26 October 2014
SCIENTISTS predict that unless international commitments are significantly and immediately increased, the Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months.
The warning came as the World Health Organisation (WHO) reported at the weekend that more than 10,000 people had been infected with the disease and nearly half of them had died.
The United Nations (UN) health agency said Sunday that the number of confirmed, probable and suspected cases had risen to 10,141. Of those cases, 4,922 people have died. WHO's figures show about 200 new cases since the last report, four days ago.
A team of seven United States scientists from Yale's Schools of Public Health and Medicine and the Ministry of Health and Social Welfare in Liberia has developed a mathematical transmission model of the viral disease and applied it to Liberia's most populous county, Montserrado, an area already hard-hit.
The researchers determined that tens of thousands of new Ebola cases - and deaths - are likely by December 15 if the epidemic continues on its current course.
The new research was published in the October 24 issue of The Lancet Infectious Diseases.
The model developed by professor of epidemiology at the School of Public Health and the paper's senior author, Alison Galvani, and colleagues' projects as many as 170,996 total reported and unreported cases of the disease, representing 12 per cent of the overall population of some 1.38 million people, and 90,122 deaths in Montserrado alone by December 15. Of these, the authors estimate 42,669 cases and 27,175 deaths will have been reported by that time.
The model predicts that much of this suffering - some 97,940 cases of the disease - could be averted if the international community steps up control measures immediately, starting October 31. This would require additional Ebola treatment centre beds, a fivefold increase in the speed with which cases are detected, and allocation of protective kits to households of patients awaiting treatment centre admission.
The study predicts that, at best, just over half as many cases (53,957) can be averted if the interventions are delayed till November 15. Had all of these measures been in place by October 15, the model calculates that 137,432 cases in Montserrado could have been avoided.
Besides, the WHO at the weekend convened a meeting with high-ranking government representatives from Ebola-affected countries and development partners, civil society, regulatory agencies, vaccine manufacturers and funding agencies to discuss and agree on how to fast-track testing and deployment of vaccines in sufficient numbers to check the Ebola epidemic.
The key consensus commitments achieved during the meeting include:
. Results from phase one clinical trials of most advanced vaccines are expected to be available in December 2014 and efficacy trials in affected countries also will begin in this timeframe, with protocols adapted to take into consideration safety and immunogenicity results as they become available.
. Pharmaceutical companies developing the vaccines committed to ramping up production capacity for millions of doses to be available in 2015, with several thousands ready before the end of the first half of the year. Regulatory authorities in countries where the vaccines are manufactured and in Africa committed to supporting this goal by working under extremely short deadlines.
. Community engagement is key and work should be scaled up urgently in partnership between local communities, national governments, Non-Governmental Organisation (NGOs) and international organisations.
. WHO was called upon by all parties to ensure coordination between the various actors.
Galvani said: "Our predictions highlight the rapidly closing window of opportunity for controlling the outbreak and averting a catastrophic toll of new Ebola cases and deaths in the coming months.
"Although we might still be within the midst of what will ultimately be viewed as the early phase of the current outbreak, the possibility of averting calamitous repercussions from an initially delayed and insufficient response is quickly eroding.
"The current global health strategy is woefully inadequate to stop the current volatile Ebola epidemic," co-author Dr. Frederick Altice, professor of internal medicine and public health added. "At a minimum, capable logisticians are needed to construct a sufficient number of Ebola treatment units in order to avoid the unnecessary deaths of tens, if not hundreds, of thousands of people."
Other authors include lead author Joseph Lewnard, Martial L. Ndeffo Mbah, Jorge A. Alfaro-Murillo, Luke Bawo, and Tolbert G. Nyenswah.
According to a statement from the WHO meeting, "Vaccines may have a major impact on further evolution of the epidemic. All parties are working together to finalise the most rapid approach for developing and distributing vaccines, including direct engagement with affected communities, so that effective treatments and prevention methods are embraced and shared far and wide by the most effective ambassadors, the communities themselves.
"Trials of vaccines have already begun in the U.S., UK and Mali, and are beginning in Gabon, Germany, Kenya and Switzerland to determine safety and dose level."
WHO Assistant Director-General of Health Systems and Innovation, Marie-Paule Kieny, said: "As we accelerate in a matter of weeks a process that typically takes years, we are ensuring that safety remains the top priority, with production speed and capacity a close second."
As a further step, the WHO Director-General will be working with groups to advance vaccines' trials and deployment in the most expeditious manner possible.
Meeting participants included high-ranking officials from the ministries of health and of foreign affairs from Canada, China, the European Union, France, Germany, Guinea, Italy, Japan, Liberia, Mali, Nigeria, Norway, the Russian Federation, Sierra Leone, Switzerland, the United Kingdom, and the United States.
There were representatives from SAGE, the African Development Bank, the Bill and Melinda Gates Foundation, the European Federation of Pharmaceutical Industries, the European Investment Bank, the European Medicines Agency, the GAVI Alliance, the London School of Hygiene and Tropical Medicine, Médecins Sans Frontières/Doctors Without Borders, the Paul Erlich Institute, the U.S. Centres for Disease Control and Prevention, the U.S. Food and Drug Administration, the Wellcome Trust, and the World Bank; and executives from GlaxoSmithKline (GSK), Johnson & Johnson, Merck Vaccines, and New Link Genetics.
Meanwhile, the WHO has warned that as many people in the hardest-hit countries have been unable or too frightened to seek medical care. A shortage of labs capable of handling potentially infected blood samples has also made it difficult to track the outbreak. For example, the latest numbers show no change in Liberia's case toll, suggesting the numbers may be lagging behind reality.
On Thursday, authorities confirmed that the disease had spread to Mali, the sixth West African country affected, and on the same day a new case was confirmed in New York, in a doctor who recently returned from Guinea.
Mali had long been considered highly vulnerable to the disease, since it shares a border with Guinea. The disease arrived there in a two-year-old, who traveled from Guinea with her grandmother by bus and died on Friday.
The toddler, who was bleeding from her nose during the journey, may have had high-risk contact with many people, the WHO warned. So far, 43 people are being monitored in isolation for signs of the disease, and WHO said on Saturday that authorities were continuing to look for more people at risk.
To help fight Ebola, the UN humanitarian flight service airlifted about one ton of medical supplies to Mali late Friday. The seats of the plane were removed to make room for the cargo, which included hazard suits for health workers, surgical gloves, face shields and buckets, according to the World Food Programme, which runs the flights.
The spread of Ebola to Mali has highlighted how easily the virus can jump borders, and Malian border police said that neighbouring Mauritania closed its border with Mali.
The health minister of Ivory Coast, which borders Guinea and Mali, said authorities there were looking for a nurse who may have Ebola and fled from Guinea, where he was being monitored by officials. But Raymonde Goudou stressed that it was still not clear whether the man had Ebola.
There was concern also in Ghana, where some worried a strike by health care workers could leave the country vulnerable to the disease. Ghana does not border any country with reported cases, but it is serving as the headquarters for the UN mission on Ebola.
In Liberia, the country hardest-hit by the epidemic, U.S. forces have been building desperately needed treatment centres and helping to bring in aid. On Saturday, Maj. Gen. Darryl Williams, who was in charge of the troops assigned to the Ebola response, handed power to Maj. Gen. Gary J. Volesky, the 101st Airborne commander.
The U.S. states of New York and New Jersey ordered mandatory quarantine for medics who had treated victims of the disease in West Africa, after a doctor who had returned from the region became the first Ebola case in New York City.
President Barack Obama told Americans on Saturday that they must be "guided by the facts, not fear." He sought to calm a jittery public by hugging one of the two nurses who became the first to contract Ebola on American soil after treating a patient, but has now been declared free of the disease.
Mali President Ibrahim Boubacar Keita aimed to ease fears after the death of a two-year-old girl, the first Ebola case in the landlocked country, who travelled from neighbouring Guinea.
"We are doing everything to prevent panic," he said in an interview with French radio.
"Since the start of this epidemic, we in Mali took all measures to be safe, but we can never hermetically seal ourselves from this," he said. "Guinea is a neighbouring country, we have a common border that we have not closed and that we will not close."
The WHO said it was treating the situation in Mali as an "emergency" because the toddler had travelled for hundreds of kilometres on public transport with her grandmother while showing symptoms of the disease - meaning that she was contagious. http://allafrica.com/stories/201410271304.html
