Kenema Government Hospital Isolation Ward in Sierra Leone | Stephen Gire
In 2014, Ebola ravaged West Africa. It paralyzed the nations of Liberia, Guinea, and Sierra Leone, and killed over 9,000 people, many of them the heath care workers trained to deal with the virus.
The worst of the crisis seems to have passed. But in a 14 February panel discussion at the AAAS Annual Meeting, scientists and health care experts tempered optimism and instead focused on the lessons this deadly outbreak had taught their organizations about how to confront and counter Ebola and other, potentially even more devastating, diseases. The keys will be long-term investments by private-public collaborations in drug and vaccines, and investments in nations' health care infrastructure and technology.
"There are plenty of lessons to go around," said Michael Kurilla, the associate director for biodefense product development at the National Institute of Allergy and Infectious Diseases.
Ebola was first identified almost 40 years ago, but research has been difficult because of the extreme safety precautions required. It only infects primates so researchers can't use rodent models to study the disease.
"This is not something companies can just willy nilly get involved with," Kurilla said and stressed the need for partnerships between private and public organizations to develop antiviral medications and vaccines.
There are now three Ebola vaccines in clinical trials, and the "secret serum" antiviral ZMapp is being tested in Africa. These potential solutions were in development long before the current crisis. The chance of entirely new vaccines and antiviral medications being discovered and deployed in the midst of a crisis was highly unlikely, Kurilla said.
Keiji Fukuda | AAAS/Ashley Gilleland
Recent scientific insights into Ebola have come at great cost, explained Keiji Fukuda, assistant director-general for health security at the World Health Organization. He spoke of how at the height of the crisis, many airlines canceled flights to the countries, isolating them. Health care services collapsed, people worried about getting enough to eat, and children whose parents had died were left orphaned on the streets.
"On a human scale, the number of tragedies are really just huge," he said.
The affected countries did not have the infrastructure to control the disease, and international efforts including WHO were slow to respond. Because it is no longer possible to stop diseases at countries borders, protecting the world from Ebola or another potential pandemic requires investment in counties health care systems so they can address outbreaks when they are still small, Fukuda said.
When small outbreaks explode, even experienced organizations must re-evaluate their approaches, said Iza Ciglenecki, a project manager for Doctors Without Borders/Médecins Sans Frontières. Although the organization had been successful treating Ebola in five other African nations, it was overwhelmed by the number of people infected in West Africa.
Ciglenecki showed photos of a MSF treatment center in Monrovia, Liberia so overcrowded with patients, that "people were dying in front of the center on the streets."
They had to scale up and redesign their hospitals to protect patients and health care workers. In the new design, Africans not yet confirmed for Ebola are kept in individual areas to prevent healthy people from catching the disease. Plexiglass walls are installed in rooms, allowing doctors and health care workers to observe patients without suiting up in full protective gear. Recovered patients, resistant to the virus, care for sick children. Improvement in treatment facilities have contributed to the disease's mortality rate of 56 percent, well below the 90 percent mortality rate of some past outbreaks, Ciglenecki reported
Stephen Gire conducting tests at Kenema Government Hospital in Sierra Leone | Kristian Andersen
Local centers to test and process samples are also needed, said Stephen Gire, a virus expert at the Broad Institute. His group had a field lab in Sierra Leone set up to study Lassa fever. When they heard about the West Africa outbreak, but before any cases were reported in Sierra Leone, they sent out a team to fully stock the lab to handle processing of incoming Ebola samples.
Within a three-week period they had 144 patient isolates and successfully retrieved the genomic sequences from 99 of them. From these, they were able to track how strains of Ebola spread through the population and share this information on a public database. However, in samples that were collected later and held in facilities with intermittent power, the viruses degraded, and researchers only succeed in sequencing 13 percent of the isolates.
To address these problems, the Broad Institute and other groups including the World Bank and several African universities have established the African Center of Excellence for Genomics of Infectious Diseases. The center will not only have next-generation sequencers, but also Africans trained to isolate and process samples from Ebola and other infected patients.
Despite these successes, the panelists pointed out that there are still new Ebola cases being diagnosed. "If you want to stop the outbreak," said Ciglenecki, "you have to catch the very last case."