Research has made considerable progress but the world is not yet ready to face another epidemics, says World Health Organisation’s former director general, Peter Piot.
Fourty years after the first ebola outbreak, occurred at Yambuku in the Eastern Province of the Democratic Republic of Congo (DRC), 250 researchers and health specialists assessed the situation during an international conference organised in Antwerp by the Institute of Tropical Medecine (ITM), from the 12 to the 15 September.
Important progress has been made in the area of research, concluded the participants. “We have now faster and more sensitive diagnosis, new treatments and vaccines (…) We have now the tools to fight the virus”, says the conference organizer, Dr Kevin Ariën. “This gives hope” admits the World Health Organisation’s former director general, Peter Piot now teacher at the London School of Hygiene and Tropical Medicine. Dr Piot also hailed the performance accomplished in 2014 by the DRC which managed to stop a seventh epidemics in the Boende area in the province of Équateur. Accordingly, this shows the combination of local diagnosis and political leadership, can produce results, owing to measures of health control based on a community approach.
Out of necessity, because of its magnitude, the recent epidemics in Western Africa which caused 11,310 death on a total of 28,616 cases, gave a huge boost to research. While in normal circumstances, there isn’t a commercial market for the pharmaceutical industry to set up vaccines against Ebola, there were a number of therapeutic trial. There have been trials, namely in Guinea-Conakry, to which the London School of Hygiene and Tropical Medicine participated says Piot, and they showed that the vaccine which was administered to patients who had been exposed to the ebola virus, was 100 percent effective according to the WHO and Médecins sans frontières (MSF). Another vaccine which was developed by Glaxo Smithkline has also proven effective according to Dr Ariën. Peter Piot also considers that third vaccine developed by Janssen, which is administered as a prevention, could be used to protect the medical staff.
Another reason for hope, according to the former WHO director is the creation in early September of the Coalition for Epidemics Preparedness Innovations (CEPI) which is supported by the Bill & Melinda Gates Foundation, Norway and India to stimulate the development of vaccines against diseases like Ebola. Dr Piot is pleased by the awareness which makes that today, the issue is now addressed at the G20 level or at the United Nations Security Council.
Yet, many challenges remain. The danger of a new epidemics is not ruled out. One of the reasons is that Ebola’s reservoir has not been formally identified. Even if the virus was isolated 40 years ago, since then, no living virus has been isolated in an animal, explains Dr Piot. There are good reasons to think that bats are the reservoir but there might be other ones. The Congolese doctor, Jean-Jacques Muyembe, another pioneer of the struggle against Ebola, mentions the case of the Cephalopus Dorsalis antelope, which is suspected to have been the reservoir of the outbreak which occurred in Ekata (Gabon) in 2001. Peter Piot considers that identification must be a priority for research, not to eliminate animals but to find out wich are the most exposed populations, because once the species which carries the virus has been identified, it becomes then easier to improve the knowledge about its distribution in Africa in order to take the appropriate measures to protect the populations. Accordingly, one has to take also into account that in the current circumstances, the demographic growth is exerting an increasing pressure on the natural habitat of the animals. “Should we ban consumption of bushmeat ? Should we ban hunting activities ?” asks Dr Muyembe. But does it make sense ? Is it feasible, the debate goes on. To Dr Peter Piot also warns against excessive optimism about the capacity of humanity to address the challenge. “I do not think we are in a very good situation to fight a new Ebola outbreak” he says. Indeed, recommendations which arise from the lessons of the epidemics in Western Africa, take a lot of time to be taken in consideration, he deplores. These recommendations include the strengthening of public health and surveillance systems, as well as the creation of the laboratories in the most vulnerable countries .
There has been lots of promises but it takes time for them to materialize, he notices. In 2001, reminds Dr Piot, African states committed to allocated 15% of their national budget to health. But only five or six honour this commitment, he observes. Yet, means make the difference: whereas in Africa, according to MSF, the mortality rate of people infected by Ebola varies between 25 % an 90%, – owing namely to collateral mortality such as the unability of public services to cope with other challenges – in Europe, the proportion is only 10 % among infected patients who were repatriated to Europe or United States who could benefit from the care of 10 to 15 medical doctors each.
The WHO’s Emergy Operations Director, Richard Brennan, stresses the challenge that is posed by the simultaneity of humanitarian crisis, which may complicate the mobilisation against a new epidemics. Other epidemics can indeed happen at the same time, such as polio in Syria or cholera in Haiti, as that was the case during the great Ebola epidemics of 2014. Today, several new humanitarian emergencies are developing in Somalia, in South Sudan and around Lake Chad. Climate change, environment degradation, urbanization, political fragility and terrorism are all “drivers of risk”, says Richard Brennan who seeks to raise awareness about the “increasing convergence of humanitarian and health security issues”. In Antwerp, debates also focussed on the strengthening of coordination and organisation of services and institutions. WHO’s which brought its Health Security and Humanitarian Departments under a single leadership is showing the way. (F.M.)