Joseph Varriale, M.S.
Ph.D. Student in Pharmacology and Molecular Sciences Johns Hopkins School of Medicine
Just one week after the health ministry in the Congo announced that a deadly Ebola virus outbreak had ended in Kinshasa, the capital of the Democratic Republic of the Congo (DRC), health officials reported new cases in North Kivu Province, across the country on the eastern border with Uganda on August 1st. This event marks the tenth outbreak of Ebola in the country’s history, and the first in North Kivu province, according to the World Health Organization (WHO) . Potential consequences of this outbreak exacerbate the ongoing armed conflict in Kivu province. Geographical implications are also a concern for officials of the WHO, who cite displacement of Congolese refugees to neighboring Uganda and humanitarian crisis as potential risk factors for widespread, multi-national transmission .
Epidemics in the DRC over the past ten years have been more frequent, but less deadly, compared to the previous outbreaks from 1976 to 2007 . Each new exposure brings a substantial economic and public health burden that continues to stunt the growth of developing nations. So how can we as a modern, global community work to prevent and contain Ebolavirus exposures in an age of rapid innovation in medical science? Global health organizations, pharmaceutical industry titans, and thought leaders in the field have a distinct role as stewards of health science. With any luck, this same innovation and expertise can be applied to resolving 2020’s outbreak of COVID-19 ravaging Earth’s populations and damaging its businesses – for which they can, at least, apply for coronavirus loans to help cope with the problem. In some senses, the outbreak of diseases like ebola and the COVID-19 pandemic has, inevitably, created more stress on the healthcare industry and led to new innovation that is vital for situations like these. Most recently, Butterfly Network have created a portable ultrasound; a simple handheld device that can connect your medical images to your phone. Along with this, healthcare professionals can talk remotely with their patients on a video call to assess their images and make the essential decision on whether hospitalization is needed or not. This will greatly reduce the pressure on healthcare industries, as well as lower the mounting costs that medical practices have.
In the circumstance of the most recent outbreak, which has seen a rising toll of 69 confirmed cases and 28 confirmed deaths as of August 19th, frontlines health organizations including the WHO and Doctors Without Borders have been deployed to make sense of the surveillance data and provide initial care to those impacted . The effort by the branch of the WHO known as the Strategic Advisory Group of Experts on Immunization (SAGE) sent down a recommendation to allow for a vaccine administered to specific at-risk populations during the outbreak that began earlier this year . Today, the vaccine is mostly being administered to healthcare workers in the region, as vaccination of the general population in a conflict zone is difficult and dangerous.
The vaccine, originally developed by scientists at the National Microbiology Laboratory in Winnipeg, Manitoba, Canada, is commonly referred to as rVSV-ZEBOV. The immunization underwent a Phase III clinical trial in 2016 that met with some criticism . Although the vaccine is neither the FDA or the EMA approved, its classification as an approved experimental therapeutic may contribute to a reduction in the spread of the virus. This innovative, nuanced regulatory decision echoes from other famous cases of patient advocacy driving pre-approval interventions.
The group behind the manufacture and regulatory filing of the vaccine is pharmaceutical giant Merck. This situation allows us to consider the role of “Big Pharma” in global health crises. Without large-scale manufacturing innovation in the viral vector landscape, we may have been devoid of some hope for the protection of healthcare workers who risk their lives to help the community in West Africa. This scenario brings to light other innovations that seek to improve the public health outcomes of endemic countries through vaccination.
One such innovation is the strategy employed to help contain the Ebola virus outbreak that occurred earlier this year in Kinshasa. This strategy referred to as “ring vaccination” seeks to identify those that are likely infected and vaccinate the people that interact with the infected persons, much like how wildfire is contained by creating a backfire; to reduce fuel that promotes spreading . The geopolitical complexities of North Kivu hinder the ability of aid workers to vaccinate a significant proportion of the general population in the region. Another extenuating factor is the lack of cold-chain technology to allow for delivery of this vaccine to remote locations. This impediment is undoubtedly on the mind of thought leader and philanthropist, Bill Gates. Mr. Gates wrote a piece on his blog, Gates Notes, in June of this year, which describes pioneering devices that would allow vaccinators to reach these remote locations with intact vaccine products.
One such method is a handheld cooling system called the Indigo, which can keep vaccines at an optimal temperature for up to 5 days without battery or electrical power. This device is in the field trial phase, but according to Mr. Gates, the method could allow vaccinators to reach “four times as many places as they could with the old ice-based coolers” . In the face of adversity brought about by the Ebola virus, it is essential to consider the many innovations that may reshape health science and bring about a safer future.
1. World Health Organization. Ebola virus disease. Who. Int Website. http://www.who.int/ebola/historical-outbreaks-drc/en/. Updated 2018.
2. World Health Organization. Ebola virus disease external situation report 1. who. Int Web site. http://apps.who.int/iris/bitstream/handle/10665/273640/SITREP_EVD_DRC_20180807-eng.pdf?utm_source=Newsweaver&utm_medium=email&utm_term=click+here+to+download+the+complete+situation+report&utm_content=Tag%3AAFRO%2FWHE%2FHIM+Outbreaks+Weekly&utm_campaign=WHO+AFRO+-+Situation+Report+-+Ebola+Virus+Disease+Outbreak+in+DRC+-+Declaration+of+End+of+Outbreak. Updated 2018.
3. World Health Organization. Ebola virus disease external situation report 2. who. Int Web site. http://apps.who.int/iris/bitstream/handle/10665/273867/SITREP_EVD_DRC_20180814-eng.pdf?ua=1. Updated 2018.
4. World Health Organization. Ebola vaccines. World Health Organization. The Weekly Epidemiological Record:313-315.
5. Metzger WG, Vivas-Martínez S. Questionable efficacy of the rVSV-ZEBOV ebola vaccine. The Lancet. 2018;391(10125):1021. https://www.sciencedirect.com/science/article/pii/S0140673618305609. doi: 10.1016/S0140-6736(18)30560-9.
6. Henao-Restrepo, Ana Maria… Marie-Paule, Ph.D. Efficacy and effectiveness of a rVSV-vectored vaccine in preventing Ebola virus disease: Final results from the guinea ring vaccination, open-label, cluster-randomized trial (ebola ça suffit!). Lancet, The. 2016;389(10068):505-518. https://www.clinicalkey.es/playcontent/1-s2.0-S0140673616326216. doi: 10.1016/S0140-6736(16)32621-6.
7. Gates B. The big chill. gatesnotes.com Web site. https://www.gatesnotes.com/Health/The-big-chill. Updated 2018.
8. Photo Courtesy: https://www.herald.co.zw/health-officials-worried-about-containing-latest-ebola-outbreak/