This is the preamble to my first ever article that I am working on for publication. I was asked to remove it since it draws away from the specific point by point discussion that the article really intends to address. However, I think it is still important to understand for those that will take the time to read it and digest what it means not just for this stock but for the field of vaccine and drug development.
This article will lay out the framework for an IBIO long term investment for just one of the many aspect for which the company may focus. It will focus on some scientific/historical background into the impact of a pandemic, why Ebola does not seem to be an issue in the USA, and how we generally approach viruses.
Imagine waking up one morning to find out more than a quarter of the population has been wiped out. Not by any act of terrorism or utilization of weapons of mass destruction. Not by any extra-terrestial mass casualty event like the meteor that dawned the era of the Ice Age. Not by anything of such massive size and grandeur but by something as small as a few hundred nanometers if not smaller. Viruses have been a mystifying entity in microbiology and the medical field for a number of decades if not centuries. So much research has gone into the field that we came to utilize their properties in vaccinations, drug development, the understanding and practice of genomics and many other new age fields of science and medicine. These entities only nanometers in size, which for reference is 1.0 x 10(-7) or 0.0000001 cm, have one of the highest likelihoods of being the cause of extinction of the human race. Skeptical? Do not think it can happen? Think again and reflect on the Influenza Pandemic of 1918. Estimations are that 20-40 million people died during this pandemic and this was in a time of less population density. It was estimated that 28% of all Americans got infected during that time and 675,000 Americans died. It was so bad that the average life span in the US at the time was depressed by 10 years during a time when the average lifespan was around 50 years of age. The virulence of this flu strain was also a bit of an anomaly since it was most deadly for populations between the ages of 20-40 when typically highest risk populations were the elderly and young children because of relative compromise in immunity. There were anecdotal stories of people dying overnight or even within hours when they were completely asymptomatic beforehand. We came very close to having that particular flu strain ravage the human race to extinction. In fact some of the only reasons that we did not succumb may have been because the government and public health departments took over with restrictive measures. The population as a whole accepted government authority and Nationalism pervaded sentiment of personal self being. The germ theory and concepts of vaccines thankfully created by Edward Jenner back in 1798 during the smallpox outbreak was really the main saving grace of the human race. Had vaccinations not been discovered over a century in advance it likely would have been the end of mankind, lest a "lucky" few be thrown into a barren wasteland of death like the cast of "The Walking Dead".
With this in mind, you have to ask yourself how has the landscape changed since 1918 and how does current epidemiology and medical resources put us at higher risk today? Thankfully the infectious nature of the current Ebola virus is no where near as contagious as influenza mainly because, unless it mutates, it is only transmitted through exposure to bodily fluids during the symptomatic phase and not truly airborne like influenza. However, the issues in West Africa especially the conditions in Sierra Leone that have caused 1000s recently to leave quarantine in search of food threatening public safety is a small demonstration of what could potentially happen in a major outbreak.
The Associated Press have recently said during their investigation of the US health care apparatus that if small clusters of Ebola break out in the US it could overwhelm parts of the system. If the USA is not prepared for small outbreaks, imagine how third world countries must be doing. The issues therein lies in population density and availability of adequate supportive care. Add to that the ability for us to now travel across the world in a days time through public transportation and you can easily see how in danger we really are when battling a natural virus and bio-terrorism which can have an incubation time of up to 3 weeks. Also peoples sentiments with assisting the elderly, pregnant women (which is how Thomas Duncan, the 1st US case contracted the virus), and children (2 yr old in Guinea was patient Zero, nurses in west Africa contracted and died while helping Ebola ridden infants, and the need to comfort seen in NYC when 5-yr child being tested was allowed contact with the mother) puts many others at risk as well.
As a medical physician myself, I recognize and relay that the premise behind the treatment is that, unlike bacterial infections which are less contagious then viruses and respond to antibiotics, viruses in the majority can only be treated with supportive care. Very few viruses have acute potentially curative treatment. There is post-exposure treatment with antibodies in rabies infections which is akin to what ZMAPP accomplishes with Ebola and how it is differentiated from a vaccine which is to prevent infection versus generally to treat it. There is acute treatment for Herpes Simplex Virus which can be a pathogen in life threatening viral meningitis and encephalitis that is caused by this vector and treated with acyclovir. Gancyclovir for cytomegalovirus infections and a few other acute treatments. Antiviral therapy as I am sure any biotech investor knows is a huge area of research and big pharmaceutical company focus in therapeutics. There are currently companies working on vaccines for Ebola that they state can be used as treatment as well. I imagine this is either due to its ability to stimulate a rapid immune response to produce antibodies or because the course of the disease can be prolonged long enough for typical vaccination to become treatment via immune stimulation.
The American public is currently comforted by the low mortality rate seen in the cases in the US. However, one must understand the following two points. This is a low sample size and a small outbreak can easily be contained in a developed nation but increased number of cases can overwhelm the system either by diverting resources from an already busy health system or being short on medical staff who are too afraid to come in to work. For a prime example, look at what is happening with women's health in West Africa. Experts believe that the mortality rate for pregnant women will sky-rocket because Obstetricians are refusing to do cesarian sections. The other more poignant point is that since viruses are generally self-limited and treated with supportive care this is the reason for low mortality in US Ebola cases. In third world nations which have a tendency towards poor sanitation and water systems and sparse medical supplies the mortality rate is expected to be higher because the rate of infection easily overwhelms available resources. Reflect on the novel "The Painted Veil" in which Walter Fane ended up dying after contracting the disease he was helping to fight because they could not obtain more saline to administer. Since Ebola leads to multi-system organ failure if allowed to progress then any place with inadequate supportive care (mainly IV fluids and life supportive measures such as ventilators and dialysis) is going to have a much higher mortality rate.
Unfortunately, in respect to influenza, it is a highly contagious and self-limiting disease meaning no current curative treatment that is effective. Such treatments as Tamiflu only decrease the symptoms by a day or so but ultimately your body fights it off while supportive care keeps you alive while this personal battle unfolds. If another influenza strain arises like the 1918 strain that can kill in a matter of a day or more realistically a few days once symptoms start then its easy to overwhelm the medical system in even the most developed areas and does not give time for an adequate response especially via current methods of vaccine and bio-therapeutic production. The Swine flu pandemic in 2009 which heralds the big pharmaceutical companies for ending the pandemic overlooks the fact that during the time it took to produce the vaccine (which was about 7 months) 43 to 89 million people contracted the disease and an estimated 8,870 to 18,300 died. Thankfully this was no where near the virulence of the 1918 strain, granted I am sure a great difference between 1918 and 2009 was medical advancements in general.
Disclosure: The author is long IBIO.