During a media event held at the American Society of Tropical Medicine and Hygiene annual meeting in New Orleans, a panel of seven infectious disease experts fielded questions related to the current Ebola outbreak.
Infectious Disease News compiled a list of challenges to containing the outbreak raised during the event, along with the responses and discussion provided by panel members.
Overwhelmed health care systems
The high volume of Ebola patients has disrupted West Africa’s health care system, Armand Sprecher, MD, MPH, public health specialist at Médecins Sans Frontières, said during the event.
“When I was in Monrovia at the end of August, all of the hospitals had stopped admitting patients, so there was no inpatient care being delivered to a city of over a million people,” Sprecher said. “We can draw conclusions about how many people suffered or died because of that … and hopefully in the coming weeks we’ll have a better idea of the actual cost.”
Sprecher said that Médecins Sans Frontières’ recent decision to provide aid with widespread malaria treatment distribution is an effort to reduce the burden on the health care system, which has already exceeded its limits.
Ebola vaccine progress
Luciana Borio, MD, acting deputy chief scientist and assistant commissioner for counterterrorism policy at the FDA, said vaccine development is a top priority.
“[The] FDA is working very closely with the manufacturers to make sure that there is no lag in vaccine availability due to any regulatory constraints,” Borio said. “We are [using a] very flexible regulatory framework … and we are doing a near real-time review of information as it is received so that we can move these as fast as we can, but clearly the development timelines are determined by the developers and the science.”
Sprecher said the potential of a successful vaccine to end the outbreak was an “open question,” but its effect could relieve overworked health care workers and facilities.
Concerns about the costs of developing these vaccines were addressed by W. Ripley Ballou, MD, vice president for emerging diseases at GlaxoSmithKline, who acknowledged that those living in the poorer nations “can’t be expected to pay [for the vaccine].” He said GlaxoSmithKline would be looking into partnerships and other ways to ensure that cost would not be a barrier to treatment.
Treatment options in the pipeline
Additional treatments for patients with Ebola are in development, but still in very early stages, Edward Cox, MD, MPH, director of antimicrobial products at the FDA’s Center for Drug Evaluation and Research, said. However, therapies that have been developed for other viral diseases also are being adapted to treat Ebola disease.
“At this point, the next step will be to get some additional human exposure data and then very quickly move toward clinical trials that will allow for the safety and efficacy of these products to be evaluated,” Cox said.
“As trials become developed, it will be important for products to be available through clinical trials so that patients can not only access [them], but we can learn about the products and their safety and efficacy,” he said.
Sprecher said one of the biggest challenges for his group is the organization of volunteers and resources as the outbreak continues to grow.
“Because of the arrival of new partners in the field, we have a lot of new people to work with who want to respond, who are seeking guidance and training and assistance in getting up to speed,” Sprecher said. “Médecins Sans Frontières has to maintain its own operations — do the things we went to West Africa to do — but also enable other organizations to do the same. That is stretching us even further.”
Médecins Sans Frontières is currently offering training programs and hands-on experience to new arrivals, but the growing demand for assistance in areas outside of West Africa is making the group’s job more difficult.
Randomized controlled trials
Cox acknowledged the debate on whether or not randomized controlled trials of experimental treatments for Ebola patients are feasible. He said that if such trials were to occur, it is important to remember that all patients within the trial would be receiving the best supportive therapy available. This would allow for designs that still provide benefits for both the control and intervention groups.
“This will be challenging, but it’s very important to be able to understand what these products are doing,” he said. “If we can quickly figure out which products are helping patients, it would be possible, then, to move toward scaling those products up and making them available to patients.”
Cox added that this would only be possible with additional resources and support, which he hopes will be coming over the next few months.