The news about Ebola these days is more about scientific progress and less about the global health threat. In an epidemic where 26,000 people fell ill and more than 11,000 died, there are only nine cases this week in Guinea and Sierra Leone, with Liberia finally free from the epidemic’s grip.
What’s newsworthy, however, is the current pace of Ebola research and development. In the last two months, an Ebola candidate vaccine has entered final stage testing in humans in Guinea and Sierra Leone. While it typically takes between five to ten years to develop and fully test a vaccine, because of the urgency provided by the Ebola epidemic, the pace of science was drastically accelerated.
On the other side of the laboratory, new diagnostics now allow for a much quicker diagnosis of the virus. Three new drugs are being tested to assess whether they are able to cure Ebola patients from the disease. Factor in the separate analyses of whether the anti-malaria drug amodiaquine or plasma transfusions from patients who survived the disease can eliminate the deadly Ebola virus in infected people, and all of a sudden scientists are concerned about having enough patients to enroll in these studies.
When an epidemic like Ebola hits, the first steps are to figure out how to control the spread of the disease while caring for the sick. With the West African epidemic, these steps dominated the news coverage—especially because the region at the center of the outbreak lacked the requisite healthcare infrastructure that these steps required.
But equally important is the lack of a vaccine that could have prevented the outbreak, medicines that could have stopped the outbreak in its tracks, and diagnostics that could have allowed faster identification of infected people.
Before this wave of R&D, Ebola was not considered a global health threat. Outbreaks had always been limited to small episodes in the tropical forests of Central Africa. Before the West Africa epidemic, the largest outbreak was in 2000-2001 in Uganda, when 425 people were infected. As a result, research on the virus had been limited to early stage development work, academic modeling, or bioterrorism concerns.
The research surge that Ebola triggered began in the summer of 2014. The world’s public health and scientific communities—including the World Health Organization, the U.S. Food and Drug Administration and the European Medicines Agency—met with national government and pharmaceutical industry representatives in Geneva to devise a way that accelerated the testing of compounds that had shown efficacy against the virus in animals and in labs. Safety trials of vaccine and treatment candidates were rapidly organized with the political will and the financing needed to do so.
The challenge today, however, is twofold. First, for Ebola, we need to get as much information as possible from the testing of the current pool of candidate medicines and vaccines, before the extinction of the epidemic forbids getting to a definitive answer on their efficacy. Our medicine cabinet needs to be stocked for future outbreaks.
But the second challenge extends well beyond Ebola. While we are on the right path to preparing for the next time Ebola emerges, other epidemic threats loom. In the U.S., for example, the Centers for Disease Control and Prevention (CDC) has reported more than 100 cases of acute flaccid myelitis, an inflammation of the spinal cord, yet experts have been unable to determine an infectious cause of the outbreak.
Other disease threats have been identified around the world. The corona virus infected just under 1,000 people in the past two years, killing more than 350 people, and remains active in Saudi Arabia. In the first four months of 2015, Niger reported more than 1500 cases of meningococcal meningitis, including 147 deaths. China has reported 20 cases of avian influenza A (H7N9) this year, including four deaths.
The Ebola epidemic in West Africa has been called a wake-up call for so many reasons. With Ebola, once the world understood the threat, the actions taken not only halted the disease, but also left us better prepared to fend off the next outbreak.
From where I sit in Geneva, the response by the global health and R&D communities awakens hope. There are many diseases with the potential to trigger chaos and human suffering, but we have learned how to jumpstart research and development to address epidemics as they occur and stem the tide of suffering from these diseases. We have also learned that we must take some critical research steps proactively before another wake-up call.
We are now in a position to design a framework for how to prepare for and respond in the most challenging public health crises. That framework needs fine tuning, and the support of the international community so that next time we are prepared to move forward more quickly, and halt the epidemic before it becomes the next dire crisis.