My interest in finding out more about Ebola was sparked by colleagues writing for the US Center for Health Solutions - The Ebola outbreak: A call to action for a translational approach to R&D.1 This article contrasts the traditional approach to pharmaceutical research and development (R&D)- which can typically take 17 to 23 years to bring a new drugs to market - with a more translational approach to R&D which makes more effective use of the exponential rise of big data and analytics and speeds up the time of the whole process.
While inherently interesting in its own right, it also highlighted that I didn't know what was really happening with the Ebola outbreak and, in the face of somewhat contradictory and confusing news items, I thought it might be helpful to try and understand the current situation better.
The current Ebola outbreak in West Africa was first reported in March 2014, and has rapidly become the deadliest occurrence of the disease since its discovery in 1976:
- by August the World Health Organisation (WHO) had declared the outbreak, recorded across five African countries (Guinea, Liberia, Nigeria, Senegal, and Sierra Leone,) as an international public health emergency and called for a co-ordinated response to stop the virus spreading
- by September, WHO noted that the number of patients was increasing far faster than the capacity to manage them
- in October, WHO declared the outbreaks in Nigeria and Senegal officially over, as there have been no new cases reported since 5 September. This was not the case, however, in Guinea, Sierra Leone and Liberia where transmission was continuing in urban areas, with a surge in Liberia driven mainly by a sharp increase in the number of cases reported in the capital, Monrovia. The situation in Sierra Leone also continued to deteriorate with a sharp increase in the number of newly-reported cases in the capital, Freetown, and its neighbouring districts
- as November gets under way there is growing - but guarded - talk within the WHO that the overall number of new cases appears to be levelling off. Using the best information available, the WHO is suggesting, guardedly, that the case incidence per week is not going to get larger than around 1,000 cases per week and that the big epidemic growth phase, seen in August and September, might be flattening. Nevertheless, 1,000 cases per week is still cause for concern and a huge amount of work remains to be done.
Whatever the next weeks and months bring in terms of on-going transmission, the West African Ebola outbreak is now the largest Ebola outbreak ever experienced:
- the total number of reported cases is in excess of 13,000
- as of 2 November, some 4,818 people across Guinea, Liberia, Nigeria, Senegal, and Sierra Leone are reported to have died from the disease, alongside a recent death in Mali
- in addition, a small number of people
who have travelled from these regions have exhibited the symptoms
in a number of western countries, all but three infected while in
West Africa. The cases include:
- nine in the USA (one who is still in treatment, one who died and seven who have recovered)
- three in Spain (one who has recovered and two who died)
- three in Germany (one recovered, one in treatment and one who died)
- one each in the UK, Norway and France who have all recovered.
The Democratic Republic of Congo has reported a separate outbreak of an unrelated strain of Ebola which by the beginning of October accounted for 70 reported cases and 43 deaths. Together, the evidence of these outbreaks has woken-up the world to the perceived threat (both real and imagined) of the disease and, importantly, has focussed attention on finding a cure.
Several companies are trying to fast-track a vaccine to prevent the spread of Ebola in West Africa but full data on its safety and efficacy is unlikely to be ready until late 2015. At GlaxoSmithKline's (GSK) vaccine research laboratories, trials that would normally take up to 10 years are being compressed into just 12 months and a vaccine has already been given to volunteers taking part in the trial in Africa. This joint effort involves the World Health Organisation (WHO), the US National Institute of Health and UK pharmaceutical firm GSK. In the next phase of the trial, the company hopes it will have 20,000 doses ready to be tested by health workers early next year. Other Ebola vaccines are being developed by researchers in Canada, Japan and Russia. Preliminary indications in Mali from the first trial is taking place seem promising.2
In the UK, Public Health England continues to work with other governments, the WHO and a wide range of partners including UNICEF and Médecins Sans Frontières, to provide support to the affected countries.3 The European Commission and the European pharmaceutical industry have also linked up to launch a 280 million euro call for proposals under the Innovative Medicines Initiative to boost Ebola research to address the current epidemic and put in place a long-term strategy to manage any future outbreaks.4
Meanwhile, the fear of an epidemic reaching US shores has raised the political temperature. President Obama announced on 5 November that he had submitted a funding request to Congress for $6.2 billion "to ensure that our doctors, scientists and troops have the resources they need to combat the spread of Ebola in Africa and to increase our preparedness for any future cases here at home."5 However, the Louisiana Department of Health and Hospitals sent a letter to 30 doctors and Ebola experts who returned recently from Liberia, Guinea or Sierra Leone warning them that they should not attend the annual meeting of the American Society of Tropical Medicine and Hygiene this week in New Orleans. Furthermore, some 30 countries have imposed a blanket or near blanket ban on people from affected areas travelling to their country.6
So while a lot is being done to tackle the spread of Ebola, now and for future generations, there is still some way to go before we have the required research and development platform to produce sufficient quantities of the vaccine, while adhering to regulators' stringent quality and safety requirements.
Footnotes
1. The Ebola outbreak: A call to action for a translational approach to R&D. 29 September 2014, byTerri Cooper, PhD, Principal, Federal Health Sector Leader, Deloitte Consulting LLP. See also: http://blogs.deloitte.com/centerforhealthsolutions/2014/09/the-ebola-outbreak-a-call-to-action-for-a-translational-approach-to-rd.html?id=us:em:na:hcc:eng:lshc:110414
2. Vaccine too late for outbreak. BBC news 17 October 2014. See als0: http://www.bbc.co.uk/news/health-29649572
3. Ebola virus: UK government response. See also: https://www.gov.uk/government/topical-events/ebola-virus-government-response
4. http://www.imi.europa.eu/content/ebola-programme-launch
5. Ebola outbreak: Barack Obama 'to ask Congress for $6 billion' 5 November 2014 . See also; http://www.bbc.co.uk/news/world-europe-29925916
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