In unity there is strength
Ebola tested our international and national responses to an epidemic crisis. On the international side, the uncoordinated and slow response to the Ebola outbreak in West Africa was stunning. We didn’t have unity or strength of effort for far too long. Misconceptions abounded about what the WHO could do or should do. The US – with the CDC, USAID and DOD each making substantial contributions – played a major leadership role in the early fall and other countries have also made major commitments in people or money. Things remain serious, but there are signs of progress. When this outbreak is contained and there is time for reflection and re-examination of international strategy and coordination, we should consider and plan for the kind of infectious disease rapid response effort – replete with doctors, nurses, labs, scientists, epidemiologists, etc – that could have made a difference.
On the domestic front, there was comparatively more unity and strength. Of course, the response has not been perfect. Communication has not always been completely clear. There were technical problems and clinical guidance issues that would have been better worked out ahead of time. There was serious political division for a time. And there were challenges in conveying information between the federal agencies and states and locals. But overall, a response to a new epidemic is never perfect, and as always, the country learns as it goes. What we can say is that, as of Dec 26, 2014, there is much to be commended in the results of the efforts overall. We’ve had only two cases of Ebola arrive unannounced to the US. We have had two health care workers get ill, both of whom took care of the very first patient, and both of whom have fully recovered. All but two Ebola patients cared for in the US have survived. The two that died were fairly sick by the time they were receiving intensive medical care. No members of the public have become ill. The reasons for this level of success are many but include: a CDC that has been working around the clock since summer time; a public health workforce that has managed hundreds if not thousands of returning West African travelers in its databases checking daily for fevers; a network of laboratories that can diagnose the disease; a health care workforce that has become educated about the illness; and, many dozens of hospitals comprehensively preparing themselves for the possibility of an Ebola patient (with the technical help of ASPR and CDC). This is the kind of effort we needed, and it is the kind of effort we will need for future infectious disease crises. When Ebola is contained, we need to build in the strengths and lessons found in the last six months.
Necessity is the mother of invention
Basic science discoveries have created a foundation of scientific knowledge about Ebola, and a number of small and large biopharma companies have made major efforts this past year to develop new vaccines and therapies. US government efforts have been providing a lot of the fuel along the way. There is no way that multiple Ebola vaccine trials would be underway now if Ebola had not been receiving research funding because of its place on the US government biological threat list. NIH and DTRA had been funding Ebola research over the years, and that research head start made it possible to move things rapidly into trials this fall and winter. A second critical part of the Ebola vaccine and therapeutic story is that FDA program helping to drive this – the FDA Medical Countermeasures Initiative - has moved with unprecedented speed to facilitate the regulatory process for these new products. A third crucial component has been the work of BARDA to fund the advanced development work that has been needed. BARDA was initially created to respond to deliberate biological threats. It then took on the pandemic flu mission. It continues to pursue both of those missions. But BARDA has also shown in the last six months that it is crucial component of the rapid vaccine and medicine development process for new outbreaks. In addition, it has also shown in this past year (and the year prior) that it has a unique role in helping develop new therapies to treat antimicrobial infections. Now that BARDA has passed a pilot test for emerging infections and AMR, it is time to give it a resources and structure to pursue those issues in a deliberate, strategic way, alongside its mission of biological threats and pandemic flu.
The hero is brave in deeds as well as in words
The Ebola fighters were justifiably named People Magazine’s “Person of the Year”. What they collectively have done in West Africa, with great risks to themselves, is extraordinary. And it is the reason that there is now an increasing chance that the Ebola outbreak could come under control. We can’t all be Ebola fighters. But we can all be supporters of Ebola fighters by supporting individual organizations like Medecins San Frontieres, or International Medical Corp or the International Rescue Committee; or by letting political representatives know how important it is to build health security internationally and domestically; or by volunteering in our own communities to help strengthen preparedness via efforts like the Medical Reserve Corps. We need to work to make ourselves better prepared to deal with the health security threats that the years ahead will bring.