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Last week marked an extraordinary advance in global health security: clinical trials of drugs on Ebola, one of the most deadly known human pathogens, in the east of the Democratic Republic of Congo (DRC), have recorded a survival rate of 90% in patients epidemics have made 90% of the victims.
The whilean experimental vaccine is used to protect people against the attack of the Ebola virus. This is the first effective treatment for people infected with haemorrhagic fever.
Never before has a drug been developed and administered during a persistent epidemic, surpassing what could be a decade of waiting through neglected disease regulators , which some call the valley of pharmaceutical death.
"This is the first time that a randomized controlled trial has shown quickly and successfully which drugs are best in the midst of an ongoing epidemic," said Anthony Fauci, director of the US National Institute of Allergy. and Infectious Diseases (NIAID), a division of the National Institute of Health (NIH).
Even more surprising is that despite all the obstacles encountered – a transmission rate tripled one year after the detection of the Ebola virus in August 2018, a neglected health care delivery system, a blocked international response , mistrust of the authorities of the affected communities and violence against health workers. – Something happened so well.
And, at the crossroads of painstaking scientific studies and small miracles, we now have a roadmap to get ahead of the chain of transmission of the Ebola virus in the DRC, which has resulted in the infection of 2,900 people and the death of 1,900 people as a framework for future international collaboration.
In August, shortly before the outbreak was declared, the DRC government approved four "compassionate use" drugs in Ebola patients, allowing NIAID researchers and researchers to investigate the epidemic. 39, World Health Organization (WHO), the DRC government and other non-governmental organizations, to design a clinical trial to ensure that each person who has participated in the treatment receives one of the treatments. There was no placebos.
Working in the conflict zone of eastern Congo where rebel forces, mercenaries and the army clashed, the researchers were forced to adapt, preparing drug trials for the disruption, including evacuations during Ebola responders attack.
Despite the violence, scientists recruited more than 700 participants, vaccinated nearly 170,000 people and sequenced the genomes of more than 270 Ebola samples.
Two of the drugs, ZMapp and Remdesivir, were antivirals developed during the Ebola outbreak in West Africa in 2014, but as there was no evidence of their safety or efficacy, Clinics only started when the epidemic came to an end, limiting patients' treatments to rehydration therapies and managing other symptoms. As a result, some 11,000 people died in Sierra Leone, Guinea and Liberia, including about two out of every three infected.
A survivor emerging from an Ebola treatment unit (ETU) during the outbreak in West Africa was a rare event – a muffled celebration sensitizing all who had not survived : children, parents, siblings, extended family and other relatives.
The other two drugs trials in the DRC, mAb114 and REGN-EB3, developed as a result of the outbreak in West Africa, are monoclonal antibodies. The first, mAb114, was developed using antibodies taken from Ebola survivors; the latter comes from antibodies generated in mice infected with the disease.
During the study, 49% of ZMapp patients and 53% of Remdesivir patients died, compared to 34% of mAb114 treated patients and 29% of REGN-EB3 treated patients. The new drugs have proven to be three times more effective. In addition, the survival rate of patients with low levels of virus in the blood was 94% on REGN-EB3 and 89% on mAb114.
"This is very good news," said Sabue Mulangu, researcher in infectious diseases at the National Institute of Biomedical Research (INRB) in Kinshasa and investigator of the trial. "We can now point out to people that more than 90% of people survive if they enter the country. [ETU] early and get this treatment. "
It is hoped that these two drugs will reverse the trend of the epidemic, which was declared public health emergency last month, by changing the behavior of local Congolese, where infected people are reassured to declare themselves and to be treat by the ETU – considered up here as a place where the sick will die. Even then, the risk of cross-border transmission will remain high.
The heroes and heroines of Ebola in the DRC are numerous: scientists and researchers, front-line health workers, including Médecins Sans Frontières, OXFAM, Mercy Corps, the International Rescue Committee (IRC), the International Federation of Red Cross and Red Crescent Societies (IFRC), WHO, NIAID, the DRC's National Institute for Biomedical Research, community mobilisers … and the tens of thousands of people who have fallen ill and are died. Everyone has helped to design the urgency of scientific discovery and global mobilization to save the next generation of lives.
But this army of practitioners would never have been assembled on the DRC battlefield without the leadership of the United States in the fight against global infectious diseases, a mission still bipartisan across successive US administrations and congresses , including the passage of $ 5.4 billion in additional emergency funding for response, recovery and preparedness following the 2014 outbreak – and, more recently, to counter the successive reductions in Foreign aid and the proposed cancellations of President Trump
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Jamie Bay Nishi, director of the Global Health Technologies Coalition, said, "Government investments are essential to advance products against all neglected and emerging diseases. In the case of Ebola, funding and political commitment from the United States has been key to recent success, as has the collaboration of other states and humanitarian organizations. "
In the latest $ 4 billion termination plans from the OMB, global health has been pulled off the table, a small victory but stifled by the misguided belief that health safety is unique and apart from an ecosystem. Access to education, water, sanitation, job creation, democracy and society. rights.
It seems that members of Congress have a job to do on their return from recess – but they may perhaps be inspired by Dr. James Lawler, an expert in infectious diseases at the University of Nebraska Medical Center. .
"Making clinical trials under ideal conditions is difficult. Doing these tests in the midst of a public health emergency is even more difficult, "he says. "All of these obstacles have been overcome in some of the most austere environments that you could potentially design in the event of an outbreak. If we can do it in this context, I think it shows that we can do it almost anywhere. "
K. Riva Levinson is President and Chief Executive Officer ofKRL International LLC, a D.C.-based consulting firm active in the emerging markets of the world, award-winning author of "Choose the hero: My unlikely journey and the rise of the first woman President of Africa "(Kiwai Media, June 2016) Follow her on Twitter @ rivalevinson
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