Public health officials around the world are nervously watching the outbreak of Middle East Respiratory Syndrome in South Korea, where the latest reports from the Health Ministry say seven people have died and at least 95 are infected. Scientists say the disease, known as MERS, is easily treatable -- but no treatment currently exists. Progress on lifesaving treatments has been impeded by the lack of profit potential for pharmaceutical companies, a scarcity of political will and strained relationships with Saudi scientists.
In the meantime, public health officials are closely monitoring the situation to see whether the virus in South Korea may mutate to spread more easily than previously thought.
“If that is true, then we are all in big trouble, and we need to jump to move even faster to really get treatments into the hands of people,” said Matthew Frieman, an immunologist at University of Maryland School of Medicine.
MERS is a respiratory illness that causes fever, coughing and shortness of breath. It is fatal in about 40 percent of cases. Just over 1,100 people have caught the virus since it was discovered in 2012, and the vast majority of those victims -- more than 85 percent -- lived in Saudi Arabia, where it was first found.
Currently, the only way to stop the spread of MERS is to isolate its victims, and at least 2,800 Koreans are in quarantine today. Global government support for drug development has been limited, and no major pharmaceutical company has invested resources to develop a vaccine or treatment for a disease that affects only a few hundred people with each outbreak.
Without further incentives, it’s unlikely that treatments will be made available to South Koreans who are suffering from MERS today or to the rest of the world as a precautionary measure.
There are several MERS vaccines in the earliest stages of development. Frieman has been working on one since 2013. Last year, he showed that the vaccine was effective in producing antibodies that fought off the virus in mice. Frieman teamed up with the vaccine company Novavax Inc. for initial research on using this vaccine but still needs a partner, such as Novavax or a federal agency known as the Biomedical Advanced Research and Development Authority, to usher it through clinical trials.
“There's nothing standing in our way from pushing this forward other than the money and the will to do it,” he says.
John R. Price, CEO of a vaccine company called Greffex that is headquartered in Amsterdam and Colorado, says he could create a potential MERS vaccine that was ready for testing in just three weeks if his company received a sample of the virus strain that’s afflicting residents in South Korea.
“I could make, for pennies on the dollar, a vaccine candidate ready for testing in three weeks with the new genetic sequence,” he says. “But we can’t test it -- we don’t have the money.”
Last year, Greffex partnered with the National Institute of Allergy and Infectious Diseases (NIAID) to run lab tests on one potential vaccine and found it produced antibodies in all of the mice they injected. But Price says progress has stalled, since the threat of MERS remains far from the borders of the world’s wealthiest countries.
“People in Memphis, Tennessee, don't believe they're going to get MERS,” he says. “People in Bristol, England, don't believe they're going to get MERS. I just have to be frank. It's a world health issue, but it's not a world health problem.”
One vaccine from Inovio Pharmaceuticals just entered the earliest stages of clinical trials in late May -- which means it is still being tested for safety rather than effectiveness.
“If we had gotten our ducks in a row earlier, we may have had something to really test in Korea,” said Trish Perl, an epidemiologist at Johns Hopkins University School of Medicine.
Meanwhile, Wayne Marasco, an infectious disease expert at Harvard Medical School, doesn’t think vaccines make sense for diseases that occur in outbreaks because it’s hard to anticipate who would benefit from immunization. Instead, he announced last fall that he had identified a host of antibodies that might fight off the virus after an individual is infected. Those antibodies still need to be tested in animal trials.
The University of Maryland's Frieman is also looking at repurposing existing drugs that the U.S. Food and Drug Administration has already approved for MERS with funding by the NIAID. The approach has worked for Ebola -- just last week, researchers announced that they had discovered Zoloft and Vascor may be effective treatments for the disease. Frieman says he has used the same methods as those researchers to identify 27 approved drugs that could potentially treat MERS, including at least two that seem to treat SARS, a closely related virus, in mice, though he has yet to publish those results.
Regardless of their success in the lab, it’s hard for any of these researchers to persuade major pharmaceutical companies to invest in a vaccine or treatment that may only be used by a handful of victims every few years during an outbreak.
“The driving force for me is to understand the virus and the way it infects,” Frieman says. “That's not what companies really care about -- they care about making a product.”
Marasco has licensed one of his antibodies to a biotech company called Abviro but says the commercial opportunities for it have so far been limited. Governments have also struggled to justify funding for MERS research or the development of new treatments -- until an outbreak occurs. Following a rash of cases at the start of the year, the World Health Organization warned of “critical gaps” in Saudi Arabia’s surveillance of and response to the disease. Last year, King Abdullah fired the nation’s health minister when 49 new cases of MERS were detected within a week.
Meanwhile, the U.S. and Europe, which fund much of the world’s pharmaceutical research, remain relatively unaffected by MERS. The U.S. Centers for Disease Control and Prevention says the disease poses a “very low risk” to Americans and only two cases have ever been diagnosed on American soil. The NIAID held a one-day summit on the disease in 2013 and established a working group to focus on developing MERS drugs.
“The government has to recognize that it's a potential threat,” Perl says. Instead, the U.S. government suspended funding last fall and called for a voluntary moratorium on research related to viruses including MERS. Some scientists were using a technique to boost the virus' contagiousness in their labs to study how it was passed between animals, and the government was worried they might unleash a pandemic.
There are still holes in scientists’ knowledge about what causes the virus and how it spreads. However, both Frieman and Marasco say they’ve found it difficult to even obtain samples of or case information about the virus from Saudi researchers. Collaborations between Saudi scientists and colleagues in Europe or America remain rare.
“You can't do a vaccine if you don't have samples,” Perl says. “Samples weren't coming out of Saudi Arabia. It's still an issue.”
Price, at least, believes the U.S. government will soon realize the need for further investment into MERS treatment, especially after rushing to fund a Ebola vaccine months into last year’s outbreak in West Africa.
“The U.S. government is adamant that they won’t be in the same position with MERS that they were with Ebola,” he says. “I believe the U.S. government was embarrassed by its inability to address a world health problem, and I don't believe they will let that happen again.”
Less than a month ago, Marasco was awarded a grant from the Qatar Foundation and the U.S. National Institutes of Health to work with King Saud University in Saudi Arabia on a MERS treatment as part of one of the first international collaborations of its kind.
Despite the immediate and serious threat to South Koreans, Marasco believes the current outbreak is merely a cluster -- the sort of bout that happens occasionally but is bound to subside following basic public health interventions. But this reassurance is contingent on further lab tests that continue to show the strain that is currently infecting South Korea remains the same strain researchers have known about all along.
“Am I worried? No,” he says. “However, we have not seen evidence that the virus is further evolving. That would change my opinion in a minute.”