Ebola vaccine trials in Africa could start by January, says WHO
The World Health Organization said that two vaccines for Ebola could be used in medical trials in West Africa as early as January. An effective vaccine聽鈥� combined with increased international aid and healthcare volunteers 鈥� should help to聽halt an outbreak that鈥檚 infected upwards of 9,000 people and killed at least 4,500, almost all in Liberia, Sierra Leone, and Guinea.
The new vaccines are currently undergoing, or in some cases will soon begin, clinical trials in Europe, Africa, and the United States. Experimental Ebola drugs were used to treat a handful of patients in August, but without clinical testing the WHO has been reluctant to roll it out on a larger scale.
As 海角大神 reported at the time, proceeding with caution with an experimental drug is paramount, particularly 鈥�on a continent with a history of being on the receiving end" of Western medicines.聽
鈥淲e can鈥檛 say for certain that these drugs are making people better, or what the medium to long-term complications might be 鈥� nevertheless we do need them,鈥澛爏ays Dr. Clement Adebamowo, chairman of the National Health Research Ethics Committee of Nigeria. 鈥淏ut we also need to make sure people understand what they are taking. A low level of Western education in a community does not mean that individuals are unable to make rational decisions on the basis of information presented to them 鈥� but it means researchers have a very high level of responsibility to provide information in a way people can understand.鈥�
... In 1996, for example, pharmaceutical giant聽Pfizer began a trial of its meningitis drug, Trovan, on children in northern聽Nigeria, then in the midst of severe outbreak of the disease. Eleven of the 200 children who participated in the trial subsequently died, and their families alleged they had never been told they were participating in a drug trial. The study鈥檚 supposed approval from a Nigerian medical ethics body was later found to be falsified. (The company denied wrongdoing, but聽聽with the regional government and made large payouts to families of victims.)
Ebola's death toll in West Africa has been devastating, but there have been some positive signs of progress in containing the outbreak. Nigeria and Senegal were both declared Ebola free this month. The Monitor鈥檚 Dan Murphy writes:
While the disease is still a major threat in Liberia,聽Sierra Leone, and Guinea, there are signs that new cases are slowing even in these hardest hit countries. In Sierra Leone, the outbreak began in the east of the country, and there are signs the disease is slowing there. That's not to say there isn't bad news 鈥� the disease聽. But there are no signs of the kinds of exponential growth that epidemiologists have been most worried about.
To be sure, alarm bells are still sounding. Dr. Bruce Aylward, the WHO's assistant director-general,聽聽that new Ebola infections "could" reach 10,000 a week "within two months" if the global response is insufficient. But Dr. Aylward's chief motivation for such statements is actually to ensure that the WHO gets the response it needs. 聽
Public health workers and volunteers fighting on the front lines in West Africa have provided vital information and first-hand accounts of what it takes to combat the spread of Ebola.
Leslie Roberts, a public health researcher at聽Columbia University,聽is working in Sierra Leone. In a 鈥渟urvivor bias.鈥� He writes that there are clinics boasting of high survival rates, but that that shouldn鈥檛 necessarily be a sign of success; he鈥檚 more impressed with the lack of infection on the part of health workers in these clinics.
Prof. Roberts writes that the survival rates at these clinics may be explained by their patients' histories: Those who are successful treated likely聽survive at least a week with symptoms, as well as an additional three to four days at the clinics awaiting test results.
Of course the longer a patient has been symptomatic when they show up at your clinic, the better the chance they will survive. But, as I said before, the primary health benefit of a patient going for treatment is not that they will get medical care and survive. The primary benefit is that they will not infect a slew of other people as they become viremic.
And sending a message to patients that the longer they delay seeking treatment the higher their chance of survival is 鈥渢he opposite of the message we want to get out,鈥� Roberts writes. He also notes other cases of bias operating during this outbreak. For example, he's heard over and over that this outbreak has lower fatality rates than those in the past. Roberts suspects that the truth lies in underreporting, relatives conducting secret burials, or more surveillance in urban areas than in rural ones.
Sean Casey, who is working as a team lead at an Ebola treatment unit in Liberia, has evidence that might back that up. , he said in an interview with Ebola Deeply:
When a patient dies, he or she is buried in our graveyard behind the ETU. The four ETUs in Monrovia cremate bodies, whereas the two rural ETUs have their own burial grounds. People much prefer to have their relatives buried. When somebody dies we call the family and we ask them if they want to come for the burial. If they do, then we keep the body overnight and then bury it the next day. They can have a service, but it doesn鈥檛 happen very often.
Mr. Casey said his team has seen "a slight dip in caseload," however, "a slowing of the infection rate isn't necessarily a good thing. It might mean that people aren't coming forward. Many ETUs have scaled up cremations instead of burials, and some people might be scared away by that ...
"But it's always difficult to tell what's happening with an epidemic as you're looking at it; it's much easier retrospectively."
