The cover of this week’s issue of Businessweek declares that ‘Ebola is coming’ in letters colored like blood, with the subtitle ‘The US had a chance to stop the virus in its tracks. It missed’. Although the article presents a good analysis of the hurdles in developing antibody therapy for Ebola virus infection, the cover is overstated. Why does Businessweek think that Ebola virus is coming to the US? (there is no mention of this topic in the article). Are we sure that antibody therapy would have stopped the outbreak? (no, as stated in the article).
How the U.S. Screwed Up in the Fight Against Ebola is an analysis of why ZMapp, the cocktail of monoclonal antibodies that block infection with Ebola virus, has not yet been approved for use in humans. ZMapp was given to two American workers who had become infected with the virus while working in Africa. The two workers recovered, but the role of ZMapp in their recovery is unknown – as the authors of the article note. Although ZMapp can prevent lethal infection of nonhuman primates with Ebola virus, it is not known if it would work in humans. Answering that question requires a clinical trial, and the article explores why this phase was not done years ago. Only after the large Ebola virus outbreak in west Africa did the US provide funds to conduct a phase I trial of the drug.
The article discusses how development of ZMapp languished for years, because the US government did not consider the Ebolaviruses to be a pressing problem. In hindsight they were wrong, and now anyone can seem smart by saying we should have pushed development of Ebola virus vaccines and therapeutics.
The real question is whether we will learn from this experience, and be better prepared for the next viral outbreak. Just because infections are rare or geographically localized should not lessen their importance, as these features can change. Knowing the animal source of a viral infection may also lead to developing ways to prevent infections. For example, because people acquire Hendra virus from horses, immunization of these animals should prevent human infections.
What other antiviral vaccines and drugs should we be developing? This question is difficult to answer because we discover new viruses regularly and making therapeutics for all of them is not possible. Testing an antiviral drug or vaccine against rare viruses is difficult because identifying populations that are at risk for infection may be a hit or miss proposition.
Influenza viruses are at the top of the list for vaccine and drug development, because nearly everyone gets infected. Other viruses we should be ready for include SARS and MERS coronaviruses, dengue virus, chikungunya virus, Lassa virus, Nipah and Hendra viruses. I’m sure you can think of other viruses that belong on this list.
Developing antiviral vaccines and drugs is expensive. For some of the viruses on my list (dengue, chikungunya) there are currently large enough markets that permit involvement of for-profit pharmaceutical companies. Development of therapeutics against viruses that cause rare infections must be supported largely by governments.
The US does not spend enough money on basic life sciences research. We do spend a great deal of money on the military. President Obama recently declared Ebola virus to be a top national security priority. Why not view all infectious diseases in this way, to ensure that they receive the funding for research that they deserve?
While the Businessweek cover is misleading, intended to stimulate sales, the article does make us think about the problems we confront when dealing with rare but lethal diseases. No one should conclude that Ebola virus outbreak in Africa could have been prevented, because antiviral therapies have not yet been tested in humans. But we won’t know if we never do the research.
I wonder if it makes just as much sense to ask why we need to use ‘national security’ as a defense. One of the reasons there was some work done on ZMapp and other therapies is because Ebola was amongst the pathogens identified as a possible bioweapon (late 1990s/early 2000s). Your analysis does seem to point to the fact that even using national security as a motivational factor has its limits as risks are calculated and decisions made about the relative dangers of the spread.
Well I guess they were right about it coming!
http://www.nytimes.com/2014/10/01/health/airline-passenger-with-ebola-is-under-treatment-in-dallas.html
–bks
or just money for epidemiological surveillance
http://www.law.georgetown.edu/news/press-releases/gostin-says-ebola-crisis-could-have-been-averted.cfm
how much money, if available and reasonably used would have prevented/contained the outbreak ?
(and hopefully still will) My guesstimate : $1B
how much money put into research earlier would have prevented/stopped it ?
That I can’t estimate, the numbers what research costs are not so easy to find for me.
You said “why do they fear Ebola is coming?”. The answer is in the case identified in Dallas
Despite the fact that this cover is now true, all of the points raised here are valid. We don’t know enough about Ebola to prevent it and its relatively low transmission rates (in comparison to viruses like influenza) allow us to smother small-scale outbreaks. More research = more promise.
as a scientist I totally agree with you. My major concern is that the globalization of mass transport works against any form of control. Ebola is for sure “better” than polio, TBC or any other hidden and more contagious bugs that is becoming again a problem here in Europe. Immigration (but also tourists) coming from areas where these diseases are endemic and the vaccination control is absent is something against which Science can do very little.
The recent case of Ebola in Texas is teaching us that: it is not really possibile to control people coming from risky areas unless they are symtomatic; the doctors at the Presbyterian didn’t take into account what the patient told them(“I just came from Liberia”) sending him home with some antibiotics (!?!?)
The article did not discuss this issue at all. When a cover does that it’s disingenuous.
You are right on that. If we do make infectious diseases national security issues, then research on them can’t be controlled by the DOD.
I’m not worried about it coming to the US. We can deal with it. I’m really worried that a case will land in a country that can’t handle it, and then it will spread there. There are dozens of countries that can’t handle this.
We have many vaccine candidates, monoclonal antibody therapy and some antivirals. Many are ready for phase I. In this case half a billion might be enough. But you are right, the conventional wisdom is that bringing a drug to market costs about a billion dollars. This is nothing compared to what the outbreak is going to cost.
It is kind of troubling that Texas Presbyterian dropped the ball and sent the guy home, but I agree with your statement. I wonder why the USA is the first country outside of Africa to have a case? –bks
but should we invest in research or in surveillance and
epidemiological intervention by WHO, as Gostin said ?
PEOPLE IN AUTHORITY WHO CAN HELP IN TREATING AND CONTROL THE SPREAD OF EBOLA NEED TO STOP WORSHIP MONEY AND HAVING GREED FOR OTHER COUNTRIES RESOURCES AVOID BARRIERS. PLEASE OPEN YOU ALL EYES. IT IS SIMPLE BAND ALL INDIVIDUALS FROM TRAVELLING OUT OF THE COUNTRIES THAT ARE EXPOSED TO EBOLA, DEVELOP A VACCINATION TO TREAT THE VIRUS BY POOLING RESOURCES FROM OTHER AGENCIES, FOR HEAVEN SAKE OPEN YOUR BRAINS AND EYES AND LOOK AT WHAT GOING ON. AFRICA IS A PLACE ALWAYS GETTING HIT LEFT RIGHT AND CENTER IT’S NOT A TESTING GROUND THE CITIZENS ARE HUMAN BEINGS AND CREATION OF GOD TREAT THEM EQUALLY AS YOU TREAT YOUR OWN. I BELIEVE THAT SOMEONE RELEASE THAT VIRUS AND THE DEPARTMENTS WHO ARE RESEARCHING KNOW WHATS GOING ON AND NOT ACTING OUT. STOP **** UP AM VERY PISSED RIGHT NOW AND TRUST ME I CAN’T BELIEVE PEOPLE STILL BEHAVING LIKE ***HOLES AND NOT WORKING TOGETHER TO COMBAT THIS VIRUS.
Ebola is a “synthesized virus.” Perhaps not creating it in the first place would have been a good idea.
Nonsense, I can assure you that our scientists and researchers are incapable of creating anything that can multiply in the wild.
A GMO Virus is a “modified” virus. You’re saying our scientists are not capable of modifying a virus? They can only modify plants but not other lifeforms?