Thursday, December 25, 2014

Ebola: Lost Opportunities in Case Management, Therapeutic Development and Diagnostic Testing

"As the Ebola outbreak has burned its way deep into Guinea, Liberia, and Sierra Leone, in one of the worst acute public health crises in 50 years, our academic medical centers have sat largely on the sidelines. They have spent a fortune preparing their facilities and staff for the much-feared scenario of a local patient with possible Ebola virus infection. What has been lacking is leadership to help quell the crisis where it is actually happening. The problem is more than a lack of effective, positive leadership, as Rosenbaum reports4: the difficulties created by many academic medical centers for trainees and staff who want to go to West Africa to help control this outbreak are more akin to roadblocks. This response stands in contrast to that in the United Kingdom, where the Wellcome Trust has encouraged academic institutions to join the fight and has provided emergency funding for their research initiatives, and to that of the U.S. National Institute of Allergy and Infectious Diseases, which is offering extensions for grant renewals to people who have taken time to participate in Ebola mitigation efforts."1

It is important to recall that the West African nations hit hardest by Ebola experienced years of war and civil unrest. Against this backdrop, public health care was struggling to emerge. Previously West Africa had not experienced an outbreak of Ebola, in the three nations now at the epicenter of this disease. "The three countries which are most affected: Sierra Leone, Guinea and Liberia, are among the poorest in the world, with extremely low levels of literacy, few hospitals or doctors, poor physical infrastructure and poorly functioning government institutions."2 Against this backdrop it is understandable that the mechanisms for trialing drugs and diagnostics were not in place prior to the outbreak however, a picture is emerging of increasing obstacles not directly related to the situation on the ground itself, but from those agencies charged with bringing the outbreak under control. 

"The leaders of academic medical centers that have put roadblocks in the path of those wishing to serve need to rethink their priorities. They should be making it easier, not harder, for altruistic physicians, nurses, and other health care providers to help care for the sick and control the Ebola epidemic in West Africa. Our medical centers have immense resources and expertise; the countries wracked by Ebola have almost none. Something is wrong when some of the greatest health care centers in the world are not helping in the fight against this disastrously dangerous threat to human health."2

While providing health care workers to West Africa is a noble cause, it is critical we put into place mechanisms which not only allow medical staff to transition for several weeks into Ebola Treatment Unit's (ETU's) but that we put in place mechanisms which allow several drugs and diagnostic technologies to be run simultaneously, particularly those which meet the criteria defined by the UN/WHO. Better coordination on the ground is key and it is certainly complicated by a lack of existing infrastructures. Given the situation across West Africa, international public health communities with their existing infrastructures and capacity to identify and treat Ebola cases must look for ways to overcome roadblocks and obstacles, some pre-existing to the outbreak but others put in place by perhaps well meaning organizations attempting to control a situation which was beyond control. While competition drives incentive, in this instance where thousands of lives are on the line it is more important to collaborate than compete and it is critical to trial as many therapeutics which meet the established criteria as possible. This is not yet the case in West Africa, drugs which have a high probability of benefit for Ebola patients are shut out of the process of trialing to the detriment of public health. What has become clear over the last few months is that we need a mechanism which allows the pharmaceutical industry to compete equally provided they meet established scientific protocols. 


Dr.Jill Bellamy is an internationally recognized expert on biological warfare and defence. She has formerly advised NATO and for the past seventeen years has represented a number of bio-pharmaceutical and government clients working on procurement strategy between NATO MS and Washington DC. Her private government relations consultancy Warfare Technology Analytics is based in the Netherlands. Dr. Bellamy's articles have appeared in the National Review, The Wall Street Journal, The Washington Post, The Sunday Times of London, Le Temps, Le Monde and the Jerusalem Post among other publications. She is a CBRN SME with the U.S. Department of Defence, Chemical, Biological, Radiological and Nuclear Defence Information Analysis Center and CEO of Warfare Technology Analytics.





1Jeffrey M. Drazen, M.D., Edward W. Campion, M.D., Eric J. Rubin. M.D., Ph.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden M.D., "Ebola in West Africa at One Year From Ignorance to Fear to Roadblocks", The New England Journal of Medicine. December 24, 2014DOI: 10.1056/NEJMe1415398 URL: http://www.nejm.org/doi/full/10.1056/NEJMe1415398?query=featured_ebola
2 "A Concrete Response to the Ebola Outbreak Cannot Wait", UNICEF. Retrieved 26, December, 2014.
3 Drazen, Campion, Rubin, Morrissey and Baden, "Ebola in West Africa One year From Ignorance to Fear to Roadblocks", URL: http://www.nejm.org/doi/full/10.1056/NEJMe1415398?query=featured_ebola

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