Almost as soon as the African Ebola epidemic hit the headlines, NIH Director Francis Collins was making the rounds arguing that we would have had an Ebola vaccine by now, if only Congress hadn’t slashed the NIH budget.
Lest you think I’m taking his words out of context, here is what he said to a House Energy and Commerce Subcommittee on Health Roundtable Discussion on Health and Medicine Issues on September 10, 2014:
The NIH began working on a vaccine for Ebola in 2001. We have steadily pursued that effort over these last 13 years, hoping that by the time a big outbreak occurred we would be ready for it. That vaccine has now been in animal trials, shown to be highly effective. But as of this summer, when the outbreak really began to catch fire, had not yet quite reached the point of a phase 1 clinical trial.
We worked in record time with enormous assistance from our colleagues at FDA to speed up the process. And last week, the first volunteers at the NIH clinical center were injected with this vaccine in a phase 1 trial to determine whether in fact it is going to be safe. And in another two or three months we will know that, and then hopefully be in a position to begin a phase 2 trial in the places where it’s most needed in Africa.
But I have to tell you, if we had not gone through this 10-year decline in the support of biomedical research, we would be a year or two ahead of where we are now. And think about the difference that would make, had we in 2014 been in the position to distribute rapidly tens of thousands of doses, in collaboration with our colleagues at GSK, of this vaccine, how much different would this be and how many lives would have been saved.
I read this testimony at the time, and was taken aback by this statement, but I was a bit reluctant to undermine efforts to increase NIH funding, no matter how cynical they might be. It was, after all, Congressional testimony, and one can forgive a bit of exaggeration in pursuit of remedying the horrible financial situation the NIH (and, thus its grantees and would be grantees).
But now Collins has gone public with this claim, in an article in the Huffington Post, and so it’s time to call this for what it is: complete bullshit.
First, let’s deal with the most immediate assertion – that if there had been more funds there would be an Ebola vaccine today. Collins argues we’d be a few years ahead of where they are today, and that, instead of preparing to enter phase 1 trials today, they’d have done this two years ago. But last time I checked, there was a reason we do clinical trials, which is to determine if therapies are safe and effective. And, crucially, many of these fail (how many times have we heard about HIV vaccines that were effective in animals). Thus, even if you believe the only thing holding up development of the Ebola vaccine was funds, it’s still false to argue that with more money we’d have an Ebola vaccine. Vaccine and drug development just simply doesn’t work this way. There are long lists of projects, in both the public and private sector that have been very well-funded, and still failed.
It is a gross overtrivialization of even the directed scientific process involved in developing vaccines to suggest that simply by spending more money on something you are guaranteed a product. And, if I were in Congress, frankly I’d be sick of hearing this kind of baloney, and would respond with a long list of things I’d been promised by previous NIH Directors if only we’d spend more money on them.
Second, let’s assume Collins is right. That the only reason we don’t have an Ebola vaccine today was that the project wasn’t properly funded. If this is true, than one should rightly ask why this wasn’t given a higher priority. The potential for a serious Ebola outbreak has been there for a long time. And while money is tight at the NIH, they still manage to find funds to do a lot of stuff I would not have prioritized over an Ebola research program it it was really on the crux of delivering a vaccine. So there is an element of choice here too that Collins is downplaying.
But what really bothers me the most about this is that, rather than trying to exploit the current hysteria about Ebola by offering a quid-pro-quo “Give me more money and I’ll deliver and Ebola vaccine”, Collins should be out there pointing out that the reason we’re even in a position to develop an Ebola vaccine is because of our long-standing investment in basic research, and that the real threat we face is not Ebola, but the fact that, by having slashed the NIH budget and made it increasingly difficult to have a stable career in science, we’re making it less and less likely that we’ll be equipped to handle all of the future challenges to public health that we’re going to be face in the future.
Don’t get me wrong. I get what Collins is trying to do. I just think it’s a huge mistake. Every time I see testimony from NIH officials to Congress, they are engaged in this kind of pandering – talking about how concerned they are about [insert pet disease of person asking question] or that and how, if only they could get more money, we’d be able to take make amazing progress. But guess what? It hasn’t worked. The NIH budget is still being slashed. It’s time for the people who run the biomedical research enterprise in this country to make basic research the center of their pitch for funding. Collins had a huge opportunity to do that here, but he blew it.