Researchers have made astonishing progress in developing a drug that combats Ebola that has been seen as disease that carried an immediate death sentence. What is amazing is that the drug was put through clinical trials under extremely difficult circumstances because the disease causes widespread panic since it is so highly contagious and lethal.
Two Ebola drugs have proven so effective in a clinical trial that researchers will make the treatments available to anyone infected with the virus in the Democratic Republic of the Congo (DRC), where Ebola has killed nearly 1,900 people over the past year.
The survival rate for people who received either drug shortly after infection, when levels of the virus in their blood were low, was 90%.
“It’s really good news,” says Sabue Mulangu, an infectious-disease researcher at the National Institute for Biomedical Research (INRB) in Kinshasa in the DRC, and an investigator on the trial. “Now we will be able to stress to people that more than 90% of people survive if they come into the [Ebola treatment unit] early and get this treatment.”
“I’m in awe about what seemed to be an impossible clinical trial to run,” says Sumathi Sivapalasingam, a senior director at Regeneron. “The team did this in such a complex emergency and still, the data quality is exceptional.”
The benefits of this drug are enormous, not least because it will also help to protect those health workers who run great risks in treating the infected.
It is a true shame that these past two major Ebola outbreaks happened at all. A really promising vaccine (rVSV-ZEBOV) which had completed animal trials in 2009, and was licensed to NewLink Genetics in 2010, sat on the shelf in Winnipeg (where it was developed at the Canadian National Microbiology Laboratory, a Biosafety Level 4 facility) for 5 years until the West African Ebola epidemic was killing thousands of people. NewLink had agreed to start Phase I human trials (the process that determines both effective dose, AND human safety at various doses) when they signed the licensing agreement with the Public Health Agency of Canada (and paid a few hundred grand for the privilege), but they delayed until thousands of West Africans were already dead.* Then, and ONLY then, did they start the Phase I trial, and subsequently re-licensed the vaccine to Merck for $50 million. Merck went on to conduct Phase II and III trials, and given that the vaccine worked well, and had a safe dose that provided nearly perfect protection against the disease, they produced hundreds of thousands of vaccine doses which are now being given to people in the DRC who have either already come in contact with Ebola patients, or who are medical/NGO staff working in the Ebola hot zone.
Further research has demonstrated that the rVSV-ZEBOV vaccine provides 97.5% protection against Ebola compared to people who have not been vaccinated. If the process of human testing had commenced in 2010 or 2011, the drug would have been ready for fast-tracked Phase II trials in late 2013 when the epidemic started in Guinea. Efficacy could have been demonstrated in as little as a few months, and mass production of vaccine could have commenced in early 2014. Thus, the very worst of the West African Ebola crisis could have been averted if only pharmaceutical companies cared as much about African lives as they do about North American lives.
ZMapp and the other drugs (as discussed in the Nature article) that have been created to fight Ebola Zaire once people already have it, are extremely useful tools in the fight against the disease. However, the focus really should be on getting this vaccine out there, into the bloodstream of every African living in Ebola prone areas. Then any future outbreaks can be limited in scope, freeing doctors and researchers to fight against the next highly dangerous pathogen to emerge from the rainforest (or, more likely, the melting permafrost). Ideally, the DRC Ebola outbreak will be the last major crisis involving this terrible virus; there will probably be flare-ups in places where vaccination is not widespread since there have been no documented cases of the virus in these locations, but with the various tools that now exist to fight this disease, death tolls can be kept small…IF the medical response is fast enough…IF the people who make the vaccines and drugs are doing their jobs properly. Fingers crossed….