I think active vaccination is still the way to go in most cases, however, for diseases with low incidence and those that progress rapidly the possibility to react immediately by giving protective antibodies has become a strong asset for managing global health emergencies. Antibodies can be used prophylactically e.g. for healthcare staff, to more quickly contain the spread of the disease and also present an important psychological component (at least there is something you can do). Recent advances in antibody technologies really allow us now to discover these antibodies and have them ready in advance. Rabies is a good example for having both vaccines and post-exposure prophylaxis (PEP) antibodies in place. Neutralizing antibodies offer also advantages in case of epitope drift / vaccine failure. Regarding costs for vaccines vs. antibodies depend not just on a dose-by-dose comparison but need to be taken to population / HealthCare level as can easily be seen for the recent Ebola crisis where total economic losses went into the trillions. In such scenarios the best advice is to have all the weaponry ready that you can have, and not "just to save lives". Other approaches are of course needed, and i think there should be a strong push towards a global pathogen surveillance (GPS) network. The technologies are derfinitely there, but it takes commitment and coordination to implement this. Two RnD aspects appear to be critical for this.For being prepared we need to know what's out there and which of our tools/measures (vaccines, antibodies, diagnostics...) are effective and this requires the ability to analyse (predict and experimentally validate) this preemtively, i.e. before there is an outbreak. Reacting quickly requires being prepared, i.e. having the right tools AND being able to deploy them (manufacturing capacity, logistics). For the latter it is not enough to rely/depend on companies (accessibility, cost, conflicting interests) and funders at the WEF should seriously consider setting up independent and globally accessible manufacturing capacity.

Markus, this is really clear and helpful. Thank you. Regarding your last sentence-does CEPI meet this need for an independent and globally accessible capacity?

There apparently are many aspects, e.g. preparedness vs. responsiveness that require ramifications. I'll look into this document (http://www.who.int/medicines/ebola-treatment/TheCoalitionEpidemicPreparednessInnovations-an-overview.pdf) and will give you my feedback in a day or two. Or do you have a different document that you'd prefer?

That would be helpful. Thank you. My expertise is in community-centered approaches and I applying this to disease outbreaks following my recent experiences in ebola and zika. A picture for me of the future is forming. What is the community role in vaccine delivery?

Vaccine delivery, clinical trials and survivor engagement.

Going back to the initial question: any change can virtually be a driver of disease emergence. Indeed, there is no general rule, and each emergence is a special case: it was pointed out as one of the main conclusions of the EDEN and EDENext projects on emerging, vector-borne diseases (see the link at the bottom of this message). However, socio-economic and behavioural drivers are often found to be more important than climatic or other environmental changes. You will find many examples, like

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000500

http://parasitesandvectors.biomedcentral.com/articles/10.1186/1756-3305-4-35

or in a fully different context

https://www.researchgate.net/publication/312491269_Drivers_of_Rift_Valley_fever_epidemics_in_Madagascar

Also, I do agree that an efficient vaccine is not enough per itself to control an emergence: vaccine delivery is often much more challenging than vaccine development. A striking fact is that though we have good vaccines for many human or animal diseases, only two diseases could be eradicated : smallpox in humans, and rinderpest in cattle. For the latter, the final stage of eradication could only be reached after a strong involvement of communities: see http://science.sciencemag.org/content/337/6100/1309

Article Drivers of Rift Valley fever epidemics in Madagascar

Book EDEN & EDENext: the impact of a decade of research (2004-201...

Great question,  lets work this one out together.

Honestly, man and complex humanitarian emergencies, the major global health challenge, in ways of major political, security and public health feature of the posted War worlds.  If we would take a few steps back and see where and what- man-made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. “Our next health emergency will be ourselves.”

Chaplain: Perry McClinton

Given the current situation of multiple biological crises represented by emerging and re-emerging diseases, it seems that this trend will continue in the sense that every now and then a new outbreak of disturbing infection will occur. Research to develop vaccines and other international actions and preparedness are essential. In addition, the political turmoil affecting many countries is likely to represent hot spots in the foreseeable future and create long lasting human emergencies. A wise world seems receding. 

I agree with the answer given by Prof. Omran S Habib.

Regards

SM Najim

Excellent responses. It seems that our inability to learn from previous lessons of outbreaks and emergencies could also be a cause of future emergencies or a worsening of a health emergency - ie the ebola outbreak.

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