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Lack of coordination during Ebola outbreak was a “lost opportunity” to test therapies

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5644 (Published 22 October 2015) Cite this as: BMJ 2015;351:h5644
  1. Anne Gulland
  1. 1London

A coordinated scientific response to the Ebola epidemic was lacking, global health experts have told MPs.

In evidence given to the science and technology select committee a group of academic, commercial, and government scientists said that research capacity and the will to respond to the epidemic in west Africa were plentiful but that coordination was not.

Trudie Lang, professor of global health research and head of the Global Health Network at the University of Oxford, told the committee that research would have to be embedded into the initial response to disease outbreaks to ensure that potential drugs could be tested early on and that a proper research infrastructure could be set up.

She said that five research teams were working on five different drugs and that it was left to organisations such as Médecins Sans Frontières and Save the Children to work out which drugs should be tested where. Writing in Nature in August, Lang had described a “chaotic land grab for patients.”1

She told the committee, “It’s not an overly sensible approach to have five different groups testing five different things . . . We should have decided which was the best intervention and really should have gone for it.”

Chris Whitty, chief scientific adviser and director of research and evidence at the Department for International Development, highlighted a similar lack of coordination in the testing of simpler therapeutic interventions such as fluids and antibiotics. He admitted that staff on the ground were “on their knees” in the early phase of the epidemic but added, “Once it had peaked in December we could have done that and had big enough numbers to test, but we didn’t. It was a lost opportunity.”

The World Health Organization was initially not interested in using vaccines to control the disease, said Ripley Ballou, head of GlaxoSmithKline’s Ebola vaccine research team. GlaxoSmithKline had the vaccine through the acquisition of a small biotech firm, which had developed it because the US government was worried about the “weaponisation” of Ebola, he said.

Ballou told the committee that, at the beginning of the epidemic, WHO was interested only in a classic public health response. “I contacted WHO and said that we have a vaccine, how can we accelerate it? But the response was that we manage Ebola through contact tracing and isolating patients,” he said, adding that it was not until August, when it was clear that the disease was out of control, that WHO accepted a need for a vaccine.

Adrian Hill, director of the Jenner Institute, urged WHO and other international bodies to draw up a list of vaccines for diseases such as Marburg disease and Middle East respiratory syndrome coronavirus that should be stockpiled in the event of a disease outbreak.

“We should have had the vaccine stockpiled ready to test, knowing it was safe in hundreds of people, knowing the dose of the vaccine. All of that could be in development before the next outbreak, and we would be prepared. It’s not happening because it’s not clear whose responsibility internationally it is to do that,” he said.

Ebola was not even on WHO’s list of neglected tropical diseases and was ignored, Hill said, adding, “For me the irony is that Ebola was not a disease [for which] it turned out to be difficult to make a vaccine.”

Jeremy Farrar, director of the Wellcome Trust, later told the committee of the need for a semi-autonomous unit at WHO dedicated to the surveillance of and response to emerging infectious diseases that is properly funded and functions “even in the inter-epidemic period.” He warned, “Trying to respond in a crisis is when we run into problems.”

The latest data from WHO showed 28 490 cases of Ebola in total so far, including 11 312 deaths. For the second week in a row no new cases have been reported.

Notes

Cite this as: BMJ 2015;351:h5644

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