'This outbreak is so unpredictable; we don’t know when it will end, we don’t know if new areas could be affected, we don’t know if there will be new outbreaks — vaccines and treatments then are crucial for curbing this epidemic and ensuring that future outbreaks are prevented or controlled.'
Following a high level meeting on access and funding for Ebola vaccines convened yesterday by World Health Organization (WHO), Médecins Sans Frontières/Doctors Without Borders (MSF) has urged that plans to get forthcoming Ebola vaccines and treatments to frontline workers must be rapidly implemented. Significant investment and incentives are needed now to accelerate these steps.
“The message we heard from WHO that the people fighting the epidemic will be among the first to test Ebola vaccines and treatments is exactly the one we needed to hear”, said Dr. Bertrand Draguez, Medical Director for MSF. “Now urgent action is needed to get those promises delivered in West Africa as soon as possible. This needs to be followed by massive roll out of vaccines to the general population once their efficacy is proven.”
The safety of front-line responders is crucial
“It is crucial that people from Ministries of Health, aid agencies and communities who are holding the response to the epidemic together, and ensuring access to essential healthcare, are protected”, Dr. Draguez added. “Resources everywhere are stretched to almost breaking point; everyone is at capacity, but it is extremely hard for the people treating and sustaining the response to do it with absolutely no safety net. Safe and effective treatments and vaccines could offer just that.”
Staff members who should be prioritized to test the vaccines include healthcare workers, community workers and people who support the Ebola response such as hygiene personnel, ambulance drivers, health promoters, contact tracers and people in charge of funerals. Medical staff providing care for other diseases than Ebola should also be prioritised to receive test vaccines.
New treatments urgently needed
While the focus of the WHO meeting was on Ebola vaccines, new treatments and diagnostics for the disease are also urgently needed to allow people treating the epidemic to do their jobs effectively and efficiently.“
The rapid development and deployment of safe and effective experimental treatments is also critical”, said Dr. Draguez. “Today, doctors and nurses involved in the struggle against Ebola are getting more and more frustrated as they have no treatment for patients with a disease that kills up to 80 per cent of them.”
The increased survival rate that treatments could bring can may also reduce the number of new infections as more people seek help. Meanwhile, safer and faster diagnostic tools will enable the rapid screening of patients for better and safer management of patients who need urgent, sometimes lifesaving, care for other diseases.
Effective decision-making required
The meeting at WHO in Geneva, which was chaired by WHO Director General Dr. Margaret Chan, brought together high-level representatives from government, industry, donors and medical responders and researchers. Topics covered included trial design and implementation, regulatory pathways, and financing and incentives for new vaccines. MSF, which was present at the meeting, has this week discharged its 1,000th patient to have survived the disease since the organization first responded to the outbreak affecting West Africa in March 2014. MSF representatives deplored the lack of concrete decisions that were made during the meeting, and warned delegates they would not be let off the hook from their responsibilities. While past promises of resources on the ground are slow to be fulfilled — and are urgently needed to be delivered — the need for vaccines and treatments that could prove the tipping point in this outbreak, and prevent future ones, is now critical.
“This outbreak is so unpredictable; we don’t know when it will end, we don’t know if new areas could be affected, we don’t know if there will be new outbreaks — vaccines and treatments then are crucial for curbing this epidemic and ensuring that future outbreaks are prevented or controlled”, said Dr. Manica Balasegaram, executive director of MSF’s Access Campaign. “We need governments and industry to play a key role; industry needs to take risks, but governments need to help incentivize and minimise these.”
More investment and incentives to develop treatments is essential
Large-scale investment in all front-running vaccines, drugs and diagnostics is vital, and sufficient resources for clinical trials and post-trial access need to be mobilized by donors now. The scientific data generated for each product under clinical trials should be published in real time, and a pooled bank of samples should be established to facilitate open research. But the lack of approved Ebola products to this point highlights a key issue that must be urgently addressed: the lack of sufficient investment and incentives to develop them.
“Appropriate incentives that give industry a reason to develop these vital tools for Ebola are needed now — government and donors must line up to help here”, Dr. Balasegaram said. “We need researchers and developers to conduct clinical trials in parallel with scaling up production supply, which we know has its inherent risks. Governments and donors must help incentivise this risk, and the path to regulation in getting approved, safe and effective vaccines and treatments on the ground in West Africa needs to be a smooth one.”