The Ebola epidemic in West Africa is far from over. Without a reliable drug or vaccine, new infections continue to surface in countries like Guinea and Sierra Leone. To fully squash the epidemic, some researchers want to overhaul current medical interventions in West Africa, as well as the way scientists conduct research in future outbreaks. The lessons researchers have learned in the last few months can be applied now, they say; they're the key to ending the current epidemic.
The rate of new infections has slowed down, but it's still pretty bad. Around 330 cases of Ebola were reported in West Africa in last three months — more than were reported in the third largest Ebola outbreak on record. And overall, the epidemic has lead to 27,800 infections and 11,200 deaths. So, although news of a potential Ebola vaccine last week is encouraging, the truth is that Ebola isn’t under control, writes Joanne Liu, head of Doctors Without Borders, in a comment piece in the journal Nature today. Now, it's time to look at long-term solutions.
To ensure that scientists have the power to act in future outbreaks, governments and health agencies have to make sure that bureaucracy doesn't hinder the search for a cure or vaccine, says Trudie Lang, a global health researcher at the University of Oxford, in a second comment piece in Nature today.
500 local health workers have died
Rebuilding health care systems in afflicted countries is key to ending the current outbreak, Liu says. Over 500 local health workers died during the epidemic in Libera, Sierra Leone, and Guinea. That has secondary effects: malaria likely killed 10,900 more people in those three countries in 2014 than it would have otherwise. To stop these deaths, more money needs to go into providing routine care, and encouraging people to seek that care, despite their fears.
Health officials must also implement mechanisms that can be used to locate new cases more easily. That means checking in on people who have been in contact with infected individuals, providing support to the families of those who have been infected, and making sure that communities know how transmission occurs — and what they can do to protect themselves, Liu says. Without these measures, more people will die of Ebola, not to mention the many other diseases that threaten West African lives.
Bureaucratic roadblocks delayed clinical trials during the peak of the outbreak
On the research side, scientists hit a number of bureaucratic roadblocks that prevented trials from taking place in a timely fashion. During the peak of the outbreak, for instance, Lang and her team set out out to test a drug called brincidofovir in Liberia. But issues with visas for health workers prevented Lang’s team from employing experienced African staff to run their drug trial — something that would have "been more appropriate and better for strengthening Africa’s research capacity and international ties," Lang writes.
In addition, her trial was held up during the legal contract approval process. "Just as the epidemic began to show signs of slowing, we were delayed by six crucial weeks while waiting for contracts to be processed through [Doctors Without Border’s] systems, which took longer than seemed necessary," Lang says. As a result, the trial that started late also had to end early; the slowing infection rate meant that Lang’s team couldn't enroll enough patients to adequately test the drug.
Create a global task force that would be on call for future outbreaks
To fix these problems, Lang says the World Health Organization should oversee the design of a global task force of about 100 to 200 clinical trial staff — one that would be on call, and cleared to work on any future epidemics. "These people should be employed in everyday studies and be trained for outbreak research so that they can be deployed immediately to coordinate a trial in the event of an epidemic," Lang says. An international and neutral body that can coordinate outbreak research should also be put in place. This group could set research priorities during an epidemic, while making sure that different teams are given access to an adequate number of sites — as well as patients.
As long as new infections continue to arise, the same ingredients that lead to the outbreak could cause it to return in full force, Liu suggests. But the lessons from the outbreak can be used now. By addressing gaps at both the research and the medical level now, scientists might be able to stop Ebola in its tracks. "We need to push through the fatigue and complacency, and put everything we have learned into action to end this epidemic," Liu says. The fight against Ebola is ongoing; health organizations and governments need to ensure that there won’t be a second act.