Healthcare, Talking Point

China’s P4 lab debate

Can a Chinese pharma firm develop a cure for Ebola?

Survivors of Ebola virus pose for a picture outside a clinic near Tubmanburg

Survivors of the Ebola virus pose for a picture outside a clinic in Liberia

The Chinese call it Sobola. But the deadly disease is better known outside China as Ebola, after one of the earliest diagnosed cases which occurred in an area near Africa’s Ebola River in 1976.

According to the World Health Organisation, as of October 12 there were 8,997 “confirmed, probable, and suspected cases” of Ebola and 4,493 deaths in Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain and the United States.

But with large numbers of traders shuttling between the African continent and Guangdong province (as well as to cities like Yiwu in Zhejiang), there is concern in China that it might experience an Ebola infection on its own soil. Moreover, putting such fears aside, Beijing has had little choice but to take a proactive interest in the Ebola outbreak. China has close diplomatic ties with its ‘brother’ emerging nations in Africa (as well as heavy investments in those countries too). As such, it is no surprise that Beijing has been keenly offering assistance to the worst-affected countries.

How has China helped?

So far 200 medical workers have been dispatched to Africa, alongside support and equipment worth $200 million. “China is ready to do more as needed,” says Zou Jiayi, director general of China’s finance ministry.

On October 1 the Sierra Leone-China Friendship Hospital Centre for Ebola Observation was opened. Within a week it had admitted 30 patients suffering from the disease (Sierra Leone has already reported 930 deaths from the virus). According to the People’s Daily, the China Centre for Disease Control and Prevention has also been active in Sierra Leone via a mobile laboratory. This began testing patients for Ebola on September 28, and diagnosed 215 sufferers in the next nine days. The newspaper reckons that the Chinese lab accounted for a fifth of the Ebola cases diagnosed in Sierra Leone in that period.

Such testing is vital in any attempt to contain the spread of the virus. A handicap, in this respect, is the time it takes to figure out if someone is infected (two days, or sometimes more between collecting samples and getting results).

Here China thinks it might be able to help with a more innovative testing method. According to Shenzhen Special Zone Daily, local firm BGI has developed a reagent testing process in conjunction with China’s Academy of Military Medical Sciences. BGI, which is sometimes described as the ‘Foxconn of genetics’, made its reputation in sequencing genomes and has earned more international attention than any other Chinese life science firm (see WiC195). It says its Ebola testing process cuts detection times to as little as four hours. It also claims to have enough of the reagent to test 10,000 people, and that it is ready to go into mass production and ship it to the areas hit hardest by the epidemic. However, BGI adds that its application to do so is still with China’s Food and Drug Administration – but hopes an “emergency approval” might fast-track the pending decision.

Could China provide a cure?

As Ebola starts to reach Europe and North America, scientists are stepping up their efforts to combat the virus. The longer term goal is to come up with a vaccine that prevents future epidemics. But in the shorter run, the scramble is to find a drug that can treat Ebola victims with some degree of success, especially in the crisis areas of Liberia, Guinea and Sierra Leone.

The best hope seemed to be offered by ZMapp, a cocktail of three antibodies developed by Mapp Biopharmaceutical of California. It was used on seven patients in August, but supplies are now exhausted. About 15 other experimental drug treatments have been touted too.

And last week a Chinese firm also signalled that it might have a possible cure. According to the Financial Times, Sihuan Pharmaceutical – founded by two former military doctors and now one of the biggest suppliers of prescription drugs to Chinese hospitals – has said it has an anti-Ebola medicine named jk-05. Sihuan says it has been working to commercialise this experimental drug – which was developed by the Chinese military, and for which it paid Rmb10 million ($1.63 million). In its statement it said the treatment had already been approved “as a special drug for military needs”. It added that it could be “a key technology for the prevention and control of the outbreak of Ebola in China”. Sihuan’s boss Dr Che Fengsheng added that his firm will try “to bring the drug to market as soon as possible”.

According to Sihuan management, the drug has been in development for five years and has been effective in animal tests conducted on mice. As of yet, there have been no clinical trials. Reuters reports that the company plans to test the drug out first on Chinese nationals who have contracted the disease in Africa. That news seemed to be confirmed this week when a top Sihuan executive told media that several thousand doses had been given to Chinese medical staff in Africa. “Aid workers have already taken the drug with them, and if a case breaks out [among the aid workers], then the drug may be used,” said the executive.

But as the Financial Times points out, no further information about jk-05 is available on the China Food and Drug Administration website, where information on clinical trials is normally made public.

News of the drug has also met with some scepticism in Chinese scientific circles – the reason being that the country lacks a P4 lab to test whether the proposed treatment actually works.

What is a P4 lab?

Until the outbreak of Ebola, few in China would have heard of a P4 lab, let alone debate why the country has taken so long to build one. Tencent Technologies says these ‘level 4 biosafety laboratories’ have such high levels of security that “researchers dress in these labs like astronauts”. The labs are used in research and development work against the most dangerous pathogens, with the bulk of such facilities located in the US, the UK, Germany and Japan.

From a technological point of view P4 labs are a major undertaking. China lacks the domestic know-how to build them, although Beijing said that getting one was a priority after the SARS epidemic in 2003. An agreement was signed with the French, but the proposed P4 lab in Wuhan remains incomplete. Tencent Technologies says the slovenly progress of the project is explained by prestige: “For a long time the eyes of the Chinese people have been on sophisticated technologies like rockets, satellites and supercomputers, where achievements from these investments generate great pride. As for the P4 lab, the Chinese people knew nothing about it, so it was paid insufficient attention.”

This, of course, begs the question: without a top-security lab, how could Chinese firms even be working on a drug to cure Ebola?

“With no P4 laboratories, one could not even test ZMapp on monkeys, let along ‘master’ a new treatment,” Tencent Technologies agrees.

The Chinese Academy of Sciences thinks the same. “A P4 lab is the crucial first step in Ebola research. The non-existence of a P4 lab means in-depth research in China of the deadly virus is at ground zero,” it lamented. “The latest Ebola outbreak underlines the urgent need for our country to speed up the development of our own P4 lab.”

Even those using the highly nationalistic military discussion forum Tiexue grudgingly acknowledged that an Ebola cure was more likely to come from the US or Japan rather than China.

“The research on a deadly virus like Ebola needs to be conducted in a P4 lab, and we don’t have one. Without a P4 lab how can we claim to have found the antivirus? Let’s build the laboratory first. It is the key task,” wrote one contributor.

The Sihuan announcement regarding its military-developed Ebola drug also prompted other netizens to ask questions. Has the Chinese military got a ‘secret’ P4 lab that it used to develop jk-05, wondered one? Or is the research being undertaken in a less secure lab environment? “Where are they doing these dangerous experiments?” demanded one netizen.

Still, investors seemed hopeful that Sihuan’s claims might be authentic. The day after it announced the drug, the company’s stock rose 6%, reports Xueqiu Finance.

Winning African favour

The Ebola outbreak comes at a time in which Washington is stepping up its efforts to counter China’s charm offensive in Africa. For more than a decade Beijing has been lavishing African leaders with attention and respect, not to mention bridges, dams and other infrastructure. During that same period America’s attention was largely elsewhere.

It shows. Last Friday the Financial Times reported from its inaugural Africa Summit that six of the continent’s largest firms were asked which foreign power was playing its cards best in Africa. “The unanimous answer: China is still winning, and big,” the FT concluded. “Africa Inc is still in love with China – despite the overtures from Mr Obama and others.” But sections of the Chinese media think the Ebola crisis will see Africa look once again to the US for support, thanks to its superior scientific research. That in turn might win back influence for Washington in African capitals. Jiang Hui, a visiting scholar in South Africa, says African newspapers have reported extensively on the efforts made by the US to thwart the disease. “It is not enough for China to emphasise its humanitarian spirit and brotherhood with Africa alone,” the Peking University academic warns. “Whoever can find the antidote, that nation is the winner of the world’s joint combat against Ebola and the saviour of the African people.”

Jiang continues: “The difference in image between China and the US in the hearts of Africans is vividly reflected in this matter: China supplies Africa with moral support and practical help, while the US sends it the method or possibility of complete cure. That’s why at the critical moment, Liberia reaches out for the help of the US.”

Nonetheless, Reference News thinks that the Chinese could play more of a role in overhauling public health systems in the countries currently afflicted by Ebola. In part that’s due to recent experience. In 2003, the SARS virus killed 800 in China, leading to belated awareness in Beijing that it faced a management crisis in its own disease control systems. Local facilities were upgraded, allowing for better surveillance of potential pandemics. More resources went into reacting quicker to outbreaks, and better isolating disease carriers. Reference News argues that the experience has helped the authorities to contain other flu outbreaks like H5N1, H1N1 and H7N9.

Swift and organised containment measures have already helped in the battle against Ebola in Nigeria, Africa’s most populous country. An emergency presidential decree allowed officials access to mobile phone records, which law enforcement agencies have been using to find people at risk of spreading the virus. A monitoring system was put in place by the government. Disease sufferers have been housed in isolation wards and their homes disinfected immediately. Social media has been used to improve awareness of Ebola. These combined actions meant that of the 800 Nigerians who came into contact with a carrier, only 20 have become infected, and only eight have died. In a rare bright spot, Nigeria is also on the cusp of reaching a key watershed in its reaction to the epidemic: 50 days without a new infection. This is the point at which the World Health Organisation can officially declare Nigeria as Ebola free. Hopefully it should be able to do so early next week.

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