Drug trials go to heart of Ebola
Experimental drugs are to be fast-tracked in West Africa so that they can be tested and, if they work, save lives in the Ebola epidemic that experts say is spiralling out of control.
Trials of vaccines are already in their early stages, with healthy British volunteers taking part in safety tests in the United Kingdom. The Wellcome Trust is committing $5.2-million to set up sites, systems and facilities to test drugs in the affected countries as well.
Healthcare systems in the three worst-hit countries – Guinea, Sierra Leone and Liberia – fragile to begin with, have largely collapsed under the strain of coping with what may be one of the most serious viral disease outbreaks the world has ever known.
A call from the British government for National Health Service volunteers to go out and help has so far led to 164 healthcare staff signing up. A similar appeal at the London School of Hygiene and Tropical Medicine by its director, Professor Peter Piot, has resulted in 35 staff volunteering.
Experts fear Ebola could become endemic in West Africa, rather than a viral disease that emerges sporadically from animals to cause outbreaks and then disappears again.
If that happens, the region could be a reservoir for the spread of the virus to other parts of Africa and the rest of the world, Piot and Jeremy Farrar, the director of the Wellcome Trust, said in an editorial in the New England Journal of Medicine.
Societies that were being rebuilt after civil war have been devastated by Ebola and will need rebuilding once the epidemic is under control, according to Piot, who believes the World Health Organisation (WHO) has been too slow to respond.
It was three months before the first cases were identified in December last year, he said, adding: “It was another five months and 1 000 deaths until WHO declared this a public health emergency and the world started getting serious about it.”
An analysis of the first nine months by the WHO’s Ebola response team in the New England Journal shows that the death rate is 70%, not 50%, when deaths outside of hospitals are counted.
Many people are too frightened to go to hospital and the number of infections is doubling every few weeks. As of September 20, the WHO said there had been 5 843 cases and 2 803 confirmed deaths. The projection is now for nearly 20 000 cases by early November.
The Centres for Disease Control in the United States has released its own projections, saying that, in the worst scenario, if Ebola were to continue unchecked, and including estimates for unreported illness, there could be 1.4-million cases by late January next year.
Others questioned the projection. “It’s a big assumption that nothing will change in the current outbreak response,” said Dr Armand Sprecher, an infectious diseases specialist at Médecins Sans Frontières. “Ebola outbreaks usually end when people stop touching the sick. The outbreak is not going to end tomorrow but there are things we can do to reduce the case count.”
Several different potential drugs are likely to be tried in West Africa, including Zmapp, which has already been used on a few foreign doctors and aid workers with the disease. All supplies of the drug, made from the leaves of the tobacco plant, have been used up but manufacturing is restarting. Independent experts will decide which drugs are suitable for testing – safety data will have to be recorded before any can be given to patients and a rapid ethical review will have to be undertaken.
“It is a huge challenge to carry out clinical trials under such difficult conditions but ultimately this is the only way we will ever find out whether any new Ebola treatments actually work,” said Farrar. – © Guardian News & Media 2014