REACTing, a multidisciplinary approach to meeting the challenge of epidemics

25

04

2016

At the Zika International Meeting, which was held at Institut Pasteur (Paris) on 25 and 26 April 2016, Yves Levy introduced the REACTing consortium, and gave an update on the progress of actions taken to control the Zika virus
 

 

 

See his full speech below:

Mr President, dear Christian Bréchot,
Ladies and gentlemen,
Dear Colleagues,

Our societies regularly face local or global health crises. These crises are most often associated with an emerging viral or bacterial infectious diseases: H5N1 and H1N1 influenza, SARS, Mers-Co, Chikungunya, Ebola and Zika, which bring us together here today.

Governments, regional and international organisations, health agencies, non-governmental organisations and the pharmaceutical industry are now challenged by these repeated crises and their consequences for health, social, economic and sometimes political equilibria. We have evidently entered a new phase of emerging and re-emerging infectious diseases. This new phase calls for new responses, to meet the challenges to be faced in the emergency of these epidemic crises.

In June 2013, under the aegis of the French Life Sciences and Healthcare Alliance, France launched a consortium called REACTing: REsearch and ACTion targeting emerging infectious diseases.

REACTing is a multidisciplinary approach bringing together excellent teams and laboratories, in order to prepare and coordinate research to deal with a threat that hasn't happened yet and that is therefore, by definition, unforeseeable.

This consortium is organised around a steering committee of some fifteen human and animal health specialists; it relies on an 8-member scientific committee and methodology centres. REACTing does not target any particular disease, and can get involved in all emerging infectious diseases. It has a broad scope, ranging from basic research to the human and social sciences, including environmental sciences, epidemiology and public health. The approach is broad-based and multidisciplinary, because we know that health crises are always complex phenomena in both their causes and their effects.

REACTing has two objectives:

  • To improve research planning during periods between crises (peace time): governance, preparation of research tools, identification of research priorities, application for funding, and preparation of ethical and legal aspects essential to preparing for research projects to be set up in an emergency.
  • To coordinate, fund and establish research projects during periods of epidemic crisis: coordination, scientific and strategic priorities, methodological assistance, and informing the authorities and general public.
  • Aid to public decision-making and to assert the place of research in the response to health crises, alongside healthcare, logistics, safety and geopolitical aspects.

REACTing was mobilised from summer 2014 in coordinating the fight against Ebola, and was represented on the inter-ministerial Task Force set up by the French Prime Minister. Against this background Inserm was able to set up:

  • an antiviral treatment trial using Favipiravir,
  • several phase 1 and 2 vaccination trials in progress in Europe and Africa, jointly with J&J,
  • the next phase 2b trial in 3 West African countries, Guinea, Liberia and Sierra Leone, in academic partnership with the NIH and LSHTM, and industrial partnership with J&J and Merck.

I will also mention the role of IRD and Inserm in studies backed by social sciences, current investigations into the Ebola reservoir, the crucial role of the Institut Pasteur in organising diagnostic and research laboratories, and the role of the EFS, the French blood transfusion service, in the therapeutic trial based on convalescent plasma.

All these actions were or are mainly conducted in collaboration with NGOs that have played a major role in organising the response to the epidemic.

In his address during the Conference on international healthcare safety, which was held in Lyon last 23 March, the French President approved the REACTing strategy and confirmed that this consortium will receive a grant of €8m, to establish a research programme on Zika and Ebola. In addition, an annual grant of €1m will allow it to continue operating.

In the last two years, nearly 2 million people have been contaminated by the Zika virus in Latin America and the Caribbean.

From the end of 2015, REACTing and the Aviesan Alliance were immediately mobilised, particularly Inserm, Institut Pasteur, IRD, the French blood transfusion service and the associated university hospitals. Our first contacts with our Brazilian colleagues from La Fiocruz took place in November 2015.

We have already taken decisions regarding several observational and clinical research projects on monitoring symptomatic pregnant women, monitoring children with malformed nervous systems or born of infected mothers, building libraries of field and biological samples, assessing penetration of the virus in populations and mathematical modelling its dynamics. We have also assembled teams working on neuroscience to start joint projects on this topic, given the neurotropic nature of the Zika virus.

More specifically, projects that have started or sometimes have already been completed and published, particularly regarding:

  • analysis of the consequences of the infection during pregnancy covering about 5,000 pregnant women in Guadeloupe, French Guiana and Martinique
  • extension of the CARBO cohort of patients suffering acute arbovirus infection
  • epidemiological analysis of microcephaly and Guillain-Barré syndrome in French Polynesia (with significant involvement of the Institut Pasteur)
  • research on sexually-transmitted contamination and persistence of the virus in the sperm.

In terms of diagnostics, the aim is to develop a reliable method rapidly at individual and population scale, particularly for the target of pregnant women and newborns, given the diversity of pathogens, particularly arbovirus, that are circulating at the same time in countries where the Zika virus epidemic is wreaking havoc.

Backed by these first results, we have also laid down the basis of a full response to a European invitation to tender, currently being prepared. For the partners of Aviesan, this means:

  • mobilising all French research forces working in the field, but also including our European and Latin-American partners in a common approach
  • rapidly deploying innovative research, particularly on
    • Zika and the nervous system,
    • modelling the virus and its spatial configuration,
    • means for controlling vectors,
    • the socio-economic dimension to propagation of the epidemic.
  • including partners that have already worked on European funding in similar situations, related to dengue fever or emerging infectious diseases.

Our mobilisation will also include vaccine research:

  • as part of an academic partnership with HIH and VRC to carry out phase 1 and 2 trials of DNA vaccine in the USA, France and the West Indies;
  • in partnership with industrial companies, which are permanently associated with the strategy of the Aviesan Alliance. We have started a collaborative project with Sanofi Pasteur to begin first pre-clinical trials rapidly on a vaccine strategy against Zika, particularly based on experience accumulated with the vaccine against dengue fever that received its first marketing authorisations in Latin America in 2015.

These two days, organised in 6 sessions, will allow fruitful exchanges to pit our knowledge and strategies against the Zika virus. On behalf of Aviesan, I would like to thank all researchers for attending and for their contributions. I wish you all the best for work here.

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