The Ebola outbreak gripped the world in 2014, infecting more than 24,000 people and claiming over 11,000 lives. In 2015, the epidemic was ongoing in parts of Sierra Leone, Liberia and Guinea. Discover talked with three scientists involved in the worst Ebola outbreak in history, about their roles and the promising vaccines that may ultimately vanquish the disease.
Alexandre Delamou
Chief of research, National Centre for Training and Research, Maferinyah, Guinea
Ebola’s lasting legacy may be in maternal and child health: Public health officials worry that deaths during childbirth and from preventable childhood diseases like measles could escalate into the tens of thousands. Delamou talks about why the collateral damage triggered by the epidemic could turn out to be even more lethal than the outbreak itself.
Delamou: There have been a lot of efforts to improve access to maternal health in Guinea, Liberia and Sierra Leone. But one of the impacts of Ebola is a decrease in hospital attendance because there were a lot of infections among health professionals. And the outbreak is not over — we had 10 to 12 new cases a week [until recently]. So people still don’t feel safe, and they continue thinking that hospitals are a place where you can get Ebola. Multiple Ebola cases occurred in rural communities, and health care providers left those areas to come to the cities, and most did not return. So now, when women in rural areas choose to deliver at home, if they have complications, there’s no one who can take care of them, and they’re more likely to die.
Children’s health is connected to their mothers’ health. Because pregnant women won’t come to the hospital to have their babies delivered, it is unlikely she will bring her newborn in later for immunizations. There is now a measles outbreak in this country, which is a direct consequence of the lack of usual immunization services, and there have already been some deaths.
Joanne Liu
President, MSF International, Geneva, Switzerland
The medical aid group Doctors Without Borders (Médecins Sans Frontières, or MSF) dispatched more than 700 doctors, health care professionals and relief workers to ground zero, treating about 35 percent of all Ebola patients, starting in March 2014. Within MSF, 28 of its colleagues became infected, 14 of whom died, and the aid group cared for more than 2,600 patients who later died. MSF was among the first to sound the alarms about the Ebola outbreak.
Liu: Ebola spun out of control because of a lack of political leadership — the world stood aside while Ebola tore through western Africa. Everyone missed Ebola, but when we said it was out of control, we were [accused of] being alarmist. It was only when an American got sick in August of 2014 that the world woke up and took action to stop Ebola from coming to their countries.
But it was too little, too late, and thousands were already dead or dying. When I visited western Africa [that] August, I saw how local people were completely overwhelmed by the situation. We didn’t have enough room for all the patients, there was no place for them to lie down, and we were completely limited in the care we were providing. This is the first time in all of our history that MSF built crematoriums — we had too many dead bodies.
This was the first outbreak that spread from rural to urban areas. Normally, outbreaks last between eight and 12 weeks, but this has lasted 17 months and is still ongoing. There is a triumphant narrative that it’s over when it is absolutely not. We are kidding ourselves. This outbreak started with one case, and it could flare up again.
Initially, we told people it’s a deadly disease and we have no cure, so essentially we’re telling them, “Come and die in an Ebola center.” We need to change that because if these people come in earlier, they have a better chance to pull through and not infect their loved ones. We know what to do because it’s like HIV and AIDS two decades ago — it was a death sentence, and people hid from it. But today it is not a death sentence, and we need to apply what we learned from fighting that epidemic.
Thomas Geisbert
Virologist, University of Texas Medical Branch, Galveston
Human safety tests of two vaccines began in the summer of 2014, after the prototypes languished in labs for nearly a decade because Ebola wasn’t enough of a threat to attract Big Pharma. But one of them — VSV-ZEBOV, in which the Ebola protein is spliced inside of a live vesicular stomatitis virus normally found in cattle — proved 100 percent effective in a preliminary test of more than 4,000 people in Guinea this past summer. Geisbert helped devise the VSV-ZEBOV vaccine and also worked on an inhaled version of the vaccine that immunized monkeys earlier in 2015.
Geisbert: After 9/11, there was a lot of concern that Ebola could be used as a bioterror agent, and the National Institutes of Health put a lot of money into biodefense. But there wasn’t any money for product development or the financial incentive for Big Pharma to get involved because who were you going to sell your drug to? Still, we made tremendous progress as a field, but everything just sat there until this outbreak. I felt a real sense of frustration watching this outbreak because we had something sitting on the shelf that might have saved lives. But the silver lining is that we now have the public’s attention.
The VSV vaccine is extremely robust and has tremendous potential to be used to control an outbreak and contain its spread rather than to vaccinate large populations. To contain, manage and control an outbreak in Africa, you need a vaccine that requires just one injection and that works quickly. The VSV vaccine works fast, within seven to 10 days. It was shown to protect up to 50 percent of primates after exposure but before they show symptoms.
Consequently, this vaccine has a great chance of combatting an outbreak in the context of ring vaccinations, where you give the vaccine only to people in close contact with infected patients. That strategy can be used to break the chains of transmission and reduce the number of cases. It can also be used with first responders and health care workers who need to be protected really quickly.
[This article originally appeared in print as "Ebola Aftermath."]
