The potential consequences of dengue in Europe for the global population are concerning.

On the final morning of August, citizens of Paris encountered a process typically limited to tropical areas – government officials fumigating the city to combat the presence of tiger mosquitoes. This occurrence served as concrete evidence of the already established public health data: Dengue, a lethal illness transmitted by mosquitoes, had officially made its way to Europe.

In 2022, there was an increase in dengue cases acquired within Europe compared to the total number in the previous ten years. This rise poses a danger to public health and also presents a potential market for dengue vaccines and treatments. This news should prompt the pharmaceutical industry to increase their funding towards addressing this neglected disease.

At first glance, this change seems to be advantageous not only for countries such as France, but also for nations like Bangladesh and the Philippines that have been struggling with dengue for a long time.

However, experts informed POLITICO that this assumption may be significantly flawed and could potentially have serious consequences.

Some experts in the field suggest that the increase of dengue cases in Western countries may lead to challenges in accessing life-saving medications for those most in need. This could be due to pharmaceutical companies focusing on developing tools that are less effective in areas with a high dengue burden, or wealthier nations stockpiling these medicines and vaccines.

Lindsay Keir, director of the science and policy advisory team at think tank Policy Cures Research, questioned whether the increase in product development is truly positive if it leads to a divide between high-income populations who have access and low- and middle-income countries who do not.

Killer invading mosquitoes

The spread of climate change and migration has led to the presence of mosquitoes that carry dengue, chikungunya, and Zika in Europe. According to the latest report from the European Centre for Disease Prevention and Control, there were 71 instances of dengue transmission in Europe in 2022, with 65 cases in France and six in Spain.

Although dengue typically causes minimal or no symptoms, it can also result in a high fever, intense headache, and vomiting. In severe cases, it may lead to bleeding from the gums, abdominal pain, and even death.

The Asian tiger mosquito has primarily been limited to Southern Europe, but it is a concern throughout the entire continent. In Belgium, the national public health research institute Sciensano has created an app for individuals to upload photos of any Asian tiger mosquitos they come across.

The illnesses transmitted by these mosquitoes have typically been classified as neglected tropical diseases, a collection of infections that primarily impact low-income nations and struggle to garner attention and funding for research and development. However, this is undergoing a shift.

In 2013, Policy Cures Research excluded dengue vaccines from their yearly report on neglected disease research and development funding. This was because the private sector had entered the market and there was no longer a perceived market failure in the area of dengue.

The organization continues to monitor the development of dengue treatments and therapies, and their report for 2022 indicates a 33% rise in funding for non-vaccine products research compared to last year. This includes a record-breaking investment of $28 million from the industry.

According to Sibilia Quilici, who is in charge of the organization Vaccines Europe, a recent evaluation of the members’ progress showed that about 10% of them are focusing on neglected diseases. Quilici stated that there has been an increase in research and development in this field.

Among the leading pharmaceutical companies, J&J is currently developing an antiviral treatment for dengue, MSD has a dengue vaccine in their research plans, and Sanofi is working on a second yellow fever vaccine. Two dengue vaccines have already been authorized in the European Union – one from Sanofi and another from Takeda. Moderna has informed POLITICO that they are closely examining a potential dengue vaccine and they are also in the process of developing a Zika vaccine.

For the minority, not the majority.

However, the expansion of markets for Big Pharma does not guarantee that the products will be appropriate for the communities that have been eagerly anticipating these tools for years.

Rachael Crockett, senior manager of policy advocacy at the non-profit organization Drugs for Neglected Diseases Initiative (DNDi), stated that an increase in pharmaceutical investments for a specific disease does not guarantee the development of globally applicable products. She also noted that both the industry and governments tend to prioritize prevention efforts.

Crockett stated that in areas where dengue is prevalent, health systems are overwhelmed during the rainy season and treatments are the most urgent necessity. As a result, tools like vaccines will be given priority.

In addition, she stated that a significant rise in funding without a system in place to guarantee access to the products created could lead to potential issues such as hoarding and high prices. This is exemplified by the existence of the U.S. national stockpile of Ebola vaccines, despite there never being an Ebola outbreak in the country.

Many of these fears stem from the errors made during the COVID-19 pandemic, where countries with less financial resources and political power were placed at a disadvantage when it came to receiving vaccines.

Head of the Brussels office for the German charity Deutsche Stiftung Weltbevölkerung (DSW), Lisa Goerlitz, cautioned that an increase in drug development due to a growing market in high-income countries could result in diminished focus on factors such as accessibility and affordability that are crucial for use in low-resource settings.

Quilici from Vaccines Europe addressed these worries by referencing the Berlin Declaration put forth by the pharmaceutical industry. The declaration suggests setting aside a portion of vaccine production for use during a health emergency. Quilici emphasized that this commitment is backed by the lessons learned from the COVID-19 pandemic and could effectively address challenges faced during such crises if it is given proper consideration.

UPDATE: This piece has been revised to fix the misspelling of Lisa Goerlitz’s name.