Ebola and ethics: autopsy of a failureBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2105 (Published 23 April 2015) Cite this as: BMJ 2015;350:h2105
All rapid responses
Just by chance I discover in a newspaper (on the web) that there are fresh cases in Sierra Leone.
The BMJ news team has missed them, perhaps.
Competing interests: No competing interests
Re: Ebola and Ethics: Ghana Academy of Arts & Sciences and Ghana Parliament Suspend Ebola Vaccine Trials
Ebola and Ethics: Ghana Academy of Arts & Sciences and Ghana Parliament Suspend Ebola Vaccine Trials
Dr J K Anand  whom I have never met refers to me as the “Korbu tribesman who also happens to be a Fellow of the RCP London”  Indeed I am a Krobo Tribesman about which see later, but his mention that I am also Fellow of the Royal College of Physicians London makes me state if boastfully that I am also Fellow of other prestigious Colleges and Academies. The one I am most proud of this very day is the Ghana Academy of Arts and Sciences not just because they once gave me their GOLD MEDAL for “Outstanding Contribution to knowledge in Medical Science” the same evening as they gave the legendary Francis Allotey also GOLD MEDAL in Mathematical Sciences, but also that they could produce a Communique like this one (below) giving reasons why they prevailed on the Government of Ghana to suspend with immediate effect the Ebola Virus Vaccine Trials due to start in the country.
WORLD EXPERTS PLEASE STUDY THIS STATEMENT
I invite the most brilliant scientists in Johns Hopkins, Harvard, Oxford, Utrecht, NIH, CDC, and London School of Tropical Medicine & Hygiene to study this GAAS Communique from which they will derive much benefit as they go about their own vaccination programmes in Europe, USA, and elsewhere. I recommend it to the WHO too.
Below is the Academy’s full narration of events leading up to the announcement of the Ebola vaccine trial in Ghana 
In January this year, the Ghana Academy of Arts and Sciences became aware, from a newspaper report, that a clinical trial for an Ebola Virus Disease (EVD) vaccine was due to start in Ghana before the end of March.
Given the uncertainties about the nature of the Ebola virus and risks in clinical trials, the Academy set up a 5-person Technical Committee made up of Fellows of the Academy to undertake an urgent review of the matter and report to the Academy.
In its preliminary report, the Committee noted, among other things, that the proposal before the Food and Drugs Authority (FDA) was for a Phase II clinical trial of an Ebola Virus Disease (EVD) vaccine, developed by GlaxoSmithKline/US National Institutes of Health (NIH).
Such an undertaking must be preceded by a thorough evaluation of the available data, and the application subjected to the appropriate procedures.
On the basis of its preliminary investigation and study, the Committee recommended a second look at the design of the study; a review of the basis for the selection of Ebola-unaffected countries like Ghana; and, because some Ghanaians have anti-bodies to the adenovirus, a fuller understanding of the adenovirus vector used in the development of the test vaccine.
In discharge of the Academy’s mandate to provide independent science-based advice for policy making, the Council of the Academy asked the President of the Academy to bring these concerns urgently to the attention of the Minister of Health.
This was immediately done, attaching a copy of the preliminary report of the Committee and confirming the Academy’s preparedness to provide all necessary support to the Ministry in dealing with this critical matter. After some delay, the newly-appointed Minister of Health convened a meeting on June 03, at which the concerns and issues raised by the Academy were discussed with the technical staff of the Ministry of Health (MOH), the Food and Drugs Authority and its expert advisors, as well as the Principal Investigators in the GSK/NIH Phase II trials.
The main concerns raised by the Technical Committee of the Academy relate to the following:
1. Major uncertainties about a. the nature and origins of the Ebola virus, including the circumstances of its appearance in Guinea;
2. Whether the Zaire strain of the virus, which is the one being used in the GSK vaccine to be tested in Ghana, is the strain responsible for the Ebola epidemics in Liberia, Mali, Nigeria, Senegal and Sierra Leone, and c. the identity and characteristics of other strains of the Ebola virus that might exist;
3. The use in the GSK/NIH vaccine of a gene particle of the wild species of the Zaire Ebola virus, rather than the gene particle of the Makona strain isolated in the epidemic in Guinea;
4. What pre-clinical animal experimentations had been carried out with a vaccine based on the Makona strain to establish evidence of safety, immunogenicity and protection?
5. What basis is there for expecting that immune responses generated against the wild type Zaire Ebola virus GSK vaccine formulation (construct), with a live non-replicating chimpanzee adenovirus carrying a gene from Zaire Ebola virus, would be effective against the Makona strain or any other Ebola virus species and strains?
6. After a test vaccine has been shown in the vaccinated individual to produce an immune response (immunogenicity), what guarantee would there be, in this instance, that the vaccine would offer protection against the full Zaire Ebola virus and other species and strains?
7. On the basis of research conducted so far towards vaccine development, what is the likelihood of the present construct of vaccines protecting communities against the rapid emergence of new, more virulent strains of the virus, as appears to have happened with the Makona: the risk of false confidence deriving from the use of a new vaccine must be noted;
8. What assurances do we have that the chimpanzee-derived live adenovirus vector used in the GSK vaccine construct, although non-replicating for now, will remain dormant and not itself cause a disease to compromise the health of the people of Ghana?
9. It is to be noted that the application for the GSK Ebola vaccine Phase II trial in Ghana includes children, even though the Phase I trial in the US, UK, Mali and Switzerland was limited to adults, raising the question of dosage profiles for children and other vulnerable groups in the Phase II trial;
10. What evidence is there of strict compliance with the The International Committee on Harmonization Protocol Guidelines for Clinical Trials, including full “informed consent” by all volunteers?
It was confirmed at the above-mentioned meeting between the President and Technical Committee of the Ghana Academy of Arts and Sciences, and staff of the MOH, the Food and Drugs Authority (FDA) and its expert advisors, and the Principal Investigators in the GSK/NIH Phase II trial, that the processes for the approval of the Phase II clinical trial of the GSK Ebola Virus Disease test vaccine had not been concluded.
Our firm understanding was that the approval process will continue to take into account the concerns and issues raised by the Academy.
In the course of the meeting, it was mentioned approval had already been given to an application for a separate Phase I trial in Hohoe, of a test vaccine with a different construct from the GSK test vaccine, which latter had been the focus of concern of the Academy.
This came as a shock to the Academy representatives at the meeting, as nothing had been said anywhere previously about a separate Phase I clinical trial application, let alone its approval.
The Academy’s representatives therefore refused to discuss that matter.
However, it is to be noted that the Phase I trial of the GSK vaccine in Europe produced an adverse event, namely, prolonged bleeding, in 10% – 15% of the vaccinated population.
This is a serious adverse event that calls for extreme caution in approving clinical trials, both Phase I and Phase II, in the country.
Moreover, it is the case that those vaccinated at Phase I and Phase II may be shedding the adenovirus vector into the surrounding community.
In the absence of a map of adenovirus prevalence in the trial sites, there is a high risk of an ‘escape virus’ merging with the endemic adenoviruses to create more virulent strains.
For that reason alone it is important that the exposed communities and, indeed, the general public be adequately informed of such trials and their benefits and risks.
In conclusion, The Ghana Academy of Arts and Sciences wishes to state its firm position that, subject to satisfactory answers to the issues it has raised, and considering the gaps in our knowledge and state of preparedness, it would be unsafe to undertake the proposed EVD vaccine clinical trials in Ghana.
The Academy affirms its availability to help the Ministry of Health, the Food and Drugs Authority (FDA) and other parties involved in the approval process to arrive at sound, independent decisions on this and other critical matters facing the country.
[The Ghana Academy of Arts and Sciences, with a membership of 111 Fellows drawn from all fields of learning, has from its inception in 1959 been charged with a key role in thought leadership and making inputs into policymaking through research and evidence-based advice.
Over the years efforts have been made, and continue to be made, to re-profile the Academy in the light of changing conditions]
Honorary Secretary, Ghana Academy of Arts and Sciences
12 June 2015
CONGRATULATIONS TO GHANA ACADEMY OF ARTS AND SCIENCES
I do not honestly know what readers of the BMJ think after reading this but, I for one, give FULL Marks to the Ghana Academy of Arts and Sciences whose current President Professor Akilagpa Sawyerr, is an International Lawyer of no mean standing. I much congratulate the Scientific Section of our noble ACADEMY for their brilliance. Ayenyekoo! As my Mother Tongue says Congratulations to a Group.
KROBO TRIBAL SENSIBILITIES
There will be so much rejoicing in my tribe. Those who read The Lancet will remember the case of the Krobo Tribal Chief who posed a question that scientists in Harvard would find hard to answer . After addressing a large gathering of chiefs, elders, women, and school children on the local epidemiology of what in our Krobo language, is called kpaanyor (meaning “eight” – the nearest acoustic rendering of AIDS in the language), when the floor was open for questions, and an illiterate chief enquired whether it was true a vaccine for AIDS was in preparation, and I said yes, he exclaimed “What? Are they going to prick us with needles so we can do what we like?” 
This chief has heard on the radio in the local language that Harvard University scientists, NIH, and CDC said eating African green monkey meat brought the AIDS calamity on the tribe when he knew full well that international prostitution killed his daughter who had gone to Abidjan in the sex trade, while her twin sister who stayed in school and refused to join the sex trade was hale and hearty . And here was I, a fellow tribesman, telling them that a vaccine was on the way so they should take heart?
The present Paramount Chief of The entire Manya Krobo mega Tribe, Nene Sakite II, is a scholar. He speaks English better than many in England. He has read from CDC publications that Africans eating bats brought the West African Epidemic, but if even the Ghana Academy of Arts and Sciences had not come out as authoritatively as they have done our Nene Sakite II would NEVER have allowed anybody to go to the tribe and vaccinate them against Ebola Virus Disease, never mind what WHO advises.
PROFESSOR JONATHAN H ADDY’S UNASWERABLE QUESTION
In the same Lancet reference  responding to Professor PJ Weidle and colleagues  on HIV Vaccines for Africa I mentioned how at Korle Bu Teaching Hospital I discussed the continental tragedy with a professor of Medicine. Even before I mentioned vaccines he said to me “Look here, for a vaccine to be worth its name, it must produce antibodies. Would you surrender your seronegative status for a sero-positive one?’” Would Ghanaians swap their Ebola Virus Antibody Negative status for a sero-Positive one? Professor Addy who discovered Ghanaian Essential Hypertension was of Mendelian Homozygous Recessive Inheritance  would not understand how scientists from abroad bypass such as him and the geniuses at the Ghana College of Physicians and Surgeons who scored Distinctions in their UK Universities (London, Glasgow, Sheffield, Cambridge), and quietly go to our Ministry of Health with Vaccination plans?
MORE THAN SCIENCE AND DANGEROUS
As Dr J K Anand implied in his comment “One can understand the pain of the share-holders of the Companies manufacturing the vaccine” , and there could be danger in obstructing programmes that would bring money to Drug Firms and share-holders. Readers of BMJ will remember my being given four Body Guards because I was unmasking a “scientific” untruth in the USA from which Insurance Companies were profiting . Suspending the Vaccine Trials would hugely displease some powerful financial interests it may prove dangerous to stand in their way. How else does one explain my 4 body guards?
BUT PRESIDENT OBAMA WILL YOU NOT HELP US?
President Barack Obama is 50 per cent African. He mentioned the word “Ebola” this past week at the G7 Conference. As Mordecai told Queen Esther of the genocide plot of Haman to destroy the Jews “Who knows whether you have come to the kingdom for such a time as this?” , applying this Africa, who knows whether this remarkable President, the most powerful man in the world, has come at such a time as this?
Whenever we Africans reveal our suspicions about Conspiracy Facts we are shouted down with “CONSPIRACY THEORIES!” But as I said less than a fortnight ago in the BMJ  some of us Africans do not trust what is happening. BMJ’s Sophie Arie  wrote “Candidate treatments and vaccines for Ebola were developed only because the United States considered the virus a potential weapon for bioterrorism” The United States? Oh Mr President, only you can stop these laboratory tinkering with the nuclei of dangerous viruses! The Lancet predicted the BIOLOGICAL BOMB . You yourself [13 14], and President Clinton  apologised openly for American scientific roguery. Please help us. O help us!
For myself, allow me to ask just two things of you before you leave Office next year, God willing, so that we do not forget you in Africa.
(1) Devise a means that can help us distinguish your good scientists the from the wicked ones who come in sheep’s clothing to (as Lord Richie Calder put it) promote “Public Health in reverse”..
(2) Electrify as much of our Continent as possible with solar energy which we have in abundance. That will help us deal with the environment, drain the marshes, build proper drains to get rid of the mosquitoes and other preventable diseases. This will reduce drastically the need for vaccines. Divert your Vaccine Donations to this effect. We have, ourselves, begun looking for African versions of Bill Gates who will donate their Billions for Environmental Infrastructure rather than for Vaccines. Why do we go on vaccinating dirty children drinking dirty water?
The Population Control by hook or by crook Motto of some Donor Countries should not be associated with you, Sir. I myself am emphasizing Genetic Counselling and Family Size Limitation to reduce the incidence of Abnormal Haemoglobin Ailments like Sickle Cell Disease [16, 17]. Please, we beg you, let your Legacy for Africa be Ethical Research and Environmental Improvement with Solar Energy for almost every home. This measure alone can reduce numbers of those traversing the Mediterranean to Europe every week in their thousands.
Visit the NIH and find out what is happening, please. Close the Dirty Labs. I knew Dr Ruddy Jackson MD of NIH and CDC’s Dr A N Schechter MD. Those were great American scientists doing marvellous work. Not like the one we unmasked at Ho in Ghana, caught red-handed by Mawuli Secondary School practicing “Public Health in Reverse” and sent back to the USA. Nor were Jackson and Schechter like the 4 Scientists whom America’s charming Ambassador in Ghana Her Excellency Shirley Temple Black forbade stepping foot in Ghana because they were bringing us drugs that your scientists proved to be useless, Oh Mr President help us before you leave Office. Thank You Sir!
FINALLY THANKS TO THE BRITISH MEDICAL JOURNAL
Finally I thank the BMJ, the world’s leading journal, for letting the Ghana Academy of Arts and Sciences educate the rest of the world. I do not know any other medical journal globally that will let Africans teach everybody else. Some rival front runners with the BMJ in Medical Journalism do not like it and reject our articles when an African criticises a European who writes (Tafracher ) “scientific” untruths. But you have allowed us to present the very impressive Protocol that Ghana has used to detect serious flaws in the Ebola Vaccine programme. This Communique from Ghana may well be referred to in other countries as “The GAAS Vaccine Investigative Protocol” Thank you Dr Fiona Godlee for helping Africa.
Conflict of Interest: I am a Krobo Tribesman concerned for Clean Science and Ethics.
Felix I D Konotey-Ahulu FGA (Fellow of Ghana Academy of Arts & Sciences)
[University of Cape Coast, Ghana and 9 Harley Street, London W1G 9AL]
1 Anand JK. Ebola and Ethics: autopsy of a failure. Dr Konotey-Ahulu’s response BMJ Rapid Response 11 June 2015 www.bmj.com/content/350/bmj.h2105/rr-6
2 Anand JK. Ebola and Ethics. Are vaccine trials going on somewhere in Africa? BMJ Rapid Response June 1 2015. www.bmj.com/content/350/bmj.h2105/rr-4
3 Ghana Academy of Arts & Sciences Communique 12 June 2015 Full narration of events leading up to the announcement of the Ebola vaccine trial in Ghana.
4 Konotey-Ahulu FID. AIDS in Africa. Lancet; 360: 1424 (2 November 2002)
5 Konotey-Ahulu FID. What Is AIDS? T-AD Co Watford 1989/1996, pages 141-143.
6. Weidle PJ, Mastro TD, Alison DG, Nkengasong J, Machara D. HIV/AIDS. Treatment and HIV vaccines for Africa. Lancet 2002; 359: 2261-67.
7 Addy JH. Ghanaian essential hypertension in homozygous recessive inheritance. Lancet Aug 8 1992 pp 377-378, and Ghana Medical Journal 1990; 24: 164-169
8 Konotey-Ahulu FID. Four body guards and the perils of unmasking scientific truths. BMJ 2007; 335: 210-211 July 28. :
9 Mordecai to Esther: “Who knows whether you have come to the kingdom for such a time as this?” ESTHER chapter 4 verse 14“
10 Konotey-Ahulu FID. Ebola and ethics: “Are vaccine trials going on somewhere in Africa?” BMJ Rapid Response 2 June 2015 www.bmj.com/content/350/bmj.h2015/rr-5
11 Arie Sophie. Ebola: A game change for vaccines, or a scare that will soon be forgotten? BMJ 2015; 350: h1938
12 Lancet Annotations. The Biological Bomb. Lancet 1968 (March 20) Volume 1: p 465
13 Tanne Janice Hopkins. President Obama apologises to Guatemala over 1940’s syphilis study. BMJ 2010; 341.c5494. October 9, page 750
14 Konotey-Ahulu FID. President Obama apologises over study: International Guatemala co-operative research and practice in jeopardy. BMJ Rapid Response 4 October 2010
15 Clinton President WJ. Apology on br-Gaultehalf of the American Government to 8 survivors of the Tuskegee Syphilis Experiment victims. World-wide Radio and Television PBS Newshour Newsreel Announcement (Jim Lehrer and Charlayne Hunter-Gault) May 16 1997
16 Konotey-Ahulu FID. Need for ethnic experts to tackle genetic public health. Lancet 2007; 370: 1826
17 Konotey-Ahulu FID. Sickle Cell and Allied Haemoglobinopathy: The Genetics that touches you and me – University of Cape Coast, Ghana GOLDEN JUBILEE MESSAGE – http://bit.ly/1DzceM (Sept 18 2014)
Competing interests: I am a Krobo Tribesman concerned for Clean Science and Ethics
There is a queer silence here. No response to the Korbu tribesman who also happens to be a fellow of the RCP of London. No response to others like me who have questioned the ethics of the Ebola vaccine trials. However, according to Yahoo News today, Ghana ( better known to us as Gold Coast) has had the trial suspended by the parliament.
One can understand the pain of the share-holders of the companies manufacturing the vaccine.
If the trials organisers were to answer the fundamental questions raised by me repeatedly in these columns, one would be at ease.
Competing interests: No competing interests
Ebola and Ethics: “Are vaccine trials going on somewhere in Africa?”
Dr J K Anand’s question “Are vaccine trials going on somewhere in Africa?” has been answered from Ghana where the natives have protested in no uncertain terms . Under the Banner of “Stop ‘criminal’ Ebola vaccines trial in Ghana – Coalition” the Coalition of Ghana’s Independence Now (CGIN) has issued a communique and broadcast “We consider the human experimentation of Ebola vaccine in a country with no Ebola case as criminal, human rights abuse, thievery, and a total disrespect of Ghanaians as human beings” . The communique went on: “We want to say without fear or favour that Ebola is not just a disease but rather a well-planned business. A business where people have created an artificial problem and are now looking for a market to sell the solution and we are telling Ghanaians beforehand that there is and will be no way by which Ghana can go through this Ebola virus human experiment without Ebola being spread countrywide.”
RINGS AN OMINOUS BELL
All this rings an ominous bell: “Emerging Viruses – AIDS & Ebola: Nature, Accident or Intentional”  is the title of Leonard Horowitz’s remarkably well referenced 595-page book that meticulously dissects Conspiracy Theories from Conspiracy Facts . Already, Lancet has published an informed Editorial on “Conspiracy Theories of HIV/AIDS” , but it was the same Lancet that alerted the world with this extraordinary statement of Conspiracy Fact: “While one group of scientists is devoting its energies to prevent diseases, another is devising man-made epidemics”  leading to what Lord Ritchie-Calder called “Public Health in reverse” . Captioning its Editorial “The Biological Bomb” Lancet warned of the potential of great evil that Recombinant DNA research was capable of, and that there was a “biological bomb lying at the heart of the nucleus, ticking us to destruction” . Ghanaians now protesting against Ebola Virus Vaccine Experiments prefer to explain the Ebola Virus Disease Epidemic that began in Guinea and afflicted Liberia, Sierra Leone, and Nigeria [6, 7] through a Public Health in Reverse exercise to accepting the “scientific” disinformation that Africans eating bats brought this calamity on themselves.
PRESIDENTIAL CONFESSION OF PUBLIC HEALTH IN REVERSE GUILT
Two living American Presidents have confessed openly that some scientists from the USA behaved shamefully; their Conspiracy Facts regarding Third World Scientific Initiatives having been exposed. These confessions, accompanied by apologies from Presidents Bill Clinton  and Barack Obama  and broadcast world-wide were heard and discussed seriously by Ghanaians. Indeed, I said in the BMJ after President Obama’s apology over the disgraceful Guatemala syphilis study that such scientific misbehaviour places “International cooperative research in jeopardy” . When scientists apparently offering to help us as body guards of Ghana’s health, are deemed to be nothing less than assassins then we may as well say goodbye to international cooperative research. What Dr Christian Gericke considers to be “compassionate use of experimental drugs and vaccines”  is, through the hindsight of research intrigue, considered to be poison. The fact that Sophie Aries , writing last month in the BMJ on Ebola Vaccines, does not acknowledge anywhere that there are two kinds of scientists working in Third World countries when she mentions the word “scientists” in almost every paragraph of her detailed article shows she knows nothing about what Lord Ritchie-Calder said in Lancet, nor that she has ever read any of the compelling evidence available today that there are scientists with Nazi proclivities in our midst [3, 13, 14]. Didier Fassin and Helen Schneider said that much in the BMJ  which made me lament how difficult it was becoming to tell “the good White man who has come to help us” from the one intent on “Public Health in reverse” for population control .
SUPERB BRITISH TRAINING EQUIPS ONE TO DETECT BAD SCIENTISTS
Fortunately, many Ghanaians including those protesting today against Ebola Vaccine experimentation boast of their excellent teachers in the UK who equipped them to see through global health initiatives presented as “just the thing to help Africans”. If one health programme is unfit to be carried out in the UK, our superb teachers have taught us to reject it when suggested to us in Africa. For instance, my excellent training in London, Cambridge and Liverpool Universities equipped me to criticise the present Global Genome Sequencing being carried out ANONYMOUSLY [17, 18] as totally unacceptable to Africans  for the same reasons I gave in an invited contribution to a Symposium on Ethics of the Human Genome Diversity Project . I started the HGDP Symposium paper with this quote: “Equo ne credite, Teucri! Quidquid id est, timeo Danaos et dona ferentes” (Do not trust the horse, Trojans! Whatever it is, I fear the Greeks even when they bring gifts) , which can now be modified Ebola vaccine-wise to “Ebolae vaccinae ne credite, Ghanaiani! Timeo researcheros dona vaccinata ferentes” [19, 20].
“VACCINES FOR EBOLA DEVELOPED (AGAINST) BIOTERRORISM VIRUS”
Sophie Arie reported in the BMJ last month “Candidate treatments and vaccines for Ebola were developed only because the United States considered the virus a potential weapon for bioterrorism” , and she admitted the possibility that the trials may “result in harmful side effects and deaths” . This confirms much of what Leonard Horowitz already said . We Africans are scared that more viruses will “emerge” to cause epidemics. Sophie Arie tells how the Drug and Vaccine Firms are geared up to tackle more imminent “emerging” viruses . But does it surprise anyone that we Ghanaians are suspicious of the Vaccine Trials Scientists? With us, it all boils down to trust which, frankly, n’existe pas!
Competing Interest: I am Krobo Tribesman identifying with fellow Ghanaians in their fear of Lord Ritchie-Calder’s “scientists who devise man-made epidemics that lead to Public Health in reverse”. 
Felix I D Konotey-Ahulu MD(Lond) FRCP(Lond) DTMH(L’pool). Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street Ltd., Phoenix Hospital Group, London W1G 9AL Email: firstname.lastname@example.org
1 Anand JK. Ebola and Ethics. Are vaccine trials going on somewhere in Africa? BMJ Rapid Response June 1 2015 www.bmj.com/content/350/bmj.h2105/rr-4 (BMJ 2015; 350: h2105)
2 Coalition for Ghana’s Independence Now (CGIN). Stop “criminal” Ebola vaccines trial in Ghana! Starr FM-on-Line www.starrfmonline.com 103’5 FM May 30 2015 4.00 pm Broadcast & Communique.
3 Horowitz Leonard G. Emerging Viruses – AIDS & Ebola: Nature, Accident or Intentional. Tetrahedron Press 2014, Las Vegas, NV, USA.
4 The Lancet. Conspiracy Theories of HIV/AIDS, Lancet 2005; Vol 365 (Feb 5) p 448.
5 Lancet Annotations. The Biological Bomb. Lancet 1968 (March 20); Volume 1: p 465.
6 Igonoh Ada. “I survived Ebola Virus Disease”. Shared with Bella Naija http://bit.ly/1oPFf42 2014
7 Konotey-Ahulu FID. Dr Ameyo Adadevoh’s Assistant Dr Ada Igonoh survives Ebola Virus Disease. BMJ Rapid Response 10 February 2015 to Anne Gulland’s Obituary to Dr Ameyo Adadevoh http://dx.doi.org/10.1136/bmj.g7558
8 Clinton President WJ. Apology on br-Gaultehalf of the American Government to 8 survivors of the Tuskegee Syphilis Experiment victims. World-wide radio and televfision PBS NewsHour Newsreel Announcement (Jim Lehrer and Charlayne Hunter-Gault) May 16 1997 http://www.pbs.org/newshour/bb/health/may97/tuskegee_5-16.html
9 Tanne Janice Hopkins. President Obama apologises to Guatemala over 1940’ssyphilis study. BMJ 2010: 341.c5494 October 9, page 750.
10 Konotey-Ahulu FID. President Obama apologises over Guatemala syphilis study: International Cooperative Research in jeopardy. BMJ Rapid Response October 17 2010 [16 references] http://www.bmj.com/rapid-response/2011/11/03/president-obama-apologises-...
11 Gerricke CA. Ebola and Ethics: autopsy of a failure (Editorial). BMJ 2015; 350:h2105 http://dx.doi.org/10.1136/bmj.h2105 (23 April 2015)
12 Arie Sophie. Ebola: A game changer for vaccines, or a scare that will soon be forgotten? BMJ 2015; 350:h1938
13 Muller-Hill Benno. Murderous Science. Elimination by Scientific Selection of Jews, Gypsies, and Others – Germany 1933-1945 [Translated from German by GR Fraser] Oxford, Oxford University Press 1988.
14 Thairu Kihumbu. The African & AIDS Holocaust: An Historical and Medical Perspective. Nairobi, Kenya 2003. Phoenix Publisher Ltd., ISBN 9966 47 1847.
15 Fassin Didier, Schneider Helen. The Politics of AIDS in South Africa, beyond the controversies. BMJ 2003; 326: 495-497 (March 1)
16 Konotey-Ahulu FID. AIDS in South Africa: Wake-up call and need for paradigm shift. BMJ 2003 Rapid Response to Fassin & Schneider http://www.rethinking.org/bmj/response_30917.html
17 Wise Jacqui. Consortium hopes to sequence genome of 1000 volunteers. BMJ 2008; 336: 237 (2 February).
18 International Consortium http://1000genomes.org/files/100Genomes-NewsRelease.pdf Jan 22 2008 Announcement News Release: The 1000 Genomes Project – Major Sequencing Effort Will Produce Most Detailed Map of Human Genetic Variation to Support Disease Studies.
19 Konotey-Ahulu FID. Sequencing Genome of 1000 Volunteers: Why do this anonymously? African Journal of Health Sciences 2011; Volume 18: pp 37-52 (96 References) http://bit.ly/1CZRIAT or www.ajhsjournal.ro.ke/admin/current/914vpjkSBOS.pdf
20 Konotey-Ahulu FID. Human Genome Diversity Project (HGDP): Cogitations of An African Native. Politics and The Life Sciences (PLS) 1999, Vol 18, No 2, pp317-322. [Invited Commentary on Professor David Resnik’s article: The Human Genome Diversity Project – Ethical Problems and Solutions. PMID: 12561789 – PubMed Indexed for MEDLINE]
Competing interests: Competing Interest: I am Krobo Tribesman identifying with fellow Ghanaians in their fear of Lord Ritchie-Calder’s “scientists who devise man-made epidemics that lead to Public Health in reverse”. 
Gericke has overlooked two other " failures".
1. Reportage of vaccine trials in West Africa.
Are vaccine trials going on Somewhere in Africa? If so, where? If so, are UK based vaccine manufacturers supplying the vaccine? If so, are our Exchequer Funds being used? Are UK based academics participating in the above?
2. Have any of the UK based Research Ethics Committees considered, approved, rejected or postponed decisions on applications for such trials?
I have assumed that no national security considerations have inhibited reporting by journalists.
Competing interests: No competing interests
Gericke1 has identified an important problem that plagues the healthcare system globally. The response to public health crises has always been a last minute effort to mitigate it. Looking at history we may find several examples for both communicable and non communicable diseases. The case of the Ebola outbreak and the delayed response to the public health crisis due to the outbreak is one such instance of inadequate preparedness. Often, the public health response to outbreak of diseases shall be based on pragmatic approach – anticipating the worst and preparing for the best response. This is missing due focus on short term outcomes than long term goals. Long term solutions are lost in myriad public health issues that are dealt at national and international level. The problem is national and international priorities in dealing with public health challenges are different. However, an important thing for us humans is to learn from past mistakes and ensure they are not repeated.
This is not the case as far as the Ebola outbreak is concerned. The first outbreak of Ebola occurred in 1976 2, almost forty years back and we did not learn from the past. In the case of viruses, they have learnt from the past and adapted. This is true even in the case of H1N1 and H5N1 viral outbreaks. Governments and agencies were unprepared for both these outbreaks. While we tried to find a treatment for one strain of virus, it mutated and adapted, and the world had to tackle another strain of virus. In the case of Ebola, five different species exist, which are Zaire ebolavirus (EBOV), Bundibugyo ebolavirus (BDBV), Reston ebolavirus (RESTV), Sudan ebolavirus (SUDV) and Tai Forest ebolavirus (TAFV). Other than RESTV, all the four subspecies have been reported to cause disease in humans.3 Hence, the danger still persists. If the outbreak is contained in the short run, there is still the risk of one of the species of Ebola virus spreading infection and leading to an outbreak, unless public health system is deployed for longer term solutions, which include prevention of such outbreaks.
Only when persons suspected of having been infected with Ebola are quarantined and strict isolation procedure is followed can transmission or spread of infection be controlled. In order to do so, the World Health Organization (WHO) has to take a mentorship role and ensure that national governments are ready to tackle any such outbreak of disease. Further, the media plays an important role. A responsible media should reach out to wider audience and provide them with factual information on preventing or contracting disease through required precautionary measures. Equally important for the media is not to spread panic among the masses that might lead to miscommunication and aggravate the situation.
Rapid response in containing disease outbreak is in the interest of everyone. If responses to an epidemic are deployed early, many lives would be saved, governments would save money and public health systems will be strengthened.
1. Gericke CA. Ebola and ethics: autopsy of a failure. BMJ 2015;350:h2105
2. Parikh F and Shah S. Ebola Virus Disease: Are we prepared? Journal of the Association of Physicians of India 2014; 62: 784-6.
3. Naresh Kumar CVM and Sai Gopal DVR. Possible risk of Ebola outbreak in India: how well are we prepared? Current Science 2014; 107(6): 937.
Competing interests: No competing interests
I beg to differ with the author of this editorial.
There seem to be a misunderstanding here. Because there was no vaccine, the health workers in the front line were desperate for an effective response; therefore the focus on specific treatments was highly appropriate. If an effective treatment had been found, people would have seen hospitals as places to go to get cured rather than places to go to die. This would have brought cases out of their houses and into isolation, and had a definite slowing effect on the epidemic.
Regarding the USD 100m (£67m; €93m) contingency fund proposed after the 2009 flu epidemic to allow rapid responses to future pandemic threats, it was not followed up for lack of contributions. The United Nations had an available balance of USD 20m, after prior commitments, in its USD 40m contingency fund approved for 2014-2015 (1), with the possibility of adding more; but even if USD 100m had been available, expenditure on the epidemic soon outran that amount. If it was not possible to raise USD 100m for H1N1 influenza, with its far greater risk of global spread and mortality, the chances of raising a multiple of that sum for a future outbreak of Ebola – or the next unforeseen outbreak – seem remote.
To claim “If only a fraction of the World Bank estimate had been spent on health system preparedness before the current epidemic“ ignores the realities that health services are almost always at the bottom of budget priorities in under-developed countries (along with education). There cannot be any long-term improvement in basic health services if countries are not willing or able to budget for attractive salaries and conditions of service for health workers (to prevent brain drain) and for maintenance of the modern facilities that have been donated to them. By the 1990s, international aid donors such as FINNIDA had already recognised that Mozambique was structurally unable to provide adequate primary health care, and that it would take two or three decades before it could sustain health systems at the basic level, even after massive rebuilding of health centres destroyed by civil war. (2)* The health systems of the three West African countries concerned were not as advanced as that of Mozambique, even before the Ebola epidemic started.
Regrettably, as has been seen during this epidemic, much international health aid has never reached the grass-roots level of the health services of those countries, disappearing unaccounted for en route, as revealed by recent audits. (3,4,5) Finally, no government does anything about improving health services until there is an emergency, when it is already too late. Apparently, the dictum “an ounce of prevention is worth a pound of cure” is not taken seriously.
*The author visited Mozambique on a WHO mission to evaluate the FINNIDA project. He is now Visiting Professor, Centre for Health Sciences, Federal University of Rio de Janeiro, Brazil (retired).
(1) United Nations (2013) Proposed programme budget for the biennium 2014-2015: Special Subjects and Programme Budget Implications. Contingency fund: consolidated statement of programme budget implications and revised estimates
(2) Lubkemann SC (2001) Rebuilding local capacities in Mozambique. In Ian Smillie, Patronage Or Partnership: Local Capacity Building in Humanitarian Crises, IDRC, 2001.
(3) AFP (Yahoo News) (2015) Sierra Leone loses track of $3.3m in Ebola funds: auditor
(4) Audit Service Sierra Leone (2015) Report on the audit of the Management of the Ebola Funds
(5) AP (Star Tribune) (2015) Liberia audit report questions how government spent $673,000 in fight against Ebola.
Competing interests: No competing interests
Most viral infections are self limiting. In people infected with Ebola, supportive and symptomatic treatment shows good results in recent epidemic in countries like the USA. A cost effective and properly designed study with minimum side effects in patients who are bleeding like people infected with the Ebola virus is the need of the hour.
Competing interests: No competing interests
Beginning from the first recognized Ebola outbreaks in 1976, it has been clear that health facilities with weak infection control procedures amplify outbreaks -- infecting health staff and patients. The outstanding ethical failure in the ongoing outbreak -- a joint failure by WHO, CDC, ministries of health, and NGOs responding to the outbreak -- has been not warning the public that attending a health facility may be a risk to contract Ebola. WHO and others responding to the outbreak have not recognized and reported patients who likely acquired Ebola in during health care -- this is in sharp contract to WHO's weekly reports of health staff infected. Silence about patients' risks runs afoul of the World Medical Association's Declaration of Lisbon on the Rights of the Patient, including: "Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services."
Competing interests: No competing interests
On Monday (27 April 2015) the BMA's Public Health Medicine Committee will be debating a motion which proposes that airport "screening" introduced by the UK government is of little or no value, and therefore that the the diversion of public health resources into this activity is unethical and should be stopped.
See http://bma.org.uk/events/2015/april/public-health-medicine-conference for details of the conference.
Competing interests: No competing interests