Tag Archives: ebola

Ebola vaccine holds hope for end of scourge

 

By Kate Kelland and Tom Miles  
July, 2015

Ebola particles in a cell

Filamentous Ebola virus particles, coloured red, budding from a blue-coloured infected VERO E6 cell. Image captured via a scanning electron micrograph at 25,000x magnification. Image by the United States National Institutes of Health, Public Domain

LONDON/GENEVA, (Reuters) – The world is on the verge of being able to protect humans against Ebola, the World Health Organization said July 31, as a trial in Guinea found a vaccine to have been 100 percent effective.

Initial results from the trial, which tested Merck and NewLink Genetics’ VSV-ZEBOV vaccine on some 4,000 people who had been in close contact with a confirmed Ebola case, showed complete protection after 10 days.

The results were described as “remarkable” and “game changing” by global health specialists.

“We believe that the world is on the verge of an efficacious Ebola vaccine,” WHO vaccine expert Marie Paule Kieny told reporters in a briefing from Geneva.

The vaccine could now be used to help end the worst recorded outbreak of Ebola, which has killed more than 11,200 people in West Africa since it began in December 2013.

WHO Director-General Margaret Chan said the results, published online in the medical journal The Lancet, would “change the management of the current Ebola outbreak and future outbreaks”.

The Gavi Alliance, which buys vaccines in bulk for poor countries who struggle to afford them, immediately said it would back an Ebola shot once it is approved.

“These communities need an effective vaccine sooner rather than later,” Gavi’s chief executive Seth Berkley said. “We need to be ready to act wherever the virus is a threat.”

This and other vaccine trials were fast-tracked with huge international effort as researchers raced to test potential therapies and vaccines while the virus was still circulating.

“It was a race against time and the trial had to be implemented under the most challenging circumstances,” said John-Arne Røttingen of Norway’s Institute of Public Health, chair of the trial’s steering group.   

    

“RING VACCINATION”

The Guinea trial began on March 23 to evaluate the effectiveness and safety of a single dose of VSV-ZEBOV using a so-called “ring vaccination” strategy, where close contacts of a person diagnosed with Ebola are immunized – either immediately, or at a later date.

As data began to emerge showing the very high protection rates in those vaccinated immediately, however, researchers decided on July 26 that they would no longer use the “delayed” strategy, since it was becoming clear that making people wait involved unethical and unnecessary risk.

The trial is now being continued, with all participants receiving the vaccine immediately, and will be extended to include 13- to 17-year-olds and possibly also 6- to 12-year-old children, the WHO said.

Jeremy Farrar, a leading infectious disease specialist and director of the Wellcome Trust, said the trial “dared to use a highly innovative and pragmatic design, which allowed the team in Guinea to assess this vaccine in the middle of an epidemic”.

“Our hope is that this vaccine will now help bring this epidemic to an end and be available for the inevitable future Ebola epidemics,” his statement said.

The medical charity Doctors without Borders (MSF), which has led the fight against Ebola in West Africa, called for VSV-ZEBOV to be rolled out to the other centres of the outbreak, Liberia and Sierra Leone, where it says it could break chains of transmission and protect front-line health workers.

VSV-ZEBOV was originally developed by Canada’s public health agency before being licensed to NewLink Genetics, which then signed a deal handing Merck the responsibility to research, develop, manufacture and distribute it.

The success of the Guinea trial is a big relief for researchers, many of whom feared a sharp decline in cases this year would scupper their hopes of proving a vaccine could work.

Another major trial in Liberia, which had aimed to recruit some 28,000 subjects, had to stop enrolling after only reaching its mid-stage target of 1,500 participants. Plans for testing in Sierra Leone were also scaled back. That left the study in Guinea, where Ebola is still infecting new victims, as the only real hope for demonstrating the efficacy of a vaccine.

Copyright Reuters 2015

(Additional reporting by Tom Miles in Geneva and Ben Hirschler in London; Editing by Kevin Liffey)

Hazmat gear for Ebola response at the Level 4 BioSafety Lab at the Texas BioMed Research Institute. Photo by David Martin Davies via Flickr, Creative Commons

Hazmat gear for Ebola response at the Level 4 BioSafety Lab at the Texas BioMed Research Institute. Photo by David Martin Davies via Flickr, Creative Commons

Research continues with other Ebola vaccines

By Ben Hirschler 

LONDON (Reuters) – Scientists and drug companies will continue to research the potential of alternative Ebola vaccines, despite a shot from Merck  and NewLink Genetics proving 100 percent effective in a trial in Guinea.

Experts said on Friday different kinds of vaccines were needed that might be better suited for different population groups.

Because Merck’s VSV-ZEBOV is a live, or replicating, vaccine, there were initial worries about its safety. In the event, it proved about as safe as a flu vaccine, said University of Reading virologist Ben Neuman, but it was still not given to children or pregnant women.

Replicating vaccines have the advantage of requiring only one dose, making them suitable for emergency use. But non-replicating vaccines, which may need two injections, could be longer-lasting and better suited to protecting people outside an epidemic.

“There is a place for all of these different modes and it’s important that development work on other vaccines continues,” Rebecca Grais, director of research at Medecins Sans Frontieres (MSF) Epicentre, told Reuters.

“It’s also important to have multiple manufacturers in order to ensure competition.”

MSF was one of the organisations behind the successful clinical trial with Merck’s vaccine, which the World Health Organization said had brought the world to the verge of being able to protect humans against Ebola.

GlaxoSmithKline applauded its rival’s success but said it would persevere with development of its alternative non-live vaccine.

“We believe that it is important that the international community continues to support the development of more than one vaccine for the control of Ebola including those that might be more suitable for vaccination of pregnant women, infant children and the immunocompromised,” it said in a statement.

GSK hopes also hopes to test its vaccine in Guinea, although WHO vaccine expert Marie Paule Kieny said this might not be possible, given the dwindling number of Ebola cases.

Johnson & Johnson, which is developing a two-injection vaccine in partnership with Bavarian Nordic, said it remained committed to the programme and hoped to start a trial in Sierra Leone in the coming weeks.

A number of other groups are at an earlier stage of research, including a team from the University of Texas working on an inhaled vaccine.

Adrian Hill, director of the Jenner Institute at the University of Oxford, said the success of Merck’s vaccine suggested other products in mid-stage trials should also prove effective.

Although these alternatives may not be tested during the current epidemic, they could still be licensed and readied for use in future outbreaks based on human immune response results and data from non-human primate experiments.

Copyright Reuters 2015

(Additional reporting by Tom Miles in Geneva; Editing by Elaine Hardcastle)

WHO revamps epidemic response strategy

By Tom Miles

GENEVA (Reuters) – The World Health Organization is creating a “blueprint” to improve the medical response to major outbreaks of diseases, after it was accused of reacting too slowly to West Africa’s Ebola epidemic, it said on July 31.

“The goal is to reduce the time from recognition of an outbreak to the availability of new medical tools to four months or less,” WHO Director-General Margaret Chan told a news conference in Geneva.

“Doing so, I believe, will leave the world better prepared for the next inevitable medical emergency. No one wants to see clinicians, doctors, left empty handed again.”

The plan is likely to cover influenza strains such as H5N1 and could help prepare for a worsening spread of Middle East Respiratory Syndrome (MERS), among other diseases, WHO officials said.

The proposal is part of a swathe of reforms designed to avoid a repetition of the U.N. health agency’s slow response to the Ebola epidemic, which has killed 11,294 people and has yet to be fully snuffed out in Sierra Leone, Liberia and Guinea.

The WHO is hoping to learn from the development of an Ebola vaccine, which has proceeded at lightning speed compared to normal drug development but only really took off once the Ebola outbreak was already at crisis point.

One potential Ebola vaccine has been shown to be 100 percent effective, trial data showed on Friday.

When the next epidemic comes, the WHO wants the tools to tackle it much more quickly. It plans to analyse diagnostics, vaccines, drugs and other medical equipment, and wants to take research far enough so that the products could reach the final phase of efficacy testing within four months of an outbreak.

“Based on our experience of Ebola and our earlier experience of pandemic influenza, in some diseases it’s very difficult to develop innovations, especially from scratch, in four months,” Chan said.

WHO Assistant-Director-General Marie-Paule Kieny said: ”What we have started to work on … is to see what should be done for other diseases of epidemic potential, prior to any epidemic starting.”

The plan will set up “step-by-step procedures, protocols, collaborative agreements, codes of conduct, and ideal product profiles that can be put in place in advance,” Chan said.

The blueprint is expected to be presented to the WHO’s annual conference of health ministers, the World Health Assembly, in 2016, Kieny said.

Copyright Reuters 2015

(Editing by Robin Pomeroy)

—-

Kenya mulls granting refuge to chimps from Ebola-hit Liberia

By Edith Honan

NAIROBI (Reuters) – Kenyan officials said on July 31 they were considering conservationists’ appeals to give two baby chimpanzees, rescued from possible traffickers in ebola-hit Liberia, sanctuary in a Kenyan reserve but public health fears were holding up transfer.

Conservationists believe the animals had been victims of trafficking that sent baby chimps from West and Central Africa to Chinese zoos and private estates in the Middle East, where they can fetch as much as $25,000.

But since Ebola was first reported in the West African countries of Guinea, Liberia and Sierra Leone, potential buyers have mostly been scared off, as chimps – man’s closest relative in the animal kingdom – can carry the deadly virus.

Ebola has killed more than 11,200 people in West Africa since it broke out in December 2013. Liberia was declared Ebola-free by the World Health Organisation in May, but there have been some new cases since then.

Two-year-old female Sweet Pea, and Guey, another female, were handed over to conservationists in April, and have been cared for by volunteers in the Liberian capital Monrovia.

But conservationists say they want to find a permanent settlement for the animals and Kenya’s renowned Ol Pejeta Conservancy is the only sanctuary with space.

“There is absolutely no other place on the continent that can take them,” Daniel Stiles, a project manager at Kenya’s Ol Pajeta Conservancy, told Reuters. “There’s no place to put them.”

Kenya’s tourism sector took a hit last year from global fears about Ebola, even though it sits further from the Ebola-affected areas than many of the European countries that supply the tourists.

“We would like some information on their health. It is an Ebola country,” Richard Leakey, the chairman of the board of the Kenyan Wildlife Service and a renowned conservationist, told Reuters on Friday. “We’ve got to be very careful about that.”

“It is not no, it is not yes, it’s please come back as soon as you can, because we realize it’s urgent,” Leakey said.

The request has aroused frustration among conservationists, who say Kenyan officials are stonewalling due to the global panic over Ebola.

“If the chimps had Ebola, so would I, because we’ve been interacting with them for months,” said Phoebe McKinney, an American non-governmental worker in Monrovia who has been helping to care for the chimps as a volunteer.

Copyright Reuters 2015

(Editing by Drazen Jorgic)

 

Further reading on F&O:

Ebola: the Black Death Revisited. By Ewa Bacon, January 2015

Ebola’s first casualty: clear thinking. By Jonathan Manthorpe, October, 2014  (paywall)

 

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Facts and Opinions is a boutique journal, of reporting and analysis in words and images, without borders. Independent, non-partisan and employee-owned, F&O is funded by you, our readers. We do not carry advertising or “branded content,” or solicit donations from foundations or causes. Support us with a subscription (click here for our subscribe page) or a donation:

 

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Noteworthy: Davos, Ebola, media matters

Davos Conference Center, Switzerland. World Economic Forum photo via Wikipedia, Creative Commons

Davos Conference Center, Switzerland. World Economic Forum photo via Wikipedia, Creative Commons

The World Economic Forum, AKA the “annual summit for the one per cent,” kicks off in Davos-Klosters, Switzerland, tomorrow. Subjects range from bicycles for African kids to global trade, Ebola to climate change, “honey laundering” to oil markets. Switzerland’s tourism industry is delighted at the publicity. Even China’s premier will be there. For the rest of us, well, there’s always online attendance. Click here for the WEF agenda and links to online webcasts.

Speaking of Ebola, there’s (somewhat) good news. The head of the United Nations said progress in fighting the disease in West Africa shows it can be done. The World Health Organization reported that Guinea, Liberia and Sierra Leone this month reported their lowest tally of new cases since August.

It’s possible to fight the virus, Secretary-General Ban Ki-moon told a UN meeting today, after a trip to the region. But he said to avoid a new surge of cases a regional response will be needed.  In case you missed them, two pieces on F&O add perspective to the deadly virus:

Ebola: the Black Death Revisited. By Ewa Bacon

There is no rational reason to fear Ebola in the developed world, writes Ewa Bacon, because we know the source of contagion and have methods to deal with it.  However, panic has set in.  Image: Plague is defeated -- a detail of the "Column of the Plague" (Pestsäule), in Graben, Vienna, Austria. Photo by Jebulon via Wikimedia, Creative Commons

There is no rational reason to fear Ebola in the developed world, writes Ewa Bacon.  Above: a detail of the “Column of the Plague” (Pestsäule), in Graben, Vienna, Austria. Photo by Jebulon via Wikimedia, Creative Commons

It is not Ebola that is stalking the land, but anxiety and fear. We fear an extinction event. We search the environment and note the loss of plants and animals. We worry as we examine “Martha,” the last ever passenger pigeon. We examine the geological record and note that not even the mighty dinosaur survived the cataclysm of Cretaceous period. Could that happen to us as well? We search history and note some sobering examples of global catastrophes. Few are as renowned as the “Black Death.” Early in the 1300’s Europeans received news of unprecedented diseases raging in the wealthy, remote and mysterious realm of China.

Ebola’s first casualty: clear thinking. By Jonathan Manthorpe (paywall)

The ebola panic overshadows far more deadly diseases. Unfortunately, humans are appalling bad at risk assessment. In recent weeks Ebola has tweaked our primal fears of the first Horseman of the Apocalypse, Pestilence, in the same way as my run in with the Black Death. Politicians, world health officials and the media are near hysteria as they pump out fear-inducing prophecies about the looming pestilential scourge.

What else we’re reading, with a focus on media matters:

Preparing for Fidel Castro’s death – How Florida news organizations plan to cover the Cuban dictator’s passing, by Susannah Nesmith in the Columbia Journalism Review is funny, in a black-humour sort of way. Excerpt:

Every year or so, a rumor bubbles up that the world’s most famous Cuban has this time, finally, truly, died. The local press corps sends crews to Versailles, the iconic Little Havana restaurant where presidential candidates appear to appeal to Cuban American voters and where journalists gather when anything about Cuba might be happening. Pretty early in the news cycle of a Fidel-is-dead rumor, The Associated Press writes a story that essentially says Castro might not be alive but no one on the island says he’s dead. This year, on Jan. 9, the AP’s Havana bureau chief, Michael Weissenstein, wrote that story, noting the rumor that the foreign press was being called to a press conference.

Weissenstein also took to Twitter. “Foreign correspondents now furiously calling each other about supposed press conference, an event not usually kept secret from press itself,” he wrote.

For the schadenfreude file: City of Paris Threatens to Sue Fox News Over False Report, in Rolling Stone report. Excerpt:

The city of Paris has threatened to sue Fox News over an erroneous report the network made claiming Paris had “no-go zones” for police and non-Muslims. The network later apologized for the error.

“When we’re insulted, and when we’ve had an image, then I think we’ll have to sue, I think we’ll have to go to court, in order to have these words removed,” Paris mayor Anne Hidalgo told CNN on Tuesday. “The image of Paris has been prejudiced, and the honor of Paris has been prejudiced.”

The comments stem from numerous segments Fox aired last week claiming that police and non-Muslims refuse to enter certain areas in France and England out of fear, with one show, Fox & Friends, erroneously showing a map “highlighting” the non-existent zones.

A F&O reader recommends a disturbing report in the Guardian about how British spies are snooping on journalists, whom they hold in similar regard to terrorists: GCHQ captured emails of journalists from top international media. Excerpt:

GCHQ’s bulk surveillance of electronic communications has scooped up emails to and from journalists working for some of the US and UK’s largest media organisations, analysis of documents released by whistleblower Edward Snowden reveals. …

One restricted document intended for those in army intelligence warned that “journalists and reporters representing all types of news media represent a potential threat to security”.  

It continued: “Of specific concern are ‘investigative journalists’ who specialise in defence-related exposés either for profit or what they deem to be of the public interest.

The country so concerned about journalists as security threats would be the same Britain whose premier David Cameron joined other world leaders in Paris this month, marching in the massive rally for freedom of expression after the terrorist attacks on the Paris satirical paper Charlie Hebdo.

 

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Ebola: the Black Death Revisited

There is no rational reason to fear Ebola in the developed world, writes Ewa Bacon, because we know the source of contagion and have methods to deal with it.  However, panic has set in.  Image: Plague is defeated -- a detail of the "Column of the Plague" (Pestsäule), in Graben, Vienna, Austria. Photo by Jebulon via Wikimedia, Creative Commons

There is no rational reason to fear Ebola in the developed world, writes Ewa Bacon, because we know the source of contagion and have methods to deal with it. However, panic has set in. Above, a detail of the “Column of the Plague” (Pestsäule) in Vienna, Austria, photographed by Jebulon via Wikimedia, Creative Commons

EWA BACON, Lewis University
Published with permission by F&O October 24, 2014

We fear an extinction event. We search the environment and note the loss of plants and animals. We worry as we examine “Martha,” the last ever passenger pigeon. We examine the geological record and note that not even the mighty dinosaur survived the cataclysm of Cretaceous period.

Could that happen to us as well? We search history and note some sobering examples of global catastrophes. Few are as renowned as the “Black Death.” Early in the 1300’s Europeans received news of unprecedented diseases raging in the wealthy, remote and mysterious realm of China.

Had the plague in Asia erupted in the 10th or 11th century, it would have stayed in Asia. However, by the 14th century long dormant contacts with Asia had revived. This was an age of globalization. Ideas and products were traded with the Far East. And so, it turns, was disease.

In 1346 the plague arrived in the great Italian trading ports of Genoa and Venice. Galleys arrived in Genoa laden with precious cargoes of spices but also horribly infected and dying men. The citizens of the town drove them off with violence, but it was too late. The contagion had spread to the city. The Black Death had arrived in Europe. 

The manifestation of the disease was horrific: disfiguring skin eruptions, an unbearable stench, vile urine. The course of the contagion was rapid and deadly. If it attacked the lymphatic system, the victim was likely to die within ten days. Perhaps a quarter of the sick survived this attack. If, however, the plague attacked the lungs, death was certain within a week. The rarest form of the plague was septicemic, attacking the blood itself. Death occurred within a day. 

The most frightening aspects of the contagion were the speed with which it killed and the speed with which it spread. When the first wave hit the wealthy and densely populated city of Florence, frightened witnesses saw hundreds of corpses stacked in the street with not enough burial grounds to accommodate them. Whole families died within a week. There were no remedies. Those who could, fled the city to find safety in isolated villas and homes in the countryside.

In Venice and Florence, hundreds of thousand citizens were dead within months. Medieval doctors were among the first to die. Health regulations were useless and finally concentrated on disposal of the dead. Today we estimate that as the epidemic spread across Europe, 40% of all Europeans perished. 

This was not an epidemic. This was a pandemic. The change in modifier is significant. “Pan” refers to the Greek god of chaos and disruption. It is also the source of the word “panic.” As we watched the Ebola epidemic in Africa, safely far away, we commiserated. But now that we think that this is a world-wide contagion, we panic.

There is no rational reason to fear Ebola in the developed world. Unlike our fore-fathers of the 14th century, we know the source of contagion and have methods to deal with it. However, panic has set in. The New York Times on October 16, 2014, featured this headline: “Experts offer steps for avoiding public hysteria, a different contagious threat.” 

This pandemic is a disease but it is also a psychological contagion of irrational fear, public hysteria. This morning as I was reading a daily science post, I noted an advertisement for the “Ebola Emergency Food Kit.” It is not Ebola that is stalking the land, but anxiety and fear. An ABC newscaster yesterday asked a passenger coming off a plane whether she feared contagion. Well, yes: there was someone coughing on the plane and perhaps they were a carrier. Note: coughing is not a symptom of Ebola.

Newspaper articles and bloggers are trying to be reassuring. After all, tens of thousands of people die annually from influenza or from hepatitis or from MRSA. This is a hopeless attempt to reassure us because millions of people have encountered these familiar scourges and are not afraid of them. Ebola is different because it is astoundingly lethal and while not air-borne, it is frighteningly contagious. This is a new pestilence.

But it is also more than just another pestilence. It is a reminder that not only are our lives finite; our species is finite. The globe is warming, the missile silos are still out there, medieval jihadists are stalking us, economies are cyclical: these are familiar fears.

But a mystery disease, highly lethal, visible in the media daily? Do we share what is, for lack of a better term, a historical traumatic memory of the Black Death? Now that we understand how fragile we are on a small planet that has had tremendous disruption, is this THE disruption?

 Copyright Ewa Bacon 2014

Re-Published with permission. Ewa Bacon is a professor of history at Lewis University in Romeoville, IL, U.S. This column is republished from Lewis’s history site.

References and further reading:

Experts offer steps for avoiding public hysteria, a different contagious threat, by Benedict Carey, New York Times 
 Ebola’s first casualty: clear thinking. By Jonathan Manthorpe, F&O International Affairs columnist (paywall*) 
Biodefence Drives Ebola Drug Development. By  Christopher Degeling, on F&O.

 

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Ebola panic overshadows far more deadly diseases

 

Hazmat gear for Ebola response at the Level 4 BioSafety Lab at the Texas BioMed Research Institute. Photo by David Martin Davies via Flickr, Creative Commons

Hazmat gear for Ebola response at the Level 4 BioSafety Lab at the Texas BioMed Research Institute. Photo by David Martin Davies via Flickr, Creative Commons

The Ebola panic overshadows far more deadly diseases, points out International Affairs columnist Jonathan Manthorpe. In recent weeks Ebola has tweaked our primal fears of the first Horseman of the Apocalypse, Pestilence. Politicians, world health officials and the media are near hysteria. It all reminds Manthorpe of his earlier run-in with the Black Death. An excerpt of his new column, Ebola’s first casualty: clear thinking (paywall*):

The email message that arrived in my office in Hong Kong throbbed with the near hysteria of the editor who wrote it.

“Jonathan,” it said, “there’s an outbreak of the Black Death in India. Please get there ASAP and file.”

I took another swig of morning coffee and composed a calming reply. “I’ve heard about the outbreak in Gujarat state,” I said. “It’s called Bubonic Plague and it’s endemic in India. Happens all the time, but I’ll happily go. It will be a good opportunity to do other stories.”

It was September, 1994, and this outbreak of the plague had touched some primal, tribal human memory. Flowery, overblown language is the lifeblood of Indian newspapers, and by the time these enhanced reports of the return of the Black Death had reached the London tabloids one could be forgiven for thinking the End of the World was at hand … log in to read Ebola’s first casualty: clear thinking. (Day pass or subscription required*).

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Western security concerns fund Ebola drugs

The World Health Organization said Tuesday the current outbreak of Ebola, which has to date killed an estimated 1,200 people in West Africa, is confirmed only in Guinea, Liberia, Nigeria, and Sierra Leone, and “at present, no cases have been confirmed anywhere else in the world.” On August 8, the organization had declared an extremely rare Public Health Emergency of International Concern over the outbreak, and the world’s news media (NY Times; CBCBBC; Al Jazeera) is carrying stories about it hour by hour.

13778452604_1a2b7facaf_z

Specialists work to contain Ebola outbreak in Guinea in 2013. Photo courtesy of European Union Humanitarian Aid and Civil Protection ©EC/ECHO/

Why is Ebola getting so much attention — and relative funding? For pennies per year per person, say experts, neglected tropical diseases that blight the lives of some billion of the world’s poorest people could be eliminated. But while money is scarce for such diseases, expensive drugs like ZMapp, for relatively obscure diseases like Ebola, are richly funded.

The interest in Ebola can be summed up by biodefence capacity in Western countries, notably America, writes Christopher Degeling, a veterinarian and Research Fellow at the Centre for Values, Ethics and the Law at the University of Sydney. This, justifiably, raises eyebrows — but Degeling argues while U.S. national interest is driving the drug development, “in the next few months they might prove to be in everyone’s interest.”  An excerpt of his piece in Dispatches/Publica:

Ebola virus disease typically only occurs in rural and remote areas among resource-poor populations. Until the large, recent outbreak in West Africa, cases of the illness were a rarity.

So the fact that we even have experimental drugs for the disease tells a story about how responses to global health crises are shaped by the social and political interests of the developed world.

Major pharmaceutical companies have shown little interest in developing effective treatments for diseases such as this. There’s no incentive for the commercial risks of research and companies naturally prefer to focus on diseases that can sustain large markets of wealthy regular users …  read Biodefence Drives Ebola Drug Development. (Free story)

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Biodefence Drives Ebola Drug Development

By Christopher Degeling, University of Sydney, The Conversation 
August 19, 2014

Ebola virus disease typically only occurs in rural and remote areas among resource-poor populations. Until the large, recent outbreak in West Africa, cases of the illness were a rarity.

14591869927_465efb13a2_z

Workers try to contain the Ebola outbreak in Guinea in 2013. Photo by Jean-Louis Mosser, courtesy of European Union Humanitarian Aid and Civil Protection ©EC/ECHO/

So the fact that we even have experimental drugs for the disease tells a story about how responses to global health crises are shaped by the social and political interests of the developed world.

Major pharmaceutical companies have shown little interest in developing effective treatments for diseases such as this. There’s no incentive for the commercial risks of research and companies naturally prefer to focus on diseases that can sustain large markets of wealthy regular users.

A similar inattention is suffered by people who have what are collectively known as neglected tropical diseases, which affect about a billion of the world’s poorest people.

They cause death and ill-health but also entrench social and political disadvantage. Even though most are preventable, and easily treatable with appropriate resources.

For those affected, the burden of these diseases, on average, equates to the loss of 56 years of healthy life through early death or chronic disability. Yet, the United States Centers for Disease Control estimates that for 50 cents per year per person, the burden of neglected tropical diseases could be eliminated.

So it seems a little incongruous that drugs for Ebola virus disease were in development at all, given the relatively small number of cases and the poverty of those most at risk of infection.

Let’s consider the most advanced drug: ZMapp, which is produced by Mapp Biopharmaceuticals and is the experimental treatment the fuss has been about. The incentive for developing ZMapp was clearly not its broad commercial potential. Instead, it is for developing capacity for biodefence.

After the anthrax attacks of 2001 the U.S. government launched project Bio-shield, a large-scale program aimed at developing organisational capacity and medical countermeasures to deal with existing and emerging biological threats to the U.S. population.

Vast quantities of drugs and vaccines have been stockpiled by the Biomedical Advanced Research and Development Authority (BARDA). BARDA and the U.S. military medical services have also partnered with hundreds of small biotechnology companies to develop medical countermeasures against pathogens that could potentially be used for bio-terrorism.

As well as ZMapp, BARDA is funding three other companies in the early stages of developing different countermeasures against Ebola virus disease.

Australia has benefited from this U.S. military interest. The anti-serum against Hendra virus infection and the equine vaccine are the products of a coalition between the CSIRO and US military medical services.

Millions of dollars were spent on developing countermeasures for an Australian bat-borne pathogen that, as far as we know, has only killed four people. Horse-owners in Queensland have been slow to take up the vaccine, but the US military considers this research worth the investment.

Agents effective against Hendra are also likely to have protective effects against the related Nipah virus. Because of its potential for “weaponisation”, Nipah virus is classified as a likely bio-terrorism agent.

Rare, albeit high-impact, infectious diseases are not able to sustain a market driven by the needs of those at immediate risk of infection. Yet because of perceptions about their potential impact on the developed world, these infectious pathogens pose challenges to national security.

The pursuit of effective drugs against Ebola virus disease is arguably part of a larger shift in the governance of infectious disease and other public health risk from prevention to preparedness.

Médecins Sans Frontières’ Philippe Calain and the anthropologist Andrew Lakoff both contend this shift has seen the rationale for many public health interventions move from health concerns towards security concerns and economic interests.

Organisations such as the International Monetary Fund (IMF) and World Bank have driven this transformation by framing emerging infectious diseases as threats to markets and economies.

Now, countries in what is known as the Global North (rich, developed countries that make up about a quarter of the world’s population) increasingly perceive people dying from infectious diseases in the Global South (poor, underdeveloped nations) as a risk to their own health and well-being.

Efforts to enhance the latter’s public health capacity and develop new drugs for infectious threats such as Ebola virus disease are driven by the perception of a need to protect the Global North from external threats.

Andrew Lakoff describes two regimes of global health: one focused on instituting systems to establish global health security, and thereby mitigate threats to developed countries. And one focused on the humanitarian relief of neglected tropical diseases in the developing world that helps their populations escape poverty.

Pointedly, Lakoff argues the second regime is being offered to the developing world as a palliation for accepting the first, which impinges on their sovereignty and places constraints on how resources can be used.

Within the new system for the global governance of infectious disease, policies aimed at protecting the Global North from pathogens become a set of “shared” global health objectives. But past national policies of stockpiling drugs and vaccines raise questions about the extent to which the Global South will benefit from any biomedical innovations.

Still, as international health law expert Sara Davies points out, we need to be careful not to view the politics underpinning moves towards global health securitisation in a wholly negative light. Even though efforts to develop treatments of Ebola virus disease are driven by U.S. national interest, in the next few months they might prove to be in everyone’s interest.

Creative CommonsThe Conversation

Chris Degeling receives funding from the Canadian Institutes of Health Research and the Marie Bashir Institute for Infectious Disease and Bioseciurity.

This article was originally published on The Conversation. Read the original article.

Recommended
Trying to Contain Ebola in Liberia, a photo-essay by John Moore, in The New York Times. Excerpt:

After reading reports of the Ebola virus’s virulent spread — with corpses left on the street and hospitals closing because of dangers to untrained health workers — I asked to be sent to Liberia.

 Other countries affected by the epidemic, like Sierra Leone, had received more news media attention, but when the situation in Monrovia was described as catastrophic, that got my attention. For me, a journalist’s responsibility is to cover difficult stories, not necessarily dangerous ones but challenging ones. And given the spread of this deadly virus, the challenges were many.

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