Be prepared for epidemics: finding answers in an emergency

Epidemics are unpredictable and often strike when we are least prepared. In 2004, during the Vietnamese New Year holiday, Professors Tran Hien, Liem, and Jeremy Farrar were among the first to respond as bird flu, or H5N1 influenza, reemerged in human patients in South East Asia. Within weeks the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam worked with the neighbouring Hospital for Tropical Diseases and the National Hospital for Paediatrics in Hanoi to report the clinical features of these patients, and within months they reported the key features of the underlying disease process.

Eight out of ten patients died. All had apparently caught their infections from handling birds: but what if the virus were to evolve to a form that could be transmitted from one human to another? An epidemic of such a disease, to which humans have little or no immunity, could be devastating. Professor Farrar argues that medical services all over the world are poorly prepared to cope should one develop.

The 2009 global pandemic of H1N1 influenza, which originated in pigs but spread between humans, led to widespread distribution of antiviral drugs such as Tamiflu. Yet, says Professor Farrar, these drugs have never been rigorously tested in clinical trials during an epidemic. 'Doctors have understandably been so focused on giving patients treatment that they have not taken the opportunity to find out which treatments or other interventions are the most effective', he says. 'This has been true in almost all outbreaks and epidemics over the past two decades.'

In December 2011 he became chair of an ambitious worldwide collaboration, the International Severe Acute Respiratory Infection Consortium (ISARIC), which aims to conduct clinical trials of available treatments next time an epidemic such as bird flu or SARS hits – as it surely will.

A clinical trial can take months or even years to set up, while epidemics typically come and go within weeks. With funding from the Wellcome Trust, the UK Medical Research Council, the Bill and Melinda Gates Foundation, INSERM, the Li Ka Shing–University of Oxford Global Research Programme and the Singapore Ministry of Health, ISARIC aims to use the current 'peacetime' period without a major epidemic to get studies designed and approved, so that they can simply be grabbed from the shelf when the first cases start reaching hospitals. Importantly, research protocols will be available to everyone: a few dozen cases in Vietnam and a few hundred in China could be added together to increase the scientific certainty of any findings.

It is a founding principle of the network that research findings and biological samples will be shared among the partners, building up the kind of long-term trust that will be essential if they are to work together effectively during an epidemic. They are already able to share information via the Global Epidemic Research website, to which the CERT-CUHK-Oxford University Centre for Disaster and Medical Humanitarian Response in Hong Kong is also a contributor. 'Emerging infections are unpredictable enemies', says Professor Farrar, 'but these networks will help to ensure that we work together to gain the evidence to deal with them effectively whenever and wherever they appear.'