Coronavirus: Will someone develop a vaccine?
While the world worries about the spread of the deadly coronavirus, now known as Covid-19, one would expect the major pharmaceutical firms to make millions, even billions, by rushing to develop a vaccine.
But in reality, this is not the case. While the global vaccine market is expected to grow to $60bn (£46bn) this year, big profits are not guaranteed.
''Successfully developing a preventive vaccine or treatment for a public health crisis is difficult. It typically takes a lot of time and money," says US-based Brad Loncar, a biotechnology investor and chief executive of Loncar Investments.
"There is typically little money in it for companies that do successfully develop something, not the billions that some investors mistakenly expect."
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The global vaccines industry is dominated by big players such as Pfizer, Merck, GlaxoSmithKline (GSK), Sanofi, and Johnson & Johnson.
Worldwide sales of vaccines totalled $54bn last year, and have almost doubled since 2014, according to data analysts Statista. Driving this growth is the increase of infectious diseases like influenza, swine flu, hepatitis and Ebola.
"One would think that the industry has the reserves to jump at this challenge. But none of the four top vaccine companies has shown significant interest," says Dr Ellen 't Hoen, director at medicines law and policy at University Medical Center Groningen in Amsterdam.
Outside of the big firms, there are a handful of smaller pharma companies pushing to find a vaccine for the deadly Covid-19 outbreak, which has already claimed more than 1,000 lives.
Gilead, a US biotech business that makes anti-HIV drugs, has announced it will trial its drug Remdesivir. Meanwhile Kaletra, a combination of two anti-HIV drugs from pharma group AbbVie is being trialled on patients in China. Both trials are based on existing medicines.
"A large company like Gilead or AbbVie will be able to use an existing medicine against this as a therapeutic treatment, but it's unlikely to be much of a needle mover from a stock market perspective for a large company like that," adds Mr Loncar.
For Covid-19, charitable donations are being used to spark pharma companies into action to find a vaccine. One of the leading players is a not-for-profit organisation called the Coalition for Epidemic Preparedness Innovations (CEPI).
CEPI co-founders include the governments of Norway and India, the Bill and Melinda Gates Foundation, and the Wellcome Trust. CEPI is supporting vaccine development programmes by Inovio Pharmaceuticals and Moderna.
Among the big pharma companies, GSK has agreed to make its technology available to the CEPI to help it create a medicine against Covid-19.
Vaccines often require lengthy testing on thousands of people before they are allowed to be sold. But in 2002 and 2003, the Sars outbreak came and went before a vaccine could be produced. In fact, there is still no protective vaccine for Sars available.
Regarding Ebola, the first vaccine was produced by Merck, and successfully deployed in Guinea, west Africa, in 2015. At the time it was an unlicensed drug, yet it was rolled out in the country for "compassionate use" after the authorisation of the Guinean government. Merck's vaccine was not given regulatory approval in the US until last year.
Another Ebola vaccine by Johnson & Johnson was made available from 2019 in the Democratic Republic of Congo.
Ronald Klain served as the US Ebola response coordinator in 2014-15. "I don't work for the companies, I'm not like a drug company fan," Mr Klain told a panel last week hosted by not-for-profit think-tank Aspen Institute, "but there's no question that a lot of them lost a lot of money trying to produce an Ebola vaccine."
A key reason why vaccines often have to wait years before they are given regulatory approval is the potential for side effects. These can also happen even when a drug has been approved.
During the 2009-10 swine flu pandemic, six million people were given the Pandemrix vaccine made by GlaxoSmithKline. However, it was subsequently withdrawn from sale after it was discovered to cause narcolepsy in some people. Narcolepsy is a sleep disorder that causes people to fall asleep numerous times a day.
Also speaking at last week's Aspen Institute event, Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said no major pharmaceutical company has come forward to say it would manufacture a vaccine for Covid-19. He called it "very difficult and very frustrating".
"Companies that have the skill to be able to do it are not going to just sit around and have a warm facility, ready to go for when you need it," Dr Fauci said.
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Dr Fauci added that it would be at least one year before a Covid-19 vaccine would be available. That timeline assumes a large pharma manufacturer steps up to help make the product. The World Health Organization (WHO) hopes a vaccine will be ready within 18 months.
Pharma companies have responded to previous public health crises by developing vaccines, only to have those crises fade, and to be left with significant research and development costs. "When we were doing this with Ebola, it was a major vaccine company that got burned who's now pulling out of that," says Dr Fauci. "It is going to be a challenge to be able to get a major company to do that."
Mr Loncar sums up the mentality of the big pharma firms when he said "most companies and investors are not in these things for the long haul".