What Merck’s history with epidemics and pandemics teaches us about this one
By Nick Kartsonis, M.D. senior vice president, vaccines and infectious diseases, clinical research
June 10, 2020
Today feels like it’s something we’ve never experienced before. And in some ways – especially the rapid, global spread of the pandemic, and the fact that we know hour by hour how many cases are where – that’s true.
But epidemics aren’t new. Just in the past few generations: the polio epidemics of the late 1940s and early 1950s. The H2N2 influenza pandemic of 1957. The H3N2 influenza pandemic of 1968. The AIDS epidemic of the 1980s. The Ebola epidemics of 2014 and 2018.
The global community, including Merck, has confronted – and responded to – these large-scale outbreaks and others. And from that, we should take some comfort and see what we can learn from them.
My company has worked in the field of infectious diseases for 80 years, and on vaccines for more than 100 years. I’ve been honored to have a small part in that long history. In my role leading our infectious disease and vaccine clinical research today, I’m now working on potential medicines and vaccines for COVID-19. I also happen to be a bit of an amateur historian, and I think today’s pandemic is a good time to look back at our history, not just to appreciate where we have come from, but for clues in terms of what lies ahead.
In 1949 and 1952, the U.S. saw its worst outbreaks of polio. Cases mushroomed to an average of 35,000 a year. While 35,000 might sound small in light of the millions of cases of coronavirus in the U.S. thus far, polio had a devastating effect on children and families and struck fear in entire communities for months on end. At that time, the pioneer Dr. Jonas Salk, at the University of Pittsburgh, created the first effective polio vaccine. And that’s where the industry came in. My company, and five others, partnered with the National Institutes of Health to manufacture the vaccine. Each of those companies had to invest heavily in infrastructure to make the vaccine – and did.
This breakthrough was transformational. The number of polio cases in the U.S. declined between 1952 and 1960 from 52,879 to 3,190. For more than 30 years now, poliomyelitis in the U.S. has proven to be eradicated – and we’ve reached a point where polio is such a distant memory that some are more fearful of the vaccine than the disease itself.
Not long after that, in April 1957, a flu epidemic broke out in Hong Kong. The late and I must say, truly great, Dr. Maurice Hilleman, then an American virologist at the Army’s Walter Reed Institute, studied samples of the virus and made a startling discovery. The H1N1 strain that caused the monumental influenza epidemic worldwide in 1918 had evolved into the strikingly different but equally threatening H2N2.
Dr. Hilleman was the first to recognize the danger looming and urged the medical community to come up with a vaccine. Among the first companies to answer that call was Merck – the company he was to soon join. The Merck vaccine program, with support from the NIH, developed an H2N2 vaccine. Before 1957 ended, my company had manufactured one-third of all the vaccines made for the pandemic. Although the H2N2 flu killed 116,000 Americans, some researchers believe that without the vaccine, the toll could have reached one million. And Dr. Hilleman’s observation of flu – known as shift and drift – was the essential observation that enables us to be able to anticipate and quickly develop vaccines for the flu today.
Just 10 years later, in 1968, when a new influenza strain emerged, H3N2, thanks to round-the-clock production, Merck became the first company in the U.S. to distribute the vaccine and eventually made more than half of all the H3N2 vaccines manufactured in the U.S.
The identification of HIV in the 1990s was unlike flu – and unlike anything researchers had seen before. Though the progression from HIV to AIDS was relatively slow compared to other infectious diseases, the fatality rate was far, far higher. When my company began its HIV research program in the mid-1980s, HIV and AIDS remained little known and understood. By 1987, an estimated 1.5 million people in the U.S. – and even more globally – had tested HIV-positive. Individuals who contracted AIDS were expected to live only one to two years.
Some of the work of our HIV research team was crucial, not just for our own research, but for others. And because it was so crucial, that information was published, quickly, in July 1988, and HIV research became a top priority for our researchers. We were not alone in that effort. Far from it. Academic, government and private organizations all came together, advancing their own programs and treatments, sharing data, sharing study designs and insights, and more. Together, that work made HIV the chronic condition it is today – but until there is a cure, that research continues.
The 2014 and 2018 Ebola epidemics in West Africa, the largest and deadliest, bring us nearly up to date. Ebola kills half the people it infects – and quickly. In response, Merck partnered with private and public entities to research and develop potential solutions to address this deadly disease. And along with international agencies and governments, Merck has played – and continues to play – a leadership role in responding to Ebola.
So, what now? What lessons has Merck learned from its experiences with epidemics and pandemics that we’re applying today? Here are some of my thoughts.
The first is about science. Science found a way before, and science will find a way today. Make no mistake: This coronavirus is obviously new to us and because it’s different from previous coronaviruses, we currently have very few treatment options. Information about the pathogen-host interactions at play here remains scant. But – like with polio, HIV, and flu – researchers far and wide are working on it, including in our own labs. And the technology we have in our hands today is light years ahead of where we were even 10 years ago. So, there is reason to be optimistic.
The second is about the role of industry. Merck – and the pharmaceutical industry as a whole – knows what it takes in a global public health crisis, which is to bring treatments and vaccines forward.
This pandemic underscores the imperative for our company and our industry to keep investing in research to combat the greatest health threats. We can only do COVID-19 research today because we do research every day – we aren’t starting from zero. Years from now, another virus will undoubtedly emerge. And when it does, we will be that much smarter, and that much better prepared.
And the last point I want to share is about collaboration. We’ve seen so many bright spots, examples of people supporting each other and working together even on the darkest of days. In every hospital where health care providers have supported and saved patients, that’s collaboration. In every community where the spread of COVID-19 has slowed, that’s because of collaboration – everyone doing their part. Collaboration is key in science, too. While with each triumph of science there is always a person, an organization, an “a ha” moment that made a difference – collaboration is always needed to take that discovery and make THE difference for the world. As a global scientific community, that is what we have done, and what we will do again.