TIME ebola

#TheBrief: Watch How the CDC Is Changing Its Ebola Protocol

As two nurses who contracted Ebola begin to receive specialized care

As the Ebola virus continues to ravage parts of West Africa and two American health care workers begin to receive specialized care, we have to wonder: Are hospitals in the U.S. well-equipped to contain any further spread at home?

Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, assured Americans in September that the country’s hospitals could control and curb any threat. But after two nurses contracted the virus while helping to treat the first person diagnosed with Ebola in the U.S., who died in Dallas last week, criticism is piling on and answers to this question and more are in high demand.

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

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Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

There’s a Solution to Ebola—It’s Called ‘Money’

Peter C. Doherty shared the 1996 Nobel Prize for Physiology or Medicine. He has worked on aspects of infection and immunity for almost 50 years.

We could have been better prepared for this outbreak, but we can’t expect industry to invest in vaccines for a sporadic, developing-world disease

The first initial diagnosis of Ebola has landed on U.S. soil. A man who had flown recently from Liberia presented on September 26 at Texas Health Presbyterian Hospital with fever and malaise. He was treated with antibiotics and sent home. By September 28, Duncan was back in the hospital and placed in quarantine.

Texas public health officials say that up to 100 people may have been exposed. Ebola has a long incubation period and patients become highly contagious only late in the course of the disease. Both from my own perceptions of watching the disease since it was first diagnosed back in 1976, and from talking to professionals who were working with it and trying to develop a vaccine, I don’t believe that Ebola, along with a whole list of horrible hemorrhagic fevers caused by a spectrum of different viruses (Junin, Korean Hemorrhagic Fever, Sin Nombre), constitutes a substantial pandemic risk. With all the federal and state resources available, along with the fact that the Liberian community in Dallas will be both readily contacted and sophisticated in how they handle information, the worst case scenario is a very limited, and likely local, outbreak.

But there are still no vaccines nor drugs nor cure for Ebola.

Gary Nabel’s group at the NIH Vaccine Research Center has been publishing on experimental Ebola vaccines for years, with 2010 seeing an account of what looks to be a reasonable candidate. Why isn’t that, or something similar, available now? The answer is one word: money. Developing and testing any product for human use runs in the range of hundreds of thousands to a billion dollars. We can’t expect industry to go down this road for vaccines with a minimal market. In addition, the Ebola outbreak is happening in West Africa, where substantial numbers of people die each year from yellow fever. We’ve had a yellow fever vaccine for more than half a century, but the problem is affordability.

Currently, two candidate Ebola vaccines (including the NIH product) are being fast-tracked through human limited human trials, providing, perhaps, a model for the future. No doubt this will be used at the earliest possible date to protect health professionals but, once the current outbreak is over, it will be interesting to see who gets the vaccine for the future.

Financial constraints also apply when it comes to developing specific antiviral drugs (small molecules) to treat Ebola. Unlike antibiotics, antivirals need to be specific for the particular pathogen. There are good “designer drug” protocols for finding a virus’s “point of vulnerability” and making an appropriate chemical to block the infection. Think of the spectrum of such pills that keep HIV-infected people alive and well. Then there is the recent drug for treating Hepatitis C virus carriers, which retails for about $80,000 per treatment.

Again, where will the money come from to bring such a product to market for a sporadic, developing-world disease like Ebola? Mimicking our own antibody response to infection, there was some evidence of clinical success with an Ebola-specific monoclonal antibody (mAb) made in genetically engineered tobacco. While many cancer patients, in particular, have been treated successfully and safely with mAbs, such “biologicals” are enormously expensive to make in sufficient volume for widespread use.

So what’s the bottom line? We could have been better prepared for his horrible Ebola epidemic, but who pays? The Bill and Melinda Gates Foundation has done a terrific job when it comes to countering developing world diseases, but they can’t do everything. One thing that would be inexpensive is to develop and distribute much better educational material using, for example, the cell phones that are as ubiquitous in developing countries as they are here.

And are we in for a U.S. Ebola epidemic, or even a pandemic? I don’t think so, though we should take this as a warning and exercise “duty of care” when it comes to sustaining our public health services.

Peter C. Doherty shared the 1996 Nobel Prize for Physiology or Medicine. He has worked on aspects of infection and immunity for almost 50 years. His recent books include Pandemics: What Everyone Needs to Know and Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World. He spends his professional time between St. Jude Children’s Research Hospital, Memphis, and the University of Melbourne, Australia.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

Ebola in America: Government Can Lock Us Up for Weeks at a Time

A nurse puts on protective gear during a demonstration at a quarantine unit set up at Wilkins Infectious Diseases Hospital in Harare on Sept. 26, 2014 to deal with ebola virus cases in the event of any outbreak.
A nurse puts on protective gear during a demonstration at a quarantine unit set up at Wilkins Infectious Diseases Hospital in Harare on Sept. 26, 2014 to deal with ebola virus cases in the event of any outbreak. Jekesai Nijkizana—AFP/Getty Images

Arthur Caplan, PhD, is the Director of the Division of Medical Ethics at NYU Langone Medical Center. Alison Bateman-House, PhD, MPH, MA, is a Rudin postdoctoral fellow in the Division of Medical Ethics at New York University Langone Medical Center.

Individual states, like the Federal government, have broad authority to protect the health of the public in the case of dangerous diseases

Thomas Duncan, a 42-year-old Liberian citizen, is in serious condition with Ebola in a Dallas hospital. His partner Louise is confined to the Dallas apartment where Duncan became very sick from the virus. Texas health officials have placed her, one of her children, and two nephews in their 20s, under quarantine. This means they have been ordered, under threat of prosecution, by the county not to leave their home or have any contact with outsiders for 21 days. Any exception requires the approval of the local or Texas state health department.

Have government officials done what they need to do to prepare us for the reality of quarantine in a time of Ebola? No. But if there is a deadly communicable disease, they can lock us up for weeks at a time. Personal freedom and liberty are foundational American values. But in the face of a threat of death, liberty can and should be, as we are watching in Dallas, limited so that you can’t move around freely and infect others.

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the Constitution. Under the Public Health Service Act, the Secretary of Health and Human Services and the CDC are authorized to take measures to prevent the entry and spread of deadly communicable diseases from foreign countries into the United States and between states. Ebola surely meets that description. So quarantine at an airport or the harbor is legal, and we should be ready to see it used.

The authority for controlling disease within a state falls to state and local health departments. Individual states, like the Federal government, have broad authority to protect the health of the public in the case of dangerous, communicable diseases such as Ebola.

Quarantine is among the oldest public health activities. It has been used to control diseases for thousands of years. It can be very effective in halting the transmission of disease, if it is scrupulously observed. But, Americans are so committed to freedom that government is only supposed to use quarantine if no other, less-restrictive, option exists.

If Duncan’s family, who may have been exposed to Ebola show no signs of illness after 21 days, they will be declared uninfected. At that point, the quarantine will be lifted – maintaining it would be an unscientifically grounded restriction of liberty.

Twenty-one days is a long time for a family to be stuck inside. During that time, Texas health authorities, who have exerted their authority over this family in the name of the public’s welfare, need to provide the family with food, drink, medical care, and – one hopes – less urgent but still important items like entertainment, educational services (they may need a computer), and financial assistance (rent, electric and water bills will still need to be paid, and anyone who works outside of the home will be unable to get there).

There’s more. Should others also wind up being quarantined, if they have pets, they will need pet food or boarding. If they have babies, diapers. If they use a Laundromat, they will need laundry services. All the things that one normally would obtain in day-to-day interactions for 21 days will need to be provided.

Public health departments these days are underfunded, so if these expenditures are a hardship for Dallas County Health and Human services, emergency funds need to be provided from somewhere to try to keep this family as comfortable and functional as possible as they endure quarantine.

Quarantine poses more hardships on the poor than the rich. Public health authorities can implore an employer to save a quarantined employee’s position for 21 days, but there may be no job awaiting upon release. If being quarantined causes an individual to become unemployed, government has a responsibility to help that person. If you are poor you are going to need more resources to get you through then if you are rich. Before you say, hey, I don’t want to pay, remember they are locked up for our sake more than theirs.

Quarantine isn’t as simple as padlocking the door and putting a police car outside on the street. If it’s going to be used, there’s a lot that needs to be in place. And the public, to support it, needs to understand why it’s being done, under whose authority and what is being done to make it both effective, fair and bearable.

Arthur Caplan, PhD, is the Director of the Division of Medical Ethics at NYU Langone Medical Center. Alison Bateman-House, PhD, MPH, MA, is a Rudin postdoctoral fellow in the Division of Medical Ethics at New York University Langone Medical Center.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME White House

U.S. to Commit $500 Million, Deploy 3,000 Troops in Ebola Fight

On Tuesday, President Obama will announce more efforts by the U.S. to lead a global battle against the spread of the deadly virus

Updated at 4:34 p.m. ET

The United States is dramatically escalating its efforts to combat the spread of Ebola in West Africa, President Barack Obama announced Tuesday, during a visit to the Centers for Disease Control and Prevention in Atlanta.

The unprecedented response will include the deployment of 3,000 U.S. military forces and more than $500 million in defense spending drawn from funding normally used for efforts like the war in Afghanistan, senior administration officials outlined Monday. Obama has called America’s response to the disease a “national-security priority,” with top foreign policy and defense officials leading the government’s efforts.

The officials said Obama believes that in order to best contain the disease, the U.S. must “lead” the global response effort. In the CDC’s largest deployment in response to an epidemic, more than 100 officials from the agency are currently on the ground and $175 million has been allocated to West Africa to help combat the spread of Ebola. Those efforts will be expanded with the assistance of U.S. Africa Command, which will deploy logistics, command and control, medical, and engineering resources to affected countries.

Officials said that the Department of Defense is seeking to “reprogram” $500 million in funding from the department’s “overseas contingency operations” fund to assist in the response. Obama has also requested another $88 million from Congress for the U.S. response, including $58 million to expedite the development of experimental treatments for Ebola.

The Pentagon will deliver 130,000 sets of personal protective equipment, thousands of kits used to test for the disease, two additional mobile lab units (one is already on the ground), and a 25-bed mobile hospital to the region. In addition, Africa Command engineers will construct additional treatment units, while the others set up a training center for to educate up to 500 health workers per week. The United States Agency for International Development will also airlift tens of thousands of home health kits and protection kits, including disinfectants and protective equipment, to be delivered to communities affected by the outbreak.

The U.S. effort, named Operation United Assistance, will be based out of Monrovia, Liberia, the country hardest hit by the Ebola epidemic and where the disease is currently spreading fastest, and will be commanded by an Army general. Obama’s announcement follows weeks of calls from global health organizations that global assistance, in particular American help, is needed to address the disease.

The World Health Organization announced last week that as of Sept. 7, there have been 4,366 confirmed, suspected, or probable cases of the disease, with 2,218 deaths. More troubling is the pace of infections, which has steadily risen despite local, regional, and international containment efforts. The WHO has predicted “thousands” of new infections in the coming weeks, calling on the global community to make an “exponential increase” in its response efforts.

U.S. officials have maintained that there is a minimal threat to the United States from the disease, but Obama warned in an interview earlier this month with NBC’s Meet The Press that failing to act could elevate the risk to the nation. “If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates,” Obama said. “It becomes more easily transmittable. And then it could be a serious danger to the United States.”

While the affected countries have imposed screenings at their airports to stop infected individuals from boarding aircraft, U.S. officials outlined efforts to build up detection and prevention capabilities at home, including new training efforts for airline employees and flight attendants to spot ill passengers. Customs and Border Protection officers manning ports of entry to the U.S. have also received additional training to spot potentially infected travelers. Currently the disease can only be spread by direct contact with the bodily fluids of infected patients.

U.S. officials said that in addition to the potential for the disease to spread to the U.S., they are concerned by economic, security, and political instability in countries heavily affected by the outbreak.

Earlier this month, Obama released a video to the people of West Africa, raising awareness about the disease.

TIME Infectious Disease

Ebola Patient in U.S.: ‘I Am Growing Stronger Every Day’

Kent Brantly is one of two Americans being treated for the ebola virus

Kent Brantly, one of two Americans being treated for the deadly Ebola virus in Atlanta, said in a Friday statement that he is “growing stronger every day.” In the message, released by international relief agency Samaritan’s Purse, Brantly also thanked God for aiding his recovery.

Brantly’s words come six days after he arrived in the United States from Liberia, where he was working as a doctor in a post-residency program.

“I am writing this update from my isolation room at Emory University Hospital, where the doctors and nurses are providing the very best care possible,” Brantly’s statement reads. “I am growing stronger every day, and I thank God for His mercy as I have wrestled with this terrible disease.”

The Ebola virus has killed more than 900 people in West Africa. On Friday, the World Health Organization declared the outbreak an international health emergency.

For more about the Ebola outbreak, see TIME’s video above.

TIME Infectious Disease

Nigeria Declares State of Emergency Amid Ebola Outbreak

The country has seven confirmed cases of the disease

Nigerian President Goodluck Jonathan declared a state of emergency Friday amid an Ebola outbreak plaguing West Africa, approving more than $11 million to fight the deadly disease. Jonathan’s move comes as the deadly disease has infected at least 1,700 people and left more than 900 dead, mostly in nearby Sierra Leone, Liberia and Guinea.

Nigeria, the most populous country in Africa, only has seven confirmed cases and two deaths, but health officials fear that the disease’s arrival there would drastically escalate the severity of the crisis.

Nigeria’s state of emergency declaration comes on the heels of the World Health Organization declaring the Ebola outbreak an international public health emergency, while Liberia and Sierra Leone have also declared similar national emergencies over the virus.

Want to know more about Ebola? Watch TIME’s explainer video above.

 

TIME Infectious Disease

We’re Getting Closer to Vaccines and Drugs for Ebola

Researchers have developed vaccines and treatments that show promise in fighting Ebola in animals, so is the outbreak a good opportunity to test them in people?

On Monday, National Institutes of Health immunologist Dr. Anthony Fauci told CBS This Morning that his research team is working on a vaccine to prevent Ebola, which is completely effective in monkeys, and will be tested in humans in September. And he’s not the only one developing a treatment for the deadly disease. The question is: Should experimental treatments be rushed into practice, given the breadth of this outbreak?

For the nearly 1,400 people who have been infected with Ebola, there isn’t much they can rely on to help them battle the vicious virus. Because the virus hones in on the liver and disrupts the formation of liver cells, which affect blood clotting, people eventually die from shock, when their blood pressure drops too low due to the build up of microscopic clots in the vessels. The only thing that can improve survival is intervening early with proper hydration and nutrition to keep the circulation strong.

But there are several promising interventions in the pipeline, all of which have been very effective in fending off the virus in monkeys, who experience the same symptoms and disease course as humans. Most of these vaccines and drugs, however, have not passed even the Food and Drug Administration’s (FDA) more lenient standards for therapies against exotic viruses like Ebola.

Should drugs get rushed to market?

Normally, companies must prove that a therapy or drug is safe and effective in people through rigorous clinical trials, but no trial would allow participants to ethically get infected with Ebola, given that it’s mortality rate ranges from 50% to 90%. So the FDA recently approved a different pathway for such products in which companies can first prove that the disease progresses similarly in an animal model as it does in people, and that the product is safe when tested in healthy people.

MORE: Picturing Ebola: Photographers Chase an Invisible Killer

Only one of the Ebola vaccines, which uses the cold virus as a vector to introduce the Ebola antigens, has reached the second stage, and public health officials are likely reluctant to introduce them widely in west Africa given their untested status and the fear and suspicion of western medicine that already makes the outbreak so difficult to contain.

“To bring a strictly experimental approach to this population – most people think that’s not a good idea, and not doable,” says Dr. Heinz Feldmann, chief of the laboratory of virology at the National Institute of Allergy and Infectious Diseases.

In order to even consider using such unapproved drugs in the crisis, they have to be requested. So far, neither the governments of the west African countries affected, WHO, nor humanitarian groups like Doctors Without Borders have done so. If they did, then regulatory officials in the U.S. would discuss whether they could be provided on a “compassionate use” basis.

Testing the vaccine on a human

That happened in 2009, when a German researcher received the shot after accidentally pricking herself while working with Ebola in the lab. The immunization she got was developed in 2005 by Feldmann and his colleagues, including Thomas Geisbert, professor of microbiology and immunology at the University of Texas Medical Branch at Galveston. The vaccine both protects against Ebola infection and treats those who are recently infected with the virus.

While it’s not clear whether the lab workers was actually infected – she got the shot 40 hours after the accident – she did not develop symptoms and did not show evidence of the virus in her blood.

“There’s just no financial incentive”

Feldmann says there are other strategies that look equally promising — but taking the next step of testing the products in people is proving more difficult, says Geisbert. “Globally, [Ebola] is not a huge problem in terms of infectious diseases in general. It’s devastating and sad for the people involved but it’s a small market for big pharmaceutical companies. There’s just not a financial incentive to develop a drug or vaccine.”

Unfortunately, it often takes outbreaks like the current one in west Africa, which is the largest in Ebola history (see Infographic: Ebola By the Numbers), to ignite interest in developing treatments. That, Feldmann notes, and the fear that a virus like Ebola could be used as a form of bioterrorism. “The fact is that biothreat countermeasure activities are what pushed multiple governments to do this work,” he says. Some of that investment may pay off in public health benefits, however, since a bioterror event is essentially an intentional and concentrated outbreak. Geisbert recently received a $26 million grant from the National Institutes of Health to study the three strategies, including in combination, to take the interventions to the next step.

And while an outbreak might seem like an ideal opportunity to test new treatments, it may actually be of little use, and may even do more harm than good. “My concern is that if you give the treatment to people in late stage disease, and if the person dies, then everybody is going to blame whatever was given,” says Geisbert. “If the person survives, you may never know if the product worked because it was somebody who was going to survive anyway, without the drug.”

Feldmann agrees. “People like me and others who have worked for years in vaccines and countermeasures are frustrated. But on the other hand, we don’t want to make a step that isn’t well thought through, and ruin the whole approach in the future.”

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