By Joyce Ojanji

As the world marks ten years since the deadliest Ebola virus disease outbreak that killed more than 11,000 people in West Africa, Doctors Without Borders/Médecins Sans Frontières (MSF) have called for an international emergency stockpile of these treatments.

The two World Health Organization (WHO) recommended Ebola treatments are REGN-EB3 (atoltivimab/maftivimab/odesivimab), marketed as Inmazeb, and mAb114 (ansuvimab), marketed as Ebanga.

The treatments remain under the exclusive control of just two US pharmaceutical corporations, Regeneron and Ridgeback Biotherapeutics, and almost all the treatments currently available worldwide are kept in a national security and biodefense stockpile held for use by the United States.

“Ten years ago, the world was not prepared for the outbreak of Ebola virus disease in West Africa. There were no antiviral treatments, and this made it hard to convince sick people to come to the treatment units. There were no vaccines, and so protecting people was limited to trying to convince them to change their behaviour, which years of experience have taught us takes time and often has limited success. This made it difficult to control the outbreak,” said Dr Armand Sprecher, Public Health Specialist at MSF.

“Now that there are effective antiviral treatments and vaccines, we can bring to bear important tools for saving lives, preventing illness, and controlling outbreaks, but only if these are fully available for the people who need them. That’s why we are calling for an emergency stockpile.”

After nearly half a century without any specific treatments, it was only during the largest outbreak of Ebola in 2014, when wealthier countries were confronted with the threat of Ebola reaching their borders, that funding for the research and development of Ebola treatments and vaccines increased dramatically.

Then, after a combination of over US$800 million in public funding and essential contributions including from affected country governments, NGOs, and academic institutions, which hosted or facilitated clinical trials, as well as patients and survivors who directly participated in testing the treatments, two treatments were approved by the US Food and Drug Administration in 2020.

These treatments were recommended by WHO in 2022, and are now included on the WHO Model List of Essential Medicines. There are now also two vaccines, which – alongside treatment – are essential to preventing and responding to an Ebola outbreak.

While a significant addition to the Ebola response toolkit, these new medical tools only respond to Zaire Ebola virus, the most common species of virus which caused the 2014 outbreak. The treatments remain largely inaccessible to the people who need them during outbreaks.

“While there are many challenges to the rapid deployment of treatments in an Ebola outbreak, the fact that only one-third of patients received either treatment in five outbreaks since 2020 is, in large part, due to the treatments not being readily available where outbreaks most often occur. Regeneron and Ridgeback retain private control of these treatments through patents and licensing, and almost all available treatments are held and controlled by the US. One clear lesson learned from the past ten years is that relying only on the goodwill of private corporations or governments is not the solution to an access-to-medicines problem,” said Dr Márcio da Fonseca, Infectious Disease Advisor for MSF’s Access Campaign.

“To make today’s and tomorrow’s Ebola treatments and preventative tools more widely available, global access conditions must be attached early in the research and development process for medical tools developed with public money, and access to treatments for the communities who tested them must be legally ensured. We need to be preparing now for the next outbreak, and must make sure there are no gaps in access to the right medical tools, including for other Ebola species, to prevent the catastrophic loss of life we saw a decade ago.”

In addition, MSF urges all patent holders of Ebola treatments to issue licenses and transfer the technology to capable manufacturers so that more producers can make Ebola treatments, as this will help increase their availability in the future.