LOS ANGELES—Public health specialists who engaged in research while responding to the 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa have concluded that conducting such work in the midst of a major humanitarian crisis is both possible and can yield valuable guidance when preparing for future infectious disease outbreaks.
The three experts, Adam Levine, Primary Investigator of International Medical Corps’ Ebola Research Team, John Beigel, of Biomedical Research, which supports the National Institute of Allergies and Infectious Diseases (NIAID), and Pia Wanek of Global Communities reported their findings during a panel discussion on October 19th at the National Press Club in Washington, DC. The event was co-sponsored by International Medical Corps and the Global Health Security Agenda Consortium.
International Medical Corps was one of the first International humanitarian groups to treat Ebola patients at the source of the West African epidemic.
“The results we heard today highlight the importance—and the challenges--of conducting research during a major public health emergency,’’ summed up Levine, who helped establish International Medical Corps’ first Ebola Treatment Unit in Liberia just six weeks after the fast-spreading virus led the World Health Organization to declare a Public Health Emergency of International Concern in August, 2014. “At a more fundamental level we have proven that with the right partnerships, the right funding and the right planning, we can do research in this type of emergency—not just research but high quality research.”
The fact that research was carried out in Liberia and Sierra Leone during the Ebola outbreak was far less well-known than the epidemic itself. Challenges of conducting such research were formidable. For example, gathering, handling and storing Ebola data gleaned from patients inside a treatment unit presented one such challenge because it was potentially contaminated with the Ebola virus. To prevent spreading the disease, some data was read through a fence by health care workers standing inside the treatment area to a colleagues standing outside the fence that separated contagious patients from the outside world. At other times data was photographed by staff inside the treatment unit using a camera that was then dipped in a chloride solution before could it be handled by anyone outside.
Another issue was that many physicians and nurses working in the treatment units had significant clinical experience, but only limited exposure to research environments. During the course of its humanitarian response to the outbreak, International Medical Corps opened five Ebola Treatment Units in Liberia and Sierra Leone, where health workers cared for more than 2,500 patients. During this time, the group’s staff collected more than 25,000 pages of epidemiologic, clinical, psychosocial and operational data.
The panelists noted that successful research in such conditions required groups of strong, diverse partners because expertise was required across an especially broad spectrum of knowledge. Levine noted his research drew variously on public health, water and sanitation, epidemiological and anthropological experts. The other panelists noted those involved came from equally diverse cultural settings that included national governments, traditional community chieftans, funding agencies, academia and humanitarian groups.
NIAID, part of the National Institutes of Health (NIH), in partnership with government health entities of four nations, plus other academic, government and non-government agencies, including International Medical Corps, co-sponsored the first controlled trial of an experimental Ebola drug on humans. It was carried out during the outbreak after obtaining the consent of patients at International Medical Corps treatment centers in Sierra Leone as well as at other sites in Sierra Leone, Liberia, Guinea, and the United States.
Findings of the trial that ran through the second half of 2015 into January 2016 for the three-component antibody cocktail known as ZMapp showed that patients suffering from the potentially deadly Ebola Virus Disease (EVD) tolerated the drug well. Treatment response levels for those given the cocktail in addition to optimized standard-of-care (oSOC) were superior to patients in a control group provided only oSOC. Both groups were treated in identical conditions, with 24 of the 72 patients participating treated at International Medical Corps centers in Sierra Leone. Eight of the 36 patients receiving the ZMapp cocktail—22%--died during treatment, compared to 13 deaths, or 39% among the 35 patients who did not.
Global Communities’ Wanek said her group studied the effects of its Community-led Total Sanitation program in Liberia as an Ebola deterrent and found that communities that had fully completed the program, and were open-defecation free, did not contract EVD, suggesting a strong correlation between CLTS and Ebola prevention. Additionally, even the communities that only partially completed CLTS had significantly reduced the risk of contracting Ebola.
International Medical Corps will present more of its Ebola-related research in the form of abstracts for seven projects next month at the annual meeting of the American Society of Tropical Medicine in Atlanta. These projects include: Lessons From the Field: Implementation of a multi-country response to the Ebola Virus Disease Epidemic in West Africa; a retrospective study of the West Africa Epidemic entitled, The Natural History of Ebola Virus Disease; a retrospective study entitled Mortality Outcomes Among Patients with Variable Infection States with Ebola Virus Disease and Malaria in Sierra Leone; and retrospective study entitled, Outcomes of Pregnant Patients Presenting to Ebola Treatment Units in Sierra Leone and Liberia.