Deadly Ebola Virus Loses Its Grip as New Treatments Emerge

(Bloomberg) --

The Ebola outbreak in the Democratic Republic of Congo has been described as the most challenging in the disease's 43-year history. Yet it's spurred innovations that will change forever how the world responds to the lethal virus.

Ibrahima Soce Fall, the World Health Organization's assistant director-general for emergency response, has led the agency's team on the ground since August 2018. He answers questions about revamped strategies for tackling Ebola, which has infected some 3,180 people in this outbreak. About two-thirds of cases have been fatal.

How significant has this outbreak been?

This is a turning point because of the new developments with vaccines and therapeutics, but also investment in social anthropologists and community engagement. More broadly, it will drive discussions about global security and health, especially preventing and responding to outbreaks in areas afflicted by conflict and political instability, and set a new agenda for where we need to invest.

How have the clinical trials changed the face of Ebola?

Vaccines and therapies have changed Ebola prevention and control. Before, there was no treatment or vaccine. Now the communication is completely different. Just saying, you can be protected by the vaccine, you can be treated if you come early to the treatment center was really important. We have these two therapies (Regeneron Pharmaceuticals Inc.'s REGN-EB3 and mAb114 licensed by Ridgeback Biotherapeutics LP from the National Institutes of Health) that can save the lives of Ebola patients.

Does that make patients more willing be treated?

When people come for treatment in the first 48 hours of their illness, the survival rate is greater than 75%. That really makes a huge difference. We can tell people: Go to the treatment center early. The delay between the onset of the signs of the disease and when a person is put into isolation was at seven to 10 days at a certain point. Right now, it is around 3.5 days. We have also worked to improve the standard of supportive care.

What other changes were introduced?

Patients are not entirely isolated because we are using bio-secure emergency-care units made with transparent materials so the family can see their relative from outside. This is something that's completely changed the way the population is perceiving the Ebola treatment centers.

What role have vaccines played?

Being able to vaccinate people in affected communities was extremely important for preventing secondary and tertiary transmission, and it played a huge role in containing the outbreak in Congo. We know that the Merck vaccine protects people against Ebola-Zaire for up to three years, and we will continue to monitor the duration of protection. In the future, we will be able to use it in a more preventive manner because we know the areas and population at risk for Ebola. If the Johnson & Johnson vaccine is also proven effective, we would use the same approach to make sure that all the populations at risk are protected, but we have to wait and see the outcome of the clinical trial.

What's different about this outbreak?

Two things. The first is the security situation and the armed groups in North Kivu. There are so many armed groups, very few humanitarian actors, and little information about the communities or the armed groups. It was a challenge getting access to the affected areas and to start a dialog with the population, which has been neglected for so many years and has a high level of mistrust of authorities.

The second thing was the weakness of the health system. The first time I visited so-called health facilities in Congo, I was shocked. I was not only worried about Ebola, but about all the transmittable diseases in the health facilities -- hepatitis, HIV, antimicrobial resistance. It was the lowest standard I have ever seen.

How has the conflict affected the medical response?

For example, in Butembo, at a certain point on a daily basis, we were receiving threats that our accommodation treatment centers would be attacked. Every team in Congo had to travel by plane to get to the affected areas and, from there, drive to the villages. The security and logistics required added significantly to the cost of responding to the outbreak.

How has WHO's response changed since the West Africa outbreak?

During the West Africa outbreak, WHO wasn't set up to be operational, but more to provide advice and guidance to countries. We had to reform the way we work in emergencies, making sure that we have the capacity to be operational.

How important were non-medical health workers?

Since the beginning, we have had a big team of social anthropologists and risk-communication professionals working with people identified in the communities to really make sure that the community is engaged. We deployed social anthropologists the same way we deployed epidemiologists, and this is clearly a big shift. You cannot implement medical interventions without community engagement.

What you would you change about the response?

More investment in preparedness. Donors are ready to provide support when there is a big outbreak, but it's so difficult to convince people to invest in preparedness to prevent these kinds of big outbreaks and protect the population at risk. With the availability of a proven vaccine, we need to take a more preventive approach because we know the areas, at least for Ebola. We shouldn't have this type of outbreak when we have a vaccine now.

When do you expect the current outbreak to end?

It's difficult to say. Our plan is to stop the transmission by the end of the year. After that, you have to wait 42 days to make sure the outbreak is over. But any major change in the security situation can impede access to the most difficult to reach and disrupt delivery of public health interventions.

To contact the reporter on this story: Jason Gale in Melbourne at j.gale@bloomberg.net

To contact the editors responsible for this story: Michael Patterson at mpatterson10@bloomberg.net, Marthe Fourcade, Jodi Schneider

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