countries and belong to the DCVMN, only four come from the MENA region—one each in Saudi Arabia (AraBio) and Egypt (Vacsera), and two in Iran (Institut Pasteur and Razi Vaccine and Serum Research Institute) [23–25], and none produces vaccines that are pre-qualified by the WHO for export . Instead, the region mostly imports its vaccines or vials in bulk . As a consequence, the MENA region is highly vulnerable to regional neglected and emerging infections, including MERS, schistosomiasis, leishmaniasis, scabies, and other NTDs, which may not be targeted by multinational pharmaceutical companies.