Cut through the Ebola sensationalism and fear tactics. Here are 10 insights from the recent American Society of Tropical Medicine & Hygiene meeting.
The 63rd annual meeting of The American Society of Tropical Medicine & Hygiene (ASTMH) was held this week in New Orleans, Louisiana. Researchers from a wide variety of sectors told me that this is the “preeminent” meeting of its kind. This year the conference brought in over 4,000 attendees, far surpassing the previous ASTMH record. As such, a buzz was in the air from the first session of Day 1 (a day in which Bill Gates delivered the keynote address) and in many ways it culminated on Tuesday, November 4 at a session titled: Ebola Virus Hits West Africa: Challenges, New Approaches and the Path Ahead. This was a chance (a chance the media hasn’t, in my opinion, adequately provided) for the world’s great Ebola experts to finally have the stage. No fear tactics, no sensationalism, no click-bait titles. ASTMH writer Matthew Davis compiled 10 of those insights and updates:
(1) There have been signs this week that the outbreak in Liberia is abating, but there could be other reasons fewer people are seeking care. MSF’s Sprecher cautioned that infected people are leery of being put in quarantine and that maybe “we’re not detecting cases because people don’t want to be detected.” He also said many Liberians are opposed to the policy at treatment centers of cremating the remains of deceased patients and so “they may not be coming to us.”
(2) The outbreak has become a particularly ominous event for pregnant women and a major setback for decades of efforts to improve maternal health in the region. Virtually all pregnant women infected with the virus have died. But that’s just part of the story. Tulane’s Moses said that in Sierra Leone, all pregnant women–infected or not–have essentially have been abandoned by the health care system. Physicians in the country have either perished from Ebola or they are unwilling to perform Caesarian sections or assist with a normal delivery for fear of coming into contact with blood that could contain Ebola.
(3) The damage inflicted by the Ebola virus will require a “Marshall Plan for West Africa” to rebuild health systems already degraded by years of civil war, economic hardship, and international neglect. Tulane’s Bausch said one reason the Ebola outbreak has been so hard to control is that funding for global health at agencies like the US National Institutes for Health (NIH) and Centers for Disease Control and Prevention (CDC) is, politically, “an easy place to cut” when there is no emergency. In addition, he noted that overall funding increases for CDC over the last few years mask the fact that funding for global health has been flat to falling. That why, Bausch said, the equivalent of a Marshall Plan is needed to drive a sustained effort in the region that will continue after the Ebola emergency has abated.
(4) Pharmaceutical companies and regulatory officials are plunging into uncharted waters as they accelerate the development of novel drugs and vaccines in the midst of the outbreak. Dr. Ripley Ballou, Vice President of Emerging Diseases at GlaxoSmithKline (GSK), said his company is contemplating the unusual step of conducting Phase 2 and Phase 3 trials of its Ebola vaccine candidate at the same time, starting as early as January. Dr. Ed Cox with the US Food and Drug Administration (FDA) Center for Drug Evaluation and Research said regulators are considering whether drug candidates could be tested in the region with a conventional “placedo control” group where efficacy is determined by giving one group the treatment and the other a placebo. He said one way to deal with the ethical questions about such an approach would be to offer equal levels of high quality supportive care to both groups.
(5) Fiercely competitive pharmaceutical companies appear to be calling a truce and cooperating to address the Ebola threat. GSK’s Ballou said rival companies are even considering combining their vaccine candidates as a one- two punch against the virus. This strategy is known as “prime-boost” in which one vaccine would prime the immune system to provide protection and the second would enhance this effect. The talks between companies, he said, “are very unusual.”
(6) Researchers are trying to understand why some people get a milder form of the disease than others. Also, getting care relatively early in an infection may not make a big difference in terms of survival. Tulane’s Bausch said health care workers are seeing a “spectrum of disease” on the ground but are not sure why some people seem to have less severe cases than others. MSF’s Sprecher said after treating a large number of Ebola victims, his organization reached the unexpected finding that when a patient arrives for treatment–whether early or farther along in the infection– “does not seem to correlate with survival.”
(7) In the midst of the outbreak, MSF has unilaterally launched a mass drug treatment strategy to combat malaria in Liberia. As of Tuesday, MSF had distributed 170,000 doses of a powerful artemisinin-based combination therapy (ACT) targeting hot spots of Ebola transmission. MSF’s goal is to reduce the burden of “febrile illness presenting at” Ebola treatment centers, which, among other things, can make it hard to distinguish malaria from Ebola.
(8) It is critically important to dramatically accelerate efforts to develop Ebola drugs and vaccines and improve health care on the ground. But don’t be surprised if the epidemic ends on its own. MSF’s Sprecher said in the smaller outbreaks his organization has confronted in other parts of Africa, the Ebola stopped spreading “when people in the community figured out for themselves” that they needed to stop touching infected people and to curtail burial practices that transmitted infections. “It’s happened before,” he said, “and I would like to think it could happen again.”
(9) Regulatory officials and other experts don’t yet know whether serum derived from the blood of Ebola survivors could provide a useful treatment. Dr. Luciana Borio, the FDA’s Assistant Commissioner for Counterterrorism Policy and Acting Deputy Chief Scientist, said the agency has been providing technical assistance to the World Health Organization to explore the potential of this therapeutic approach. She said the “data is foggy” and that, also, it would be “logistically quite complicated” to implement serum treatment “on a large scale.”
(10) Ebola did not take over the ASTMH conference and ASTMH officials are not holding grudges over Louisiana’s decision to block Ebola experts who had visited the affected countries in the last 21 days from attending. ASTMH President Dr. Alan Magill said the 2014 Annual Meeting has been a “rich feast” of discussions on multiple topics and featured important research results relevant to diseases like malaria and dengue. He said the discussions generated by the Ebola outbreak helped to enrich the meeting’s overall focus on global health. Magill also said that despite the tensions over 21-day rule and the fact that it prevented important Ebola experts from attending, “we have been having a great meeting and New Orleans is a great place to be.”
Cameron Conaway is the author of Malaria, Poems.
–Feature photo, from left to right: Tim Jagatic (Médecins Sans Frontières, Toronto, ON, Canada), Jessica K. Fairley (Emory University, Atlanta, GA, United States), Armand Sprecher (Médecins Sans Frontières, Brussels, Belgium)