Via BMJ Blogs, a post by pediatrician Aser García Rada: Some thorny questions posed by our response to Ebola. Excerpt:
Over the last few months, I had been getting ready for being deployed to Liberia or Sierra Leone with a non-governmental organisation. Regrettably, owing to several doubts I had with the project, I finally will not be going. However, I have been trying to learn as much as possible about the Ebola virus disease (EVD) and I am concerned about some of the things I learned.
Last December, I attended a roundtable on this topic at the Institute of Health Carlos III (ISCIII) in Madrid. Alberto Infante, a former professor of international health at the National School of Public Health, pointed out some striking facts.
Firstly, and as Google Trends show, as the risk of the disease spreading in Western countries drops, our interest sharply declines.
Secondly, the affected western Africa countries were growing at rates between 4 and 11 per cent of their GDP before the epidemic, while currently they have negative growth rates. An upcoming food crisis is evident and, although EVD is now their main economic problem, HIV/AIDS, malaria, diarrhoea, and tuberculosis—which cause far more deaths than EVD—remain leading health issues. Yet so far we still lack a consolidated plan for the international funds required to tackle these problems.
Thirdly, denial of the problem has too often been the general rule for the affected countries—which still last June were criticising MSF for alarmism—the international community, and transnational institutions—which have been too slow with their aid offerings. “I was working at the WHO [World Health Organization] in the cabinet of Margaret Chan April through June, and I am a witness of inaction,” Infante said.
Fourthly, Nigeria’s strategy—in contrast to what was done in Liberia or Sierra Leone—facilitated contact tracing, instead of making those who came into direct contact with a sick Ebola patient flee: borders were not closed, mass quarantines were not established, nor was the army commanded to tackle the problem.
Both the way in which research for a specific treatment is being tackled and the way in which we Western citizens perceive that process throw up certain concerns. Antonio Sarria, head of evaluation of health technologies at the ISCIII, whom also spoke at the roundtable, quoted one of the very few studies to date on specific therapies: a small trial developed during an outbreak in the Democratic Republic of the Congo in 1995, which showed a 12.5% case fatality rate among eight patients who received blood transfusions from convalescent donors.
Although the study is quite limited, WHO quoted its “promising” results, and a panel of experts summoned by the organisation concluded last September that “the use of whole blood therapies and convalescent blood serums needs to be considered as a matter of priority.”
If, in fact, this is the only specific therapy that has proved effective so far, why has so much research emphasis—in news headlines and even by WHO itself—been placed on vaccines? Is vaccinating large groups of the population the most useful tool to deal with a still rare disease, which is not spread by airborne transmission, needs close contact for transmission, and appears mostly in self-limited outbreaks, or is it the most profitable therapy to focus on?