Ebola is deadly and there’s no cure or vaccine for it yet: What must be done

By JOSEA RONO
A woman, wearing a protective face mask and gloves, speaks to a worker upon arrival at the Murtala Muhammed Airport in Lagos on August 11, 2014. Cameroon closed all its land, sea and air borders with Nigeria in a move to help prevent the spread of the Ebola virus on August 18, 2014. AFP PHOTO | PIUS UTOMI EKPEI |  NATION MEDIA GROUP

In Summary

• The virus carries a protein that has been called “VP24” that disrupts normal immune responses to infections.
• According to E&K Health Consulting’s analysis, innovating and bringing a new therapy or vaccine to the public market typically takes an average of 10 to 15 years and costs approximately $1 billion.
• Notably, despite the fact that all 20 Ebola outbreaks in history have been in Africa, they have been resolved by the same approach: teams of foreign health specialists fly in, recruit local health workers and set up field hospitals where Ebola victims are quarantined.

The Ebola outbreak in Guinea, Sierra Leone and Liberia is so out of control that governments have resorted to approaches similar to the medieval-era disease control approach last used in 1918: the “cordon sanitaire” whereby no one is allowed out of a barricade established around an infected area.

According to the World Health Organisation, the epidemic that began in Guinea in December 2013 has now become the largest, most severe and most complex outbreak of the Ebola virus disease in history and has so far resulted in more than 1,800 clinical cases and 1,000 deaths.

The situation has been described as a “state of war” by American virologist and special adviser to Sierra Leone’s Ministry of Health, Mr Joseph Fair. The affected governments appear to be unable to contain it.

Similarly, the WHO, which declared the epidemic a “public health emergency of international concern”, its highest level of alert on August 8, seems resigned to the tragedy. For instance, whereas “cordon sanitaire” is considered a brutal, inhumane and desperate intervention whereby everyone within the cordon is left to die or survive until the outbreak has ended, WHO has not opposed it.

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Additionally, Dr Margaret Chan, WHO’s director-general, said at a news conference in Geneva on August 8 that the UN health agency was “extremely stretched” in its capacity to deal with the outbreak. This desperate situation begs two questions: why is Ebola so deadly and why isn’t there a cure or vaccine for it?

SPORADIC NATURE

Ebola is one of the most deadly diseases known to man and has a case fatality rate of up to 90 per cent. One of the main reasons is that, like HIV, but faster, the virus shuts down the human immune response to infections.

The virus carries a protein that has been called “VP24” that disrupts normal immune responses to infections. This protein disables some of the most useful machineries that our bodies have for fighting viral infections and leaves the body with only crude defences. The virus is thus left free to replicate, eventually leading to death.

The lack of any licensed treatment or vaccine against Ebola is attributable to many factors, key among them the sporadic nature of the disease which has raised little interest on the part of pharmaceutical companies to invest in developing treatments or vaccines.

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With the exception of the current outbreak, all previous outbreaks dating back to the first one in the Democratic Republic of Congo in 1976 have been in sparsely populated areas and have “burned themselves out”.

In this regard, there has not been a market, as it were, for therapies and vaccines against Ebola.

This factor is further compounded by the fact that developing therapies for human diseases is time-consuming and expensive. For instance, according to E&K Health Consulting’s analysis, innovating and bringing a new therapy or vaccine to the public market typically takes an average of ten to 15 years and costs approximately $1 billion.

REACTIVE GOIVERNMENTS

Further, there has not been significant investment into biomedical research (including research into potential therapies for Ebola) by African governments.

Notably, despite the fact that all 20 Ebola outbreaks in history have been in Africa, they have been resolved by the same approach: teams of foreign health specialists fly in, recruit local health workers and set up field hospitals where Ebola victims are quarantined.

African governments have so far been reactive rather than proactive – and since most of them have more elaborate armies than healthcare systems, armies are often deployed to cordon off infected areas.

African governments can borrow the lessons they have learnt through addressing famine, key among them being that the shot-gun approach of reactively addressing and moving from one famine to another is unsustainable and that long-term proactive approaches are better.

The Ebola outbreak is, therefore, a wake-up call for African governments to focus attention on biomedical research and long-term improvement of health system infrastructures.

Dr Rono is co-founder and lead health consultant, E&K Health (josea.rono@gmail.com) Twitter: @Dr_Josea_Rono