Health and Medicine
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It’s 4 pm on a Friday when you get the call. You were just starting to think about wrapping things up, maybe heading out early. The person on the other end of the line actually apologizes for the time, but says they didn’t want to wait the whole weekend. You see, there’s been a report from a country on the far side of the world, a cluster of people with strange, unexplained symptoms of an as-yet unidentified illness.
They’re all in the same area, could possibly have visited the same stores, worked out in the same gyms, or live in the same apartment building. People on the ground are rushing to find that out; meanwhile, one of the patients is already being cared for in the ICU, and it’s not looking good for them.
By the time you’re back in your office on Monday, the number of suspected cases has doubled.
The following week, you get another call: scientists have found the cause. It’s a virus, not quite the same as any other the world has seen before, but similar enough that your brain immediately starts filling in some of the gaps with the most likely data.
Respiratory illness. Airborne transmission. Possible animal hosts. Vulnerable populations. Estimated case fatality rates.
But even as all this data is cycling through your mind, you know exactly what to do next. You’ve planned for this and the clock is ticking. Because right now, you and scores of similarly placed people in a global network are all mobilizing towards the same cause: getting a safe and effective vaccine ready to meet this new viral threat in just 100 days.
The scenario we just laid out was fictional. But the mission to develop a vaccine for each new epidemic or pandemic within 100 days is very real.
IFLScience spoke to Mark Lucera, Director of Strategy at CEPI – the Coalition for Epidemic Preparedness Innovations – to find out how they’re working to bring it to fruition.
“The art of the possible”
One hundred days sounds like a very ambitious target, but recent events have shown us why speed is of the essence when it comes to meeting a new disease outbreak head-on.
“The COVID pandemic really exposed the challenge of lacking vaccines and other medical countermeasures in a timely fashion to save lives quickly. But frankly, also to save economic dollars,” Lucera told IFLScience.
“We know the cost of having to respond is [a] much higher order of magnitude. I think the world kind of recognized through COVID that we needed to have a plan in place to move more quickly to develop safe and effective vaccines.”
Knowing how COVID ultimately played out, we would have saved approximately 8 million lives and around about $14 trillion.
Mark Lucera
And if we had been able to hit that 100-day target back in 2020?
“Knowing how COVID ultimately played out, we would have saved approximately 8 million lives and around about $14 trillion”.
To be fair to the global scientific community, they were pretty speedy with the COVID vaccines – 326 days, Lucera informed us – and that was largely because there had already been years of research to build the necessary foundation.
We call this type of work “basic science”, but there’s nothing basic about it. It encompasses all of the studies you need to figure out how different viruses behave, what types of vaccines work best against them, and then all the preclinical work in cells and animal models that needs to happen before you can get a vaccine into a human for the first time.
In light of COVID, Lucera explained, “the CEPI team actually looked at, okay, in an ideal scenario, what's possible? And essentially, we looked at all the steps of that very linear vaccine development value chain, that pipeline, and tried to say, where is there opportunity for time savings? And what kind of innovations and shifts would we need to make to shorten the timeline?”
All of this analysis led them to the conclusion that 100 days was a feasible target to shoot for.
“It really was around, you know, don't let a crisis go to waste, but what's in the art of the possible to be innovative – again, without sacrificing safety – to be able to develop a vaccine quickly. And that was really the genesis and how CEPI birthed the 100 Days Mission in the context of COVID.”
The known and the unknown
Not letting a crisis go to waste means seizing every opportunity to test out aspects of the mission. And there has been no shortage of opportunities.
“We've had to grapple with outbreaks since COVID,” Lucera pointed out. “We've dealt with […] Marburg fever. We've dealt with Rift Valley fever in Senegal. We've dealt with mpox. We've dealt with chikungunya.”
Most recently, the world was gripped by the news of an outbreak of hantavirus disease on a cruise ship. At time of writing, there’s an outbreak of Bundibugyo Ebola virus disease that’s sickened over 1,000 people, mostly in the Democratic Republic of the Congo.
Many of these diseases have no available vaccine (mpox is a notable exception).
There are also the ever-present known threats, like avian flu viruses that could mutate to become more efficient at spreading between humans – H5N1 is in the news a lot these days, but it’s not the only one.
On top of that are the unknown threats: the fabled Disease X, a pandemic-in-waiting caused by an emergent pathogen that isn’t specifically on anyone’s radar right now.
No one has a crystal ball. We can’t predict precisely when and where the next pandemic will hit. But what CEPI and their many collaborators are trying to build is a tried and tested playbook that would enable the development of a new vaccine to combat any type of disease threat within 100 days of identifying it.
“It's really about what set of capabilities do countries, regions, and the global community need to be able to accelerate vaccine development,” Lucera told IFLScience. “There's that piece on vaccine development and having those capabilities in place.”
That means all of that basic science we talked about earlier, plus the knowledge you gain from developing effective vaccines for related pathogens – any new flu vaccine, for example, will build on existing seasonal flu vaccines as well as those that exist for similar types of viruses.
“There's [also] an entire piece on what we call the policy or regulatory sort of readiness,” Lucera went on, “[…] making sure that regulators are comfortable and ready to have trust in the safety and the efficacy of vaccines”.
[When all of this is working seamlessly] you don’t hear about it. Therefore, it doesn’t happen in the eyes of the general public.
Mark Lucera
You also need to have manufacturing capacity, preferably close to the worst-affected regions. Either that, or a plan in place right from the start as to how you’re going to ensure equitable access to the finished product.
“CEPI has six institutions spread around the world who are part of a vaccine manufacturing facility network,” Lucera explained. “And as part of those partnerships, we’ve actually negotiated manufacturing rights capacity in the event of a pandemic, so that way we are able to access that manufacturing early and enable those potential doses to go to countries in the Global South who would need them.”
None of this matters without knowing the disease is there in the first place, so you also need strong surveillance and early warning systems.
As Lucera points out, when all of this is working seamlessly, “you don’t hear about it. Therefore, it doesn’t happen in the eyes of the general public.”
Leave it to the experts to have sleepless nights over where the next virus might be coming from (and spare a thought for your friendly neighborhood science communicators too!) – just know that all of this background work is going on all the time.
“It’s not about taking a shortcut”
Up to now we’ve focused a lot on the benefits of speed – but it’s understandable that someone might hear this target of 100 days and think, “How can we possibly meet that without cutting corners?”
Getting to 100 days for us is not about skipping steps. It's not about taking a shortcut. It's really about where can we do the work as a head start in ‘peacetime’.
Mark Lucera
Safety is paramount, which is why the regulatory piece of CEPI’s mission is so critical, as Lucera explained.
“Getting to 100 days for us is not about skipping steps. It's not about taking a shortcut. It's really about where can we do the work as a head start in ‘peacetime’.”
The basic science, as we’ve learned, can be done well in advance. Lucera also told us that phase I trials – the first stage of clinical testing that focuses on safety in humans – can also be done and the data banked for later.
“Our hypothesis is if you know enough about that, the knowledge of an entire virus family, you might have confidence in the data from all these different types of vaccine projects in that family to say, oh, if we look at all this together, that's a pretty strong package of data that says these vaccines are safe.”
“It's not taking shortcuts. It's not saying that clinical trials aren't important because they're absolutely urgently needed for any product development that you take. But how can you be smart about how you design those when you do them, and the types of data you need in order to make decisions about [the] safety and efficacy of a vaccine?”
“They knew who to call”
As well as the scientific research that can be done in “peacetime”, meaning when there isn’t an immediate disease outbreak to respond to, there are logistical things that can be worked through.
CEPI partners with different stakeholders to run simulations. Just like the fictional scenario we opened this article with, these allow governments to test out strategies to respond to a hypothetical pandemic.
“I’ll give you a really practical example from a few years ago,” Lucera told IFLScience. “We actually took the decision to partner with the Rwandan government a couple of years ago to say, hey, we have experience testing CEPI capabilities – can we work with you to demonstrate and exercise your own capabilities in the event of a simulated crisis?”
This tabletop exercise saw the Rwandan government working with CEPI to identify who they would need to contact in the event of a real crisis, what capability they already had in place as far as things like manufacturing are concerned, and where any gaps may have been.
But barely had this exercise been completed that they found themselves thrust into such a scenario for real.
“Without even planning for this, a few weeks later, they had a real-life Marburg outbreak,” said Lucera.
Marburg virus is from the same family as Ebola and causes a similar hemorrhagic fever, with a case fatality rate of up to 88 percent.
.jpg "Colorized scanning electron micrograph of Marburg virus particles (yellow) both budding and attached to the surface of an infected VERO E6 cell (blue). Image captured at the NIAID Integrated Research Facility in Fort Detrick, Maryland. Credit: NIAID")
“What really kind of stood out for us was they knew who to call. They had just exercised this in a practice, and they were able to actually mobilize a response with collaboration, support, partnership, with CEPI involved. And they were able to initiate a clinical trial of an experimental vaccine in about 10 days, which is pretty incredible, right?”
It’s just one example, but it was a record-breaker and shows just how worthwhile these simulations can be.
“We just held another one of these country-level exercises with the Korean government, [the] Republic of Korea, a couple of months ago. […] We're doing this again with the Indonesian government in several months,” said Lucera.
Another success story centers around a Rift Valley fever outbreak in Senegal in 2025.
CEPI has been dedicating a huge amount of time to ensuring that every part of its own response pipeline is seamlessly interlinked, from designing a new vaccine, to testing it, to getting regulatory approval, to manufacture, and finally delivery where it needs to be.
The Senegal outbreak was an opportunity to test the links between these cogs in the vaccine machine.
“We had the different networks – like our animal models, and our labs, and the vaccine manufacturers, and the clinical trials – actually test those handoffs,” Lucera explained. “We were able to actually produce ready-to-use vaccine in about 70 days, which is pretty good to get to get that ready for a trial.”
It’s hoped that broader, regional exercises will be on the cards next. CEPI are not the only ones involved in these simulations, nor are they the only organization running such exercises – governments set up their own, as do global players like the World Health Organization.
One of the important aspects of CEPI’s work, however, is encouraging governments to continue to prioritize this.
“It takes a lot of sustained partnership, education, advocacy to get governments to really see this as mission critical,” said Lucera. “[W]e do have some examples where governments are keeping this on the front burner, but then we need them to invest and actually spend the dollars and the workforce and the energy into making sure we do the work.”
“A shared reality”
The 100 Days Mission is ambitious. We’re not there yet – despite successes like the Rwanda Marburg outbreak example – but we had to ask Lucera: just how close are we?
“The hope of our new strategy is that we can push the world to make it a shared reality, not just a CEPI reality, by the end of our next strategy, which would five to six years from now.”
What we need is the world to agree with us on this plan, sign up to it with us, commit to it, and fund it.
Mark Lucera
This strategy is called CEPI 3.0 and runs until 2031. They say that $3.6 billion in investment will be needed to deliver it, of which $1.1 billion is already secured, to tackle three priorities:
- Developing vaccines for known epidemic threats
- Accelerating vaccine production technologies
- Working with their global networks to execute the 100 Days Mission
“By 2031 or so, we hope that for some [virus] families, this should be a reality,” Lucera told us. “Maybe not every family. There will always be an exception. New threats that arise that we didn't even know existed. But I think for us, that's our plan. And I think what we need is the world to agree with us on this plan, sign up to it with us, commit to it, and fund it.”
Ebola is one of those virus families that’s an obvious target for this kind of work. The ongoing Bundibugyo outbreak has thrown this into sharp relief – while there are some Ebola vaccines, they’re not targeted at this particular virus, so health workers have been having to respond to the outbreak without this key weapon in their arsenal.
It's possible that could soon change. In just the last few days, a phase I clinical trial of a CEPI-backed candidate Bundibugyo vaccine has been launched in Oxford, UK. The trial will involved 50 healthy adults and recruitment is already underway. The candidate vaccine uses the same platform that worked so successfully for the Oxford/AstraZeneca COVID-19 vaccine that formed a key part of the early pandemic response.
Other Bundibugyo vaccine candidates are also in development – when dealing with infectious disease, it's best not to put all your eggs in one basket. And there are other hemorrhagic fevers too, like Lassa fever. There’s no vaccine for it currently, but CEPI is backing two candidates that are in active scientific development.
“There’s not going to be a one-size-fits-all, sort of silver bullet maybe, for every family, but we need to test a couple of different approaches based on what we know about the diversity of that family”.
And, Lucera points out, it’s vital that those working in this space don’t limit themselves only to naturally occurring disease threats.
“We try to take a kind of broad, source-agnostic view to make sure that we're not just biasing ourselves into those naturally prone outbreaks, but that we're preparing for the high-risk potential for these pathogens to be used in a way that is bad. And it's why we've really spent a lot of effort thinking about biosecurity and the use of artificial intelligence, etc, into how we think about CEPI work.”
Again, leave it to the experts to have sleepless nights over this stuff. But be grateful that they do, and remember that when the next pandemic comes – as we saw with COVID – it will impact all of us.
As Lucera said towards the end of our conversation, “Whether or not you're a scientist, every person has a role to play in building and maintaining trust in science and in the 100 Days mission.”
