The first in-human clinical trial of a vaccine against the deadly Nipah virus has been launched by Oxford. The Nipah virus is fatal in up to 75% of cases, with outbreaks occurring across Southeast Asia; the WHO labels it a “priority disease requiring urgent research”. This trial marks a groundbreaking milestone after 25 years without any vaccines or treatments approved for the virus.
Nipah virus was first identified in 1988 after an outbreak among pig farmers in Malaysia and Singapore, with 100 out of 257 cases resulting in death and the culling of over a million pigs to control the spread of the disease. Since then, there have been outbreaks in Bangladesh and most recently in Kerala, India. The disease is carried by fruit bats and is spread to humans through contact with infected animals such as bats and pigs; it can also be transmitted from person-to-person contact and via contaminated food. The virus causes moderate to severe brain swelling, which results in death in about 40-75% of cases. Dr. In-Kyu Yoon of the Coalition for Epidemic Preparedness Innovations (CEPI), the sponsor of the trial, shared that Nipah had epidemic potential due to the densely populated regions fruit bats are found in – including areas home to over two billion people.
The trial is developed as part of the Pandemic Science Institute’s Henipavirus Programme, which targets diseases in endemic countries and works with local partners to develop preparation tools for future outbreaks. Development of the vaccine made use of the same platform as the Oxford/AstraZeneca COVID-19 vaccine, ChAdOx1. The Oxford Vaccine group will lead the first trial, comprised of 51 participants, aged 18 to 55; over the project period of 18 months, further trials will be conducted in a Nipah-affected country. Dr Yoon also stated that the insights gained from this trial could inform the development of countermeasures to common viruses such as measles and mumps.
Additionally, the project could help shed light on the public health ethics involved in current preventive measures. A paper by the Ethox Centre at Oxford Population Health brought into question the relevance of some methods used by the local public health authorities during the 2023 Kerala outbreak, which included introducing a lockdown for the first time despite the virus’ low transmission rate. Dr Euzebiusz Jamrozik, a postdoctoral research fellow at Oxford Population Health, addressed whether such extreme measures were “ethically justifiable for Nipah virus”, given the differences from previous responses which had “focused more on contact tracing and other traditional infection control measures”. He mentioned that the design of future vaccine trials “should also be informed by ethical considerations, including the results of local community engagement activities”.
The researchers believe that as the virus gains more attention in discussions of epidemic preparedness, work on the public response to the disease must follow suit. They stress that the development of intervention measures should consider all “ethically relevant factors” through consultation and collaboration with local biomedical experts and communities most likely to be affected by the virus. More extensive bioethics work could improve research and interventions for the disease to be “ethically acceptable and more […] effective”.
