On Friday, the World Health Organization formally declared an international public health emergency in response to what its director general, Dr. Margaret Chan, called “the largest, most severe, most complex outbreak” of the deadly Ebola virus “in the nearly four-decade history of the disease.” And what has the world done in those 40 years to defend against the disease? Not much. Apart from inflicting a staggering human toll, the spread of the Ebola virus in West Africa has laid bare how unprepared the United States and other advanced countries are to protect and treat thousands of Africans whose lives are threatened by an extremely dangerous virus for which there is no cure.
The W.H.O. reported that Ebola has infected about 1,800 people in four West African countries and killed almost 1,000 of them. The drugs that could potentially treat those already infected and the vaccines to protect healthy people from infection are all in the earliest stages of testing. And even if they do pass muster in clinical trials, they cannot be produced in large quantities quickly enough to stem the widening epidemic anytime soon.
These uncertainties were highlighted by the special treatment given to an American doctor and an American aid worker who were infected while caring for patients in Liberia and treated there with a drug that has worked well in monkeys but never been tested in humans. They were flown back to Atlanta to receive the best care possible in an isolation ward at Emory University Hospital. There were exuberant media reports that they had been saved by the drug and demands from Liberia that the drug be made available to African patients. Yet at this point no one knows whether the drug played any role in helping the two Americans, only that it didn’t kill them.
In any case, very little of the drug is available, and the small company that makes it does not have the capacity to produce large quantities to treat large numbers of patients in the field. Another drug candidate is in clinical trials with a small number of patients, but the trials were recently suspended and then partially reinstated because of fears that it could harm the patients. Meanwhile, a clinical trial of the first potential vaccine is being expedited, but it will be months before its safety can be verified and the vaccine made available for humans.
As the Centers for Disease Control and Prevention put it: “We do not know how to treat Ebola or vaccinate against it — and it will be a long time before we do.”
Many drug companies have little interest in devising treatments or vaccines for Ebola because the potential for profit is small. Much of the research has been financed by the National Institutes of Health and the Department of Defense and carried out by small start-ups, but some experts believe the federal government has not shown enough urgency to push these programs ahead.
Traditional public health measures, like finding and isolating patients who become sick, tracing their contacts and using stringent infection control procedures in hospitals, remain the best bet for containing the epidemic in West Africa.
The C.D.C. has elevated its response to the highest possible level and is sending 50 more health care professionals to the area, backed by hundreds more professionals in this country. Sierra Leone, which has the highest number of cases, is planning to deploy hundreds of troops and police officers to enforce isolation measures that its residents have so far ignored, and Liberia, with the second largest number, has declared a 90-day state of emergency that allows it to suspend civil liberties and impose quarantines. Nigeria has also declared a state of emergency. Such public health measures should ultimately, although perhaps not quickly, bring the outbreaks under control.
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