Abstract
Background: Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that prevail in tropical and subtropical conditions (WHO 2017). There have been NTD outbreaks which demonstrated to be quite severe and were able to be impactful outside their endemic region. An example of such an outbreak is the recent Ebola and Zika virus. Given that there have been more than twenty Ebola outbreaks and that the virus was first discovered in 1976, there was no approved treatment or vaccine for Ebola at the time the most recent epidemic began. Following the recent Ebola and ZIKV outbreak, the trend of increasing cases has fallen due to increased innovation efforts.
Objective: Only recently the Ebola and Zika virus found their way to the “awareness radar” on a global scale, even though these NTDs have existed for decades. This, in turn, has led to increased intervention and innovation efforts. This has encouraged the research for this review on the various factors which have led to this
Methods: The method used in this literature review is a systematic search followed by a narrative approach. The methodology followed for this literature review included two main phases: selection and analysis. The selection phase contained key terms to collect a comprehensive set of articles addressing studies about factors that increased innovation efforts regarding Ebola and Zika disease after the recent outbreaks. The analysis phase consisted of a careful and critical review of articles in order to identify patterns and recurrent themes.
Results: The reviewed articles revealed the following sub-themes, namely; travel, spread, fear and global threat. These sub-themes belonged to the following generalized themes; globalization, awareness, and media.
Conclusion: Globalization, travel, spread, media, fear, awareness and global threat are the defining factors which have led to increased innovation efforts after the recent Ebola and Zika virus outbreak. Patterns had to be identified and analyzed which proved a bit difficult because there were no pre-defined models available regarding this subject, as only a relatively small number of articles actually went into depth and detail describing the reasons leading up to innovation efforts as a defined factor. Further research is still needed in order to generalize this study’s results to virulent diseases other than Ebola and Zika.
1. Introduction
Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that prevail in tropical and subtropical conditions (WHO 2017). World Health Organization (WHO) has identified 17 core NTDs which affect more than one billion people in the world, causing significant illness which causes severe pain, long-term disability, and even death. The death cause is estimated at 534,000 people per year (Hotez, Molyneux et al. 2006) The reason these diseases have been ‘neglected’ for years is the low prevalence in western countries. Populations living in poverty are those who are most affected by NTDs due to poor living conditions, sanitation or have less to zero access to public health and health care systems for treatment (Mackey, Liang et al. 2014). Despite the fact that many of these diseases are preventable or treatable through specific low-cost interventions, these are still considered to be too expensive for people living in extreme poverty. Though not all NTDs are caused by poor hygiene and as such require more than low-cost interventions in order to be remedied. The pharmaceutical industry is considered to be a key facet able to combat the spread of NTDs by creating the medicines and vaccines used in the treatment of NTDs (Matter and Keller 2008, Frew, Liu et al. 2009, Hotez 2011, Mueller-Langer 2013, Jackson and Stephenson 2014, Berdud, Towse et al. 2016, Everts, Suto et al. 2016). However, research and development is a multi-faceted costly endeavor, not only as a financial aspect but as a time consuming process as well, as such pharmaceutical companies invest in this costly endeavor when a return on investment (ROI) from sales forecasts are deemed to be viable (Fitchett, Lichtman et al. 2016). Developed countries run government health insurance programs which strengthen the purchasing power of the “market”, this viable level of purchasing power lacks in developing countries which happen to be the most afflicted by NTDs (2016, Tambo, Ugwu et al. 2016, Hafner, Walkowiak et al. 2017). As such pharmaceutical companies are reluctant to invest in research and development for NTDs for uncertainty to recuperate the cost required for research and development (Fitchett, Lichtman et al. 2016). There have been NTD outbreaks which demonstrated to be quite severe and were able to be impactful outside their endemic region. An example of such an outbreak is the recent Ebola epidemic that emerged in late December 2013 and appeared to be contained until May 2014, when it rapidly accelerated its rate of incidence and crossed into urban areas in Sierra Leone and Liberia (Omilabu, Salu et al. 2016). In June 2014, Ebola cases were confirmed in over 60 locations across three countries, with more cases rising exponentially, front-line health workers were dying in large numbers. The International aid machinery did not respond until late July when two US aid workers had been evacuated from Liberia after being infected by Ebola. (Gostin and Friedman 2015)
Another example of an NTD’s severe spread outside its endemic region is the recent outbreak of the Zika Virus (ZIKV) where fewer than 10 human cases had been described before the first recorded outbreak in Yap Island, Micronesia in 2007, the ZIKV managed to spread to other countries in the Pacific, as of 2014 the epidemic spread reached French Polynesia, New Caledonia, the Cook Islands and Easter Island (Imperato 2016). As of 2016, the ZIKV caused outbreaks in 19 Latin American countries, with up to a million estimated cases in Brazil alone (Sam, Chan et al. 2016). The spread of Zika in the densely-populated countries of Central and South America was rapid. This swift spread was as mentioned due to the densely populated urban areas which lacked proper sanitation, the presence of an efficient arthropod vector namely the Aedes mosquitos and the high level of population mobility (Shukla, Hong et al. 2016).
The recent ZIKV and Ebola outbreaks are illustrative of a persistent theme: where research and development of treatments and vaccines have been neglected for infectious diseases that are largely endemic to impoverished populations, even when taking into account the societal level of severity. These outbreaks epitomize a largely failed global response, with delayed action by leading international agencies. The lack of a licensed vaccine or effective therapeutic drugs has contributed to the uncontrollable surge in cases and inability to control transmission beyond traditional infection control practices (Maehira, Kurosaki et al. 2016). Given that there have been more than twenty Ebola outbreaks and that the virus was first discovered in 1976, there was no approved treatment or vaccine for Ebola at the time the most recent epidemic began (Gostin and Friedman 2015, Reperant and Osterhaus 2017). Shukla, Hong et al. (2016) wrote that a rapid detection method was developed for Zika after the recent outbreak. Following the recent Ebola and ZIKV outbreak, the trend of increasing cases has fallen due to increased innovation efforts. What are the reasons for this increase in innovation efforts?
1.1 Research aim and research question
1.1.1 Research aim:
Only recently the Ebola and Zika virus found their way to the “awareness radar” on a global scale, even though these NTDs have existed for decades. This, in turn, has led to increased intervention and innovation efforts. This has encouraged the research for this review on the various factors which have led to this increased innovation effort of research and development of vaccines, treatments, and policy. As such the research aim is to identify the factors which have led to increased innovation efforts of the NTD’s Ebola and Zika after the recent outbreaks.
1.1.2. Research Question:
Which factors have led to increased innovation efforts in Ebola and Zika after the recent outbreaks?
2. Methods
The method used in this literature review is a systematic search followed by a narrative approach. This approach is more accurate as it uses specific systematic search functions and makes it possible to discuss a variety of topics within a subject, while articles are summarized on a specific topic. The methodology followed for this literature review included two main phases: selection and analysis. The selection phase contained key terms to collect a comprehensive set of articles addressing studies about factors that increased innovation efforts regarding Ebola and Zika disease after the recent outbreaks. Ebola and Zika are used as cases, to examine factors which had an impact on the innovation of these low prevalence diseases. The analysis phase consisted of a careful and critical review of articles in order to identify patterns and recurrent themes. As the aim of this study was to explore, analyze, identify and understand the key factors which contributed to increased innovation efforts after the recent outbreaks of Ebola and Zika
2.1 Search strategy
In order to perform the systematic search, different electronic databases were used for collecting relevant articles. Due to the lack of time, only two different electronic databases, Pubmed and Web of sciences, were used for collecting relevant articles for this review. The key concepts of the research questions were translated into search items, these keywords were used for searching through the two electronic databases for relevant articles. The keywords that were used included (Ebola AND Innovat*) OR (Zika AND Innovat*). The truncation was used for the term innovation, one or more characters at the end of the search term innovation was replaced by *. This to broaden the search to include multiple forms of the search term innovation. The keywords combination was only used in title and abstract in each article. The title and abstract of each article was selected, for the reason that the title and abstract of an article should express the main goal, background, and findings of the article. This way only the most relevant articles are searched through the databases. The search was adapted for the individual databases as needed. The full search strategy is included in additional file 1.
2.2 Selection criteria
The studies were identified as relevant to this review if they effectively addressed that there was an increased innovation effort regarding Ebola and Zika virus disease after their recent outbreaks and reporting the factors that contributed to this increased innovation effort.
The studies also needed to have the following characteristics;
– The articles were published between the year 2014 and august 2017. This time period was chosen due to the main focus of this review regarding the recent outbreaks. Ebola outbreak started since March 2014, this was when West Africa experienced the largest outbreak in history (Bellizzi 2014). Zika virus outbreak has been spreading, since May 2015, in the continental region of the Americas, in the State of Bahia, Brazil (Etienne, Santos et al. 2017).
– The articles must be written in English
The exclusion criteria were as follow;
– Articles that were not peer-reviewed
– Articles that were published as a commentary, abstract or a report were also excluded from the review
2.3 Study selection
A total of 155 articles were identified and 7 articles were manually added from grey literature. These articles were found in a previous study about innovation in NTDs, which also met the inclusion criteria for this study. These articles were also found through the same electronic database as used for this study. The titles and abstracts were reviewed of each the 106 articles, the duplicates and no access articles were removed followed by relevance and eligibility identification in the primary search. Articles titles and abstracts were independently screened to select articles for full text reading. Book reviews, commentary, and articles that did not mention innovation in Ebola and Zika after their recent outbreaks were excluded. A total of 49 articles failed to satisfy these inclusion criteria. Eventually, a total of 57 articles were retrieved for a full-text review. The analysis was focused on the identification of factors that affected innovation in Ebola and Zika after their recent outbreak. Each of the 57 articles was thoroughly read to assess their contents in the context of the research question posed in this review. At the end of this stage, the pool of publications was narrowed down to 21 articles that effectively addressed that there was an increased innovation effort regarding Ebola and Zika virus disease after their recent outbreaks. As the aim of this study was to explore, analyze, identify and understand the key factors which contributed to this increased innovation, shared characteristics were analyzed and selected from different parts of the articles, being either introduction, results or conclusion (fig.1).
2.4 Data analysis and synthesis
For this review, content analysis was used to synthesize the results from the articles. Content analysis is a research tool that is used to determine the presence of certain concepts within texts (Cavanagh 1997). The texts from these articles were coded into manageable categories on a variety of themes. A meta-analysis was inadequate for this study because the included articles reported methods and results in different ways. Open coding was used for the coding process. The articles were carefully read and each fragment that was relevant to the research question was coded as sub-theme. The sub-themes were categorized in themes to explore relationships within and between studies. A data extraction form was developed in Microsoft Excel to transcript the open coding process. From every article, the following data were collected: script, sub-theme, theme, innovation, disease, geography, result factor, research question or hypotheses articles.