Put research at the heart of the response to epidemics like Ebola saves lives

Published: 31 July 2018

As the recent Ebola outbreak in the Democratic Republic of Congo is officially over, Regnier looks at how Wellcome's support has helped the people of the DRC – and the rest of the world – to be better prepared for the future. next.

Source: Kannah Junior D / AFP / Getty Images

On May 8, 2018, the government of the Democratic Republic of Congo (DRC) confirmed an Ebola outbreak in the country. The DRC has experimented and contained Ebola virus several times since virus identification in 1976, but after the 2013-16 epidemic in West Africa, where more than 11,000 people are dead, we realized that it could become more serious. On the same day, Ebola was confirmed, Wellcome released £ 2 million to fund research in the DRC that would support the emergency response. The UK Department for International Development has allocated an additional £ 1 million through its partnership with the Joint Epidemic Preparedness Initiative

. Nobody knew what the scale of the epidemic would be or how long it would last. Because some of the early cases were around the town of Mbandaka, there were concerns that it could get out of hand. In the end, 33 people died of 54 cases – about the same magnitude as three epidemics in the DRC between 2008 and 2014, and much less devastating than the West African epidemic.

So what research was supported this time, and how? will it help us prepare for future epidemics?

Immunization

For the first time, an Ebola vaccine was available early in an epidemic. The vaccine, rVSV-EBOV, is manufactured by MSD (Merck). It has been developed through the efforts of many individuals, from the Public Health Agency of Canada researchers to pharmaceutical companies, governments and NGOs, as well as to scientists and medical teams who have conducted trials clinics and the volunteers who participated. 19659008] Wellcome also played a role in funding research and encouraging the conduct of clinical trials during the 2013-2016 epidemic. These trials, coordinated by the World Health Organization (WHO), showed that the vaccine was safe and effective.

rVSV-EBOV is not the only vaccine under development, but it was the only one to demonstrate a protective benefit in 2013- The outbreak was stored by GAVI, the Vaccine Alliance accordingly. However, it has not yet been authorized, which means that it can only be used in research studies when consent is obtained from participants and they are followed to monitor safety. .

With our research funding in place, the DRC government, the WHO and Médecins Sans Frontières were able to quickly set up a vaccination program. This included everything: taking freezers to store the vaccine at -70 ° C, hiring the people who would do the field work, and working with other partners such as UNICEF to mobilize the affected communities.

Guinea will share its direct experience of good clinical practice in the care of people with Ebola and the "ring vaccination" approach. Ring vaccination involves starting with a patient and finding everyone who has been in contact with them, then tracing everybody with the people in that first "circle". All members of these circles then receive the vaccine, as well as first responders such as health workers and taxi drivers.

Compared with vaccination of the general population, this approach is more practical in times of crisis. But it still relies on epidemiologists, laboratories that test samples and thousands of personal visits by qualified contact tracers

The program in the DRC began May 21 and at the end of June, 3,300 people had been vaccinated. 19659008] The vaccination program may have helped to slow down and even stop the spread of the virus, but it will be difficult to draw definitive conclusions since the epidemic has been relatively – and fortunately – short. However, we will know more about the safety of the vaccine as a result of this program

Clinical Care

People with Ebola must be able to trust that they will receive the best care possible, and the best care starts with the right diagnosis. In its early stages, Ebola tends to cause fever, pain, and pain – like other infections like malaria or the flu.

During an epidemic, it is essential to know who actually has the Ebola virus. threatening symptoms, including vomiting, diarrhea, organ failure, and internal and external bleeding.

Part of our funding has been used to strengthen the DRC's capacity to use and evaluate new diagnostic tools in epidemics like this one. 19659008] A handful of drug treatments against the Ebola virus are under development – none of them has yet been approved, so the authorities of the WHO and DRC have accepted protocols to use them on a case by case basis. Although the outbreak is over before any of them is prescribed, it is helpful to put these protocols in place so that experimental drugs can be used and evaluated quickly at the next outbreak.

Communication, Coordination and Ability

Outbreaks are alarming and scary wherever they occur. It is essential that communication between officials and the public is constructive, that research is supported, coordinated and shared, and that people feel involved in the decisions made.

Wellcome funded a team to produce operational briefs describing local social and cultural contexts – This has contributed to communication with communities affected by the Ebola virus, the vaccine and other public health measures in effect .

A portion of our funding has also been used to build research capacity in the DRC. The next time Ebola hits. This includes support from the National Regulatory Authority and the Ethical Research Committee, and the creation of a National Research Coordinator at the National Institute of Biomedical Research (INRB) in Kinshasa.

Our support relates to issues such as the best In the end, the effect of the quick commitment of funding was to ensure that research was integrated into the answer of "the best". Ebola outbreak emergency, led by the DRC government with support from WHO and other partners.

Epidemics are not isolated events. Every nation around the world needs to know its risks – some have to deal with seasonal epidemics, others with sporadic epidemics, but all must be ready with solid plans in place. And, crucially, research must be an integral part of these plans so that we can learn more from each epidemic and better prepare ourselves for the next.

Michael Regnier is a scientific author at Wellcome.

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