Andrew, 14, sits in his one-room home before being taken to an Ebola isolation ward in Monrovia, Liberia in 2014 | John Moore/Getty Images How the Ebola vaccine broke new ground The speedy pace was the exception to the norm for vaccine development.

This is the latest in a POLITICO special report on vaccines: the accomplishments, history, controversy and business challenges.

The global effort to produce an Ebola vaccine within two years of a disease outbreak was remarkable for many reasons — chiefly, a process that usually takes a decade was completed in a fraction of the time.

While work still needs to be done to license the most advanced vaccine, an agreement has already been made to stockpile it.

So what lessons can be learned from this experience in cutting time and money from the standard process?

POLITICO spoke with Mike Turner, head of infection and immunobiology at the medical research charity the Wellcome Trust, who played an integral role in the Ebola team that funded clinical and anthropological studies.

A head start

What helped this effort was that there were already several Ebola vaccine projects in development.

“There were data and models sitting available to be used,” Turner said. “All the pre-clinical work had essentially been done and that was extremely helpful.”

Nevertheless, the research needed to be collated and assessed and then supported financially to expedite clinical development.

The Wellcome Trust formed a novel partnership with the Center for Infectious Disease Research and Policy at the University of Minnesota, the first unique element in the Ebola vaccine story.

They established that 13 Ebola vaccine candidates were already in various stages, and work began to support their speedy clinical development.

This was the relatively easy bit. “We were able to proceed ‘at risk’: to give people money without the normal level of due diligence,” said Turner.

The industry also took a gamble. “Many people in industry pursued projects at risk … without the knowledge that they would get this investment back, and I think that’s to their credit. Many people set aside their business model for a moment and decided to do the human and moral thing.”

A more challenging task was checking off regulatory requirements. At every stage of vaccine development, regulatory applications need to be made, including for every clinical trial and every manufacturing process.

“There were regulatory things to be sorted out but there was an incredible willingness from all parties: funders, governments, regulators, and crucially on the ground in West Africa,” said Turner.

Collaboration, for a change

The European Medicines Agency set up an Ebola team to expedite all Ebola vaccine applications. “That was great, but they couldn’t do that for all vaccines … it was a special situation,” said Turner.

Additionally, one of the great achievements was speedy agreement between the ethics committees in the U.K., Sierra Leone and Guinea on trial designs. “Often there are disagreements and it goes back and forth,” said Turner, but for Ebola, there was collaboration and agreement.

“It’s reasonable to take a year in West Africa for ethics committees to agree; that process was reduced to two weeks, which is quite extraordinary, and without compromising standards.”

By January 2016, a Merck product demonstrated preliminary efficacy results in late stage testing in Guinea, and this was sufficient enough for GAVI, the vaccines alliance, to agree to buy 300,000 doses to stockpile against a future outbreak, as well as support the drugmaker through the regulatory process.

This product and others remain in clinical development, although since incidence of the disease has declined, late stage efficacy trials have been suspended. Mid-stage studies continue to evaluate safety, immunogenicity, and duration of protection for the vaccines under study, and trials of other vaccine candidates are ongoing, according to the report.

“The Ebola reaction was not just unique in my experience, it was unique in everybody’s experience. Nobody has ever managed to achieve that before. It’s remarkable. But the whole point is that it remains remarkable and doesn’t happen again,” Turner said, hoping that another deadly disease won’t again devastate a population, without there being a treatment.

One of the key ingredients in the process was “urgency.”

For endemic diseases, such as tuberculosis, “you don’t have that same extent of urgency… That means people don’t take that slightly more risky approach.”

In the development of vaccines for endemic diseases, there doesn’t appear to be “a single bottleneck or roadblock,” but Turner believes in general there is room to “step it up.”

He said normally funders like the Wellcome Trust take six months to a year to make decisions, then it takes the same amount of time to design and secure regulatory approval of the first phase of testing. “so you’ve already taken two years and only started Phase I.”

Oversight boards, ethics committees and regulators all need to be consulted at every stage of the development, as well as convincing investors to back a project. “Nobody is trying to hold things up, but it’s a complex process … and then you realize it’s taken five to 10 years.”

Keeping the momentum

Since the urgency for an Ebola vaccine has subsided, the Wellcome Trust and its Minnesota partner are concerned that momentum has stalled and there remains no licensed vaccine.

Last month, they urged immediate action. “Without renewed commitment from the global public health community, progress towards approved vaccines for Ebola could grind to a halt as memories of the outbreak in West Africa begin to fade,” they said.

Meanwhile, Turner thinks lessons can be learned from the Ebola response in tackling future pandemics.

He says there is growing support for a global push to bring together stakeholders to ready themselves for the next event.

Funding will be key. A recent report outlined the case for a $2 billion global fund to support development of vaccines for possible disease targets.

“Two billion sounds like a lot but there was an awful lot more than $2 billion spent on dealing with Ebola,” Turner said.