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 – combined with increased international aid and healthcare volunteers – should help to halt an outbreak that’s 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 The Christian Science Monitor reported at the time, proceeding with caution with an experimental drug is paramount, particularly “on a continent with a history of being on the receiving end" of Western medicines. 

“We can’t say for certain that these drugs are making people better, or what the medium to long-term complications might be – nevertheless we do need them,” says Dr. Clement Adebamowo, chairman of the National Health Research Ethics Committee of Nigeria. “But 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 – but it means researchers have a very high level of responsibility to provide information in a way people can understand.”

... In 1996, for example, pharmaceutical giant Pfizer began a trial of its meningitis drug, Trovan, on children in northern 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’s supposed approval from a Nigerian medical ethics body was later found to be falsified. (The company denied wrongdoing, but eventually settled for $75 million 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’s Dan Murphy writes:

While the disease is still a major threat in Liberia, 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 – the disease has spread to the west. 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, said Oct. 14 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.  

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 Columbia University, is working in Sierra Leone. In a recent blog post he writes about the so-called “survivor bias.” He writes that there are clinics boasting of high survival rates, but that that shouldn’t necessarily be a sign of success; he’s 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 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 “the opposite of the message we want to get out,” 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. His facility runs a burial site behind the treatment center, 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’t 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."