©
icddr,b
More than 25 years since the Nipah virus was discovered in Malaysia, there are still no approved vaccines or treatments available for this deadly disease.
To unlock scientific progress on Nipah virus, researchers at Bangladesh’s International Centre for Diarrheal Disease Research (icddr,b) and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), which is hosted by the Pandemic Sciences Institute (PSI), call in The Lancet Infectious Diseases for a new framework to develop therapies, and make them available and affordable to those in need.
Identifying critical barriers to progress
Author Dr Md Zakiul Hassan, a DPhil candidate at PSI and researcher at the Programme for Emerging Infections at icddr,b, said: “As a healthcare worker in a Nipah-endemic country, I have personally witnessed the deadly toll of this virus, watching patients succumb, including a friend who was an intern doctor.
“The lack of progress over 25 years in developing treatments is not only frustrating but also a glaring failure in global health and research policy for neglected diseases like Nipah virus, which persistently threatens larger epidemics.”
The researchers note general patterns of neglect for outbreak diseases that are endemic to low-resource countries, which receive attention only when they spread to higher-income countries. They cite as case in point the 2022 mpox multi-country outbreak.
The absence of therapies for Nipah and other such neglected diseases is the result of both market failure – there is no business case to appeal to profit-driven investors – and a failure of global health policy to foster a public health driven research and funding environment that ensures new tools are developed and reach those in needs in a timely way.
The authors lament that, “even when interventions are available, they may not reach those who need them most but are instead stockpiled and reserved for use in high-income countries, as seen for mpox, Ebola and the COVID-19 pandemic.”
That is why new approaches are urgently needed to develop, test and make available new therapies for Nipah and other outbreak-prone diseases.
A new framework for action on Nipah virus
Building on a similar framework developed in the context of Lassa Fever in West Africa the authors propose a regionally-led clinical development and access framework focused on South and South-East Asian countries most at risk for Nipah outbreaks to simultaneously work to:
-
enhance understanding of the disease’s clinical epidemiology
-
define clear use cases and product profiles for therapeutics
-
develop rapid point-of-care diagnostics
-
design realistic and effective clinical trials, and strengthen local trial capacity
-
create a regional clinical trial platform to collaboratively implement the trials
-
develop an end-to-end value proposition that fosters adequate financing and ensures access to ultimate treatments
-
engage communities throughout all above activities.
Working with international partners
PSI has taken significant steps to address the threat of the Nipah virus, including the launch of its Henipavirus Programme in 2023 to expand research across the University of Oxford on the disease. Managed by Dr Tara Hurst, the programme includes work across the breadth of pandemic sciences.
Also last year, a Memorandum of Understanding was signed between PSI and the icddr,b, a leading global health research institute that works with Bangladesh’s Ministry of Health and Family Welfare on infectious disease research and response. PSI and icddr,b will collaborate on further developing the proposed framework.
Professor Sir Peter Horby, PSI Director, said: “Researchers have outlined a clear plan of action, led by local partners in endemic countries and supported by the US CDC, to finally find an effective treatment for the Nipah virus. This partnership will be especially instrumental in implementing the new framework.”
Dr Tahmeed Ahmed, Executive Director at icddr,b, said: “The Nipah virus, leading to deadly encephalitis, poses a significant risk in Bangladesh and other countries. There is a pressing need for vaccine development, research into new therapeutic options, and repurposing existing antivirals. This collaboration with ISARIC, PSI, and Bangladesh's Institute of Epidemiology, Disease Control and Research (IEDCR) will lead to advancing therapeutic strategies and improvement of clinical care for patients, and better prepare the world for potential epidemics.”
Professor Dr Tahmina Shirin, Director of IEDCR, Bangladesh, said: “Since the first Nipah outbreak in Bangladesh, IEDCR has been at the forefront of the response, establishing the country's first diagnostic lab in 2006 and conducting sentinel surveillance for early case detection in partnership with icddr,b and with support from the United States Centers for Disease Control and Prevention (CDC). This partnership and the framework will not only enhance clinical care during sporadic outbreaks but also support our preparedness for potential larger epidemics.”
Read the paper in The Lancet Infectious Diseases