Ebola vs. Us

September 28, 2014

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Ebola vs. Us

By Ilene

Ebola is spreading too quickly for Ebola-vaccine makers to conduct typical studies of safety and efficacy on experimental vaccines. Instead, vaccines will be tested for basic safety, but then deployed with protocols devised now in order to test for efficacy essentially on the field. Testing has to be expedited because the situation in West Africa gets worse every day while there are no approved vaccines or other treatments.

The chart below is from a paper in the New England Journal of Medicine showing estimates of the virus's trajectory projecting out to November 1, 2014. If current trends continue, the number of confirmed and probable cases will reach 20,000 by November (Business Insider).

Almost half of the 20,000 cases of Ebola will be in Liberia, a country whose medical care infrastructure was destroyed by fourteen years of civil war. During the war, 90% of health care workers fled and 80% of health care facilities were shut down. Andy Sechler M.D., associate medical director at Last Mile Health and physician at Brigham and Women’s Hospital and Boston Children’s Hospital, describes health care in Liberia:

…At the time of the peace accord in 2003, there were just 50 doctors serving a population of 4 million, leading to some of the worst maternal and child health statistics in the world; 1 in 8 women there die from childbirth complications.

Over the last decade Liberia’s Ministry of Health and Social Welfare has made laudable strides with available resources, but only so much can be expected in 10 years for a nation emerging from civil conflict and requiring (to this day) the presence of U.N. peacekeepers. It still ranks 175th out of 187 on the world development index, with neighboring Guinea and Sierra Leone coming in at 179th and 183rd, respectively.

What should be done? Liberian President Ellen Johnson Sirleaf, during a meeting with international partners, said it best: “Many people are coming to help us deal with Ebola, and that is fine. But they will disappear. The real issue is our health care system.” (Hell hath no fury like an Ebola virus out of control)

In addition to the inadequate health care systems of poor countries such as Liberia, the failure of developed nations to respond quickly to the emerging threat has aggravated the outbreak and increased the potential for worst-case scenarios. In April, Ebola had killed less than 100 people in West Africa. Doctors Without Borders warned that failure to act could result in an "unprecedented epidemic."

Lauren F. Friedman at the Business Insider reports that we are now facing the consequences of our earlier failure to respond appropriately:

[T]he world responded with what Nicholas Kristof of The New York Times called "a global shrug." Over the summer, as residents of the developed world comforted themselves with the knowledge that an outbreak on our home turf was highly unlikely, the death toll in one of the poorest corners of the world climbed sharply.

The "unprecedented epidemic" went from dire prediction to on-the-ground reality, and now the Centers for Disease Control and Prevention has said that — worst-case scenario — there could be 1.4 million cases of Ebola in West Africa by January.

[…]

"The international response to the disease has been a failure," [said Ken Isaacs of Christian relief organization Samaritan's Purse]. "The international community allowed two relief organizations [Samaritan’s Purse and Doctors Without Borders] to provide all of the clinical care for Ebola victims in three countries."

On their own, Liberia, Sierra Leone, and Guinea "simply do not have the capacity to handle the crisis in their countries," Isaacs said. "The world will effectively be relegating the containment of this disease to three of the poorest countries in the world."

That assessment was echoed by Daniel Bausch, an American doctor who talked to Business Insider in August about his experience on the ground in Guinea and Sierra Leone. "You have a very dangerous virus in three of the countries in the world that are least equipped to deal with it," Bausch told us. "The scale of this outbreak has just outstripped the resources. That's why it's become so big." (We Screwed Up On Ebola, And Now The Crisis Is Getting Much Worse)

The chart below (from Business Insider) shows when developed nations should have responded forcefully vs. when we actually began to seriously intervene.

In Scientists grapple with ethics in rush to release Ebola vaccines, Kate Kelland discusses the need to abandon the usual time-consuming and expensive protocols for bringing new drugs to market. Researchers and health care officials will need to test vaccines at the same time they are deploying them. Infused with the ethical issues, there are procedural issues that make the deployment of experimental vaccines within high-risk and vulnerable populations especially complicated.

LONDON (Reuters) – Normally it takes years to prove a new vaccine is both safe and effective before it can be used in the field. But with hundreds of people dying a day in the worst ever outbreak of Ebola, there is no time to wait.

In an effort to save lives, health authorities are determined to roll out potential vaccines within months, dispensing with some of the usual testing, and raising unprecedented ethical and practical questions.

"Nobody knows yet how we will do it. There are lots of tough real-world deployment issues and nobody has the full answers yet," said Adrian Hill, who is conducting safety trials on healthy volunteers of an experimental Ebola shot developed by GlaxoSmithKline.

Hill, a professor and director at the Jenner Institute at Britain's University of Oxford, says that if his results show no adverse side-effects, GSK's new shot could used in people in West Africa by the end of this year.

Even if a drug is shown to be safe, it takes longer to prove it is effective – time that is simply not available when cases of Ebola infection are doubling every few weeks and projected by the World Health Organization to reach 20,000 by November.

[…]

GSK is one of several drug firms that have either started or announced plans for human trials of candidate Ebola vaccines. Others include Johnson & Johnson, NewLink, Inovio Pharmaceuticals and Profectus Biosciences. (Scientists grapple with ethics in rush to release Ebola vaccines – Yahoo News.)

While humans struggle to decide what measures to take and how to successfully and ethically launch untested drugs among populations of people already dying, Mother Nature doesn't care. The virus spreads with no concern for our questions or our answers.