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Did it have to take Ebola …?

The outbreak of Ebola is now receiving the attention that it needs. The death of Thomas Eric Duncan, the first Ebola patient to die from the disease on US soil is a wakeup call. The first Ebola patient to die from the disease in Europe (Spain) is likewise a wakeup call.

For months Ebola was regarded by governments around the world as an African disease.  The attention given to it has been abysmal as a result. Ebola certainly didn’t seem like a disease that would disrupt the lives of people in developed and comparatively wealthy countries. The rate of infection of Ebola is doubling in the affected African countries every 2 to 4 weeks. This now presents real danger to whole communities beyond the borders of Africa because of global air travel and speed with which a contagious disease could spread as a result. This would obviously have an impact on the global economy. Clearly real action must now be taken to contain the epidemic at its source.

How should patients be treated and managed who have the disease? The disease appears to require expert use of aseptic technique for all those involved with the treatment of patients in Africa and elsewhere. The problem is that very few people are truly trained in the use and application of aseptic technique. The Spanish nurse that contracted Ebola after nursing the patient in Spain, has now recalled that she touched her face with a soiled glove.  The truth of the matter is that even taking off the soiled suit presents real challenges, and is likely to result in the carer’s skin coming into contact with the soiled parts of the body-suit unless extreme precautions are taken. This means that patients must be treated in specially designed facilities like the one at the Royal Free Hospital, in London, United Kingdom, and Emory Hospital in Atlanta, USA, unless many other people including nurses and doctors treating them are to be infected.

What action can be taken to stem the crisis at its source? Western governments often want to throw money at the problems in the developing world. The interesting thing is that if one follows the trail of the money spent in developing countries, it most often ends up being spent back in the donor country, or benefiting the donor country in some way. Anyone that has watched the news about Ebola has seen the “hospitals” in Sierra Leone and the other parts of Africa devastated by Ebola. The primitive state of the facilities is a disgrace. How can anyone be surprised that Ebola has spread under these types of conditions? This begs the question, will the millions of USD now promised for the Ebola outbreak lead to the construction of specialist hospitals that are properly equipped to address these types of epidemics in the future? Will the infrastructure be put in place to address the many tropical and other diseases that these countries are ill equipped to address?  Will staff in these specially constructed hospitals be given the training that is needed to care for the patients with Ebola and other infectious diseases? Without the specialist training, this crisis is only going to get worse. How can we spend 600 million USD in the few weeks that are available without wasting the funds and leaving the countries in the same condition they are currently in healthcare-wise?  Certainly the building of basic and functional toilet facilities  and availability of clean water would help to ensure the most basic of hygiene standards are addressed for those who live in rural areas. Cultural and lifestyle issues that support the spread of the disease must also be addressed through education perhaps using properly designed social media campaigns.

We cannot look at needed solutions without looking at the regulatory system for assessment of new treatments. The experimental drug ZMapp produced by MAPP Pharmaceuticals (San Diego) has been made available to some of the patients who have Ebola in the US, Africa and Europe. Some of the patients who received the drug have recovered, and are alive today. The drug remains unlicensed for commercialization. One certainly hopes that the company is collecting as much information as possible about the conditions of compassionate use to support licensure. In the case of ZMapp, the US regulatory system allowed itself to be bypassed because of the crisis situation.  It will be interesting to see how the FDA and EMA will respond to this situation now that several other experimental treatments are in development for Ebola. Will the regulatory review system be suspended so that these treatments can be approved and made commercially available at profit for the companies that have developed them? The Animal Rule is in place to allow the commercialization of treatments tested in animals where it is unethical or too dangerous to test the treatments in patients.  Treatments like ZMapp may qualify under the Animal Rule for ethical reasons.  For example, African patients with Ebola may be induced to be dosed with an unlicensed experimental drug even though it is unlicensed, but is this ethical? These are interesting but important questions that need to be addressed.

It is tragic that it took Ebola for everyone to begin to look at the tragic state of affairs of healthcare delivery for millions of people in Africa.

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