Ebola Good News/Bad News Follow-Up

A few weeks ago, I took a break from climate change blogging to voice my concern over the recent Ebola outbreak in West Africa. Since then, some good news and some bad news have developed. I can't ask you in real-time which you want first, so I'm just gonna hit you with the bad news to start...

Dr. Sahr Rogers, one of Sierra Leone's bravest and most influential healthcare workers, has lost a battle with the illness and died. It's hard for us here in the cynical, resource-rich West to appreciate the importance of fearless, knowledgeable leadership when proper medical supplies and facilities are lacking. The people of Sierra Leone have lost one of their finest, most dedicated medical professionals, and someone who undoubtedly helped dispel some of the counterproductive superstition surrounding the sickness.

As of August 28, 2014, the official death toll of this latest epidemic had risen to 1,552 people, though some unofficial reports say that total could be grossly underestimated. Even when cases are reported and Ebola is detected, due to other health complications afflicting some patients at the same time, such as influenza or malaria, it can be difficult to determine the specific cause of death. Needless to say, however, the potent pathogen must have played some role in diminishing health and causing the fatalities.

Unlike his American counterparts, Miguel Pajares, the infected Spanish missionary flown back to Spain for treatment, died, and serves as a sobering reminder that the somewhat mysterious ZMapp drug produced from the tobacco plant, the true efficacy and safety of which has yet to be determined, is no guarantee of recovery, perhaps especially so for older patients. Though cleared by the FDA for urgent or compassionate-use cases only, the medicine is in short supply presently and, to date, does not seem to lend itself to rapid production and deployment.

August 12, 2014 at 8:30 AM - The available supply of ZMapp™ has been exhausted. We have complied with every request for ZMapp™ that had the necessary legal/regulatory authorization. It is the requestors’ decision whether they wish to make public their request, acquisition, or use of the experimental drug. Any decision to use ZMapp™ must be made by the patients’ medical team. Drug has been provided at no cost in all cases.

Another Westerner, a German epidemiologist, has contracted the disease and gone home for treatment, and some countries are recalling their staff.

Despite these disappointing developments, and their troubling implications for successful containment, there is some good news...

Brantly and Writebol, the two Americans flown back to Atlanta, have recovered and been released from Emory Hospital.

Pharmaceutical companies are working with the FDA and government agencies to increase production of ZMapp, so the exhausted supply issue may be corrected soon.

"Mapp and its partners are cooperating with appropriate government agencies to increase production as quickly as possible," LeafBio said in a statement on its website. Currently, it's unclear how long it will take to manufacture more of the serum.

And most encouraging of all, if you ask me, is the fact that the NIH will begin testing an experimental vaccine (not just a drug) on human enrollees next week.

The Vaccine Research Center (VRC) has developed an Ebola vaccine candidate in collaboration with Okairos, a Swiss-Italian biotech company recently acquired by GSK. The investigational vaccine, which was designed by VRC scientists, contains no infectious Ebola virus material. It is a chimpanzee adenovirus vector vaccine into which two Ebola genes have been inserted. This is a non-replicating viral vector, which means the vaccine enters a cell, delivers the gene inserts and does not replicate further. The gene inserts express a protein to which the body makes an immune response. The investigational vaccine has recently shown promise in a primate model. The VRC vaccine will enter into a phase 1 clinical trial, which could start enrollment as early as fall 2014, pending approval by the FDA. The VRC is also in discussions with governmental and non-governmental partners regarding options for advancing this candidate beyond Phase I clinical evaluation.

Initial results may be reported as early as October or November.

That's not just good news, that's great news. Let's keep our fingers crossed for a successful trial.

Ebola: It's Overwhelming the Brave People Fighting It

This blog, obviously, is mostly concerned with climate change. And while the link between a warmer world and the spread of Ebola is becoming increasingly clear...

Ebola: This virus is lethal to humans and other primates, and has no cure. In addition, it is unclear where the disease, which causes fever, vomiting and internal or external bleeding, comes from—though scientists suspect fruit bats. What is clear is that outbreaks tend to follow unusual downpours or droughts in central Africa—a likely result of climate change.

...I am going to set that mantle down in this post in order to talk strictly about the urgency of this most-recent hemorrhagic fever outbreak. If we've all assumed that the sickness is nothing more than a bad Hollywood movie premise or plot device that will never affect us, well then, we better get over that quick. And by "quick" I mean right now.

What Has Changed
Unless your front door opens onto a tunnel that leads to the sheltering seclusion under a giant rock, you've probably heard or read about confirmed and suspected Ebola victims being treated in the US, Canada, and Europe, after getting sick in Africa. Thankfully, their prognoses in modern medical facilities after receiving an experimental treatment are good, but the arrival of the first Ebola victims to our own hospitals should alert you that something is different now. This recent outbreak in West Africa has reportedly taken over 900 lives, and therefore is the deadliest on record. While influenza, HIV, and cholera, among other infectious diseases, can and do claim more lives, it is precisely the location of this latest epidemic that should worry us all equally nonetheless. Starting in Sierra Leone, the virus has expanded into Guinea, Liberia, and Nigeria, which are some of the more densely-populated and underdeveloped countries in all of Africa, and therefore, as far as underdevelopment goes at least, the world, some with vast majorities living under the international poverty line. Hopefully, I need not impress upon anyone too strongly that this is a far from promising situation not entirely conducive to containment.

The Battle
You may or may not remember that here in America we've actually experienced at least two incidents involving Ebola. Luckily, the infected monkeys in both instances carried a strain that does not make humans seriously sick, unlike this latest Zaire strain. And luck was all that prevented what could have been a very serious health crisis.

In Africa, the story has been very different. Since Ebola's discovery in 1976, the various strains of the virus, with mortality rates up to 90%, have claimed over two thousand lives, with recent events nearly doubling the total.

Médecins Sans Frontières (MSF) has spearheaded efforts to bring the spread under control, but it is pleading with the international community to help, because it does not have enough resources and funding for effective treatment and containment on its own.

MSF currently has 676 staff working in Guinea, Sierra Leone and Liberia, but warns that it has reached its limit in terms of staff, and urges the WHO, health authorities and other organisations to scale up their response.

Over 60 healthcare workers have died from the disease in Sierra Leone, Liberia and Guinea. These people should be remembered as heroes who sacrificed everything treating the sick and preventing others from getting sick, but, unfortunately, superstitious beliefs are portraying them as the enemy. I won't belabor the point, but I do believe I've already strongly stated my opinion on the origins of such intellectually-debilitating madness.

MSF is not the only organization which cannot meet the demands of such an intense outbreak alone. The World Health Organization itself lacks the funds to respond properly. For more on that, as well as the challenges involved in the struggle, have a listen to this Science Friday report.

What Can Be Done
One thing on our side thus far is Ebola cannot be as easily contracted as crappy Hollywood movies depict. It's not an airborne virus, or a pathogen like malaria or West Nile that gets spread quickly and far and wide by biting insects. To the best of our knowledge, it can only be passed from host to host by contact with bodily fluids, or contaminated implements, so with correct medical procedures and protocols in place it can be contained, and we can provide ourselves the time required to come up with a cure. However, as the Science Friday piece mentions, implementing those procedures can be prohibitively-expensive and sometimes impossible in Third World nations. But, perhaps more troubling, is the fact that Ebola's location and low death toll relative to other infectious diseases, has led to a systematic shuffling of feet.

Pharmaceutical companies have little incentive to pour research and development dollars into curing a disease that surfaces sporadically in low-income, African countries. They aren't likely to see a large pay-off at the end — and could stand to lose money.

We've wasted enough time and watched enough people die already. Whatever it takes, even injections of cash, we need to break through this medical industry inertia.

Down with Disease

This is a highly-technical but engrossing talk given at Yale about infectious disease and climate change. Before watching this, I would have expected a more direct correlation between increased temperatures and increases in diseases like malaria, but it turns out the story is much more complex. For one, it seems malaria is not quite so happy to see higher temperatures as previously thought. Now, that would be good news for the broiling hot tropics (what little good news these areas can hope for), but possibly bad news for higher latitudes where the temperatures approach malaria's sweet spot. Also, wealth leads to less exposure to the natural world (indoor climate control, screened doors and windows, etc.), and therefore less exposure to vectors of transmission like mosquitoes, so, as the continent's economy improves, Africans may remove themselves from conditions which facilitate the spread, leading to a decrease in malaria, even were it the case that it preferred 40+ °C. But that reduction assumes climate change will not negatively impact the region's economic growth, something Kevin Lafferty points out in the video is rather presumptuous. See? Like many things in science, it gets complicated quick. We can be thankful dedicated professionals like Lafferty take the time to conduct field research and draft complex analyses in an effort to quantify and understand all the factors and variables involved. We can also be thankful scientists like Lafferty appreciate that computer models greatly aid the effort, rather than disparage them. Notice how heavily Lafferty relies on them for predictions in his basic parasitology research and for understanding climate change impacts such as disruptions of host/parasite populations. Splitting the baby in situations like this must drive deniers mad. After all, in order to maintain the denier delusion that computer models of the climate are inherently flawed and worthless, they have to willfully ignore their usage/efficacy elsewhere in science, such as parasitology.