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Vaccine Success Holds Hope For End To Deadly Scourge Of Ebola

Vaccine Success Holds Hope For End To Deadly Scourge Of Ebola

By Kate Kelland and Tom Miles

LONDON/GENEVA (Reuters) — The world is on the verge of being able to protect humans against Ebola, the World Health Organization said on Friday, as a trial in Guinea found a vaccine to have been 100 percent effective.

Initial results from the trial, which tested Merck (MRK.N) and NewLink Genetics’ (NLNK.O) VSV-ZEBOV vaccine on some 4,000 people who had been in close contact with a confirmed Ebola case, showed complete protection after 10 days.

The results were described as “remarkable” and “game changing” by global health specialists.

“We believe that the world is on the verge of an efficacious Ebola vaccine,” WHO vaccine expert Marie Paule Kieny told reporters in a briefing from Geneva.

The vaccine could now be used to help end the worst recorded outbreak of Ebola, which has killed more than 11,200 people in West Africa since it began in December 2013.

WHO Director-General Margaret Chan said the results, published online in the medical journal The Lancet, would “change the management of the current Ebola outbreak and future outbreaks.”

The Gavi Alliance, which buys vaccines in bulk for poor countries who struggle to afford them, immediately said it would back an Ebola shot once it is approved.

“These communities need an effective vaccine sooner rather than later,” Gavi’s chief executive Seth Berkley said. “We need to be ready to act wherever the virus is a threat.”

This and other vaccine trials were fast-tracked with huge international effort as researchers raced to test potential therapies and vaccines while the virus was still circulating.

“It was a race against time and the trial had to be implemented under the most challenging circumstances,” said John-Arne Røttingen of Norway’s Institute of Public Health, chair of the trial’s steering group.

“Ring Vaccination”

The Guinea trial began on March 23 to evaluate the effectiveness and safety of a single dose of VSV-ZEBOV using a so-called “ring vaccination” strategy, where close contacts of a person diagnosed with Ebola are immunized — either immediately, or at a later date.

As data began to emerge showing the very high protection rates in those vaccinated immediately, however, researchers decided on July 26 that they would no longer use the “delayed” strategy, since it was becoming clear that making people wait involved unethical and unnecessary risk.

The trial is now being continued, with all participants receiving the vaccine immediately, and will be extended to include 13- to 17-year-olds and possibly also 6- to 12-year-old children, the WHO said.

Jeremy Farrar, a leading infectious disease specialist and director of the Wellcome Trust, said the trial “dared to use a highly innovative and pragmatic design, which allowed the team in Guinea to assess this vaccine in the middle of an epidemic.”

“Our hope is that this vaccine will now help bring this epidemic to an end and be available for the inevitable future Ebola epidemics,” his statement said.

The medical charity Doctors Without Borders (MSF), which has led the fight against Ebola in West Africa, called for VSV-ZEBOV to be rolled out to the other centers of the outbreak, Liberia and Sierra Leone, where it says it could break chains of transmission and protect front-line health workers.

VSV-ZEBOV was originally developed by Canada’s public health agency before being licensed to NewLink Genetics, which then signed a deal handing Merck the responsibility to research, develop, manufacture, and distribute it.

The success of the Guinea trial is a big relief for researchers, many of whom feared a sharp decline in cases this year would scupper their hopes of proving a vaccine could work.

Another major trial in Liberia, which had aimed to recruit some 28,000 subjects, had to stop enrolling after only reaching its mid-stage target of 1,500 participants. Plans for testing in Sierra Leone were also scaled back. That left the study in Guinea, where Ebola is still infecting new victims, as the only real hope for demonstrating the efficacy of a vaccine.

(Additional reporting by Tom Miles in Geneva and Ben Hirschler in London; Editing by Kevin Liffey)

Photo: A member of the French Red Cross disinfects the area around a motionless person suspected of carrying the Ebola virus as a crowd gathers in Forecariah, Guinea, January 30, 2015. REUTERS/Misha Hussain 

‘Epidemic Of Fear’ Has Driven Ebola Debate, Experts Say

‘Epidemic Of Fear’ Has Driven Ebola Debate, Experts Say

By Tony Pugh, McClatchy Washington Bureau

WASHINGTON — In his 30 years as director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci has seen his share of public health scares.

When AIDS exploded in the 1980s among gay men, Fauci recalls that some people didn’t want gay waiters to serve them in restaurants. And during the anthrax scare that followed the 9/11 terrorist attacks, many were afraid to open their mail.

But when it comes to Ebola, “This one’s got a special flavor of fear,” Fauci said at the recent Washington Ideas Forum, sponsored by The Atlantic magazine and the Aspen Institute, a nonpartisan policy group.

The growing death toll in West Africa has helped create “an epidemic of fear” in the U.S., Fauci said, even though most experts feel the likelihood of a widespread outbreak in this country is minimal.

James Colgrove, a public health professor at Columbia University, said the chances of an outbreak in this country are “extremely remote.” Pamela Cipriano, president of the American Nurses Association, went even further. “What we know right now would suggest that there is no risk of an epidemic,” she said.

Enhanced screenings of West African visitors allow U.S. health officials to “very quickly identify and sequester and evaluate and care for anyone who shows any type of risk,” Cipriano said. “That’s a very high level of control.”

Even in Dallas, where Liberian Ebola patient Thomas Eric Duncan triggered the nation’s first potential outbreak, only two nurses contracted the virus after direct contact with Duncan while he was desperately ill. That’s out of 70-plus health care workers and 48 family and community members who interacted with him.

Despite the flawed federal and local response, the Dallas episode proved what Fauci and other experts have said all along: Ebola is tough to catch and even tougher to spread when contact tracing, patient isolation and quarantines are in place.

But rather than validate experts’ calls to trust the science and impose public health precautions that reflect actual risk, the Dallas scare triggered a policy backlash driven by fear. Individual states imposed mandatory quarantines for all health care workers returning from Ebola-stricken West Africa, even if they had no symptoms and weren’t contagious.

Kaci Hickox, a Doctors Without Borders nurse who treated Ebola patients in Sierra Leone, was, upon returning, kept in an isolation tent for a weekend by New Jersey officials, even though she showed no symptoms of the virus.

She was permitted to return home to Maine, where officials tried to legally quarantine her. A judge ruled in her favor, requiring only that Hickox monitor herself for signs of Ebola for 21 days, which ended Monday night.

“The fear is trumping science,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Lawmakers continue to call for outright travel bans from West Africa, which, experts say, would only cause people to seek alternative entry while discouraging U.S. caregivers from helping out in Africa.

Fauci said the severe responses are simply good-faith efforts by politicians to protect fearful constituents.

“You have to respect the fear of people,” he said. “You can’t denigrate it and say, ‘Why are you afraid?’ You’ve got to try and explain to them and you’ve got to do it over and over. … It’s just that as a health person, as a physician and a scientist, I would say you look at the data, and it tells you what the risk is.”

Ebola is only transmitted by direct contact through broken skin or mucous membranes with the body fluids of infected people. Airborne transmission of the virus — through tiny, dry particles that float through the air — does not occur.

But if larger saliva or mucous droplets from an infected person are expelled by coughing or sneezing and come in contact with another’s eyes, nose or mouth, that person could become infected. No such infections, however, have ever been documented.

Americans’ lingering fears about the disease stem partly from health officials’ misstatements about the nation’s readiness to fight it.

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, originally said hospitals in this country were ready to care for Ebola patients. Many, in fact, were not.

The agency then had to revise its outdated and insufficient guidance on personal protective equipment to ensure the safety of Ebola caregivers. The CDC also provided contradictory information about whether people being monitored for Ebola symptoms should be allowed on public transportation.

“Some of the missteps have eroded some of the trust that the public has had,” said Cipriano, the nurses association president. “I think that it certainly has added to the sense of, ‘Well, who do we trust?’ ”

Colgrove said Frieden’s mistakes were surprising, because the CDC director had always excelled in the art of communicating risk. Frieden used to refer to public health in an epidemic as “the art of controlled hysteria,” Colgrove said.

“You want people to be worried enough that they give you the resources that you need to do the job,” explained Colgrove, the Columbia professor, “but you don’t want them to be so worried that they do stupid things. It’s a very, very delicate balance that he has to walk. That any public health official has to walk.”

With a lull in the number of new Ebola cases, many are hoping the U.S. has seen the worst of the deadly virus. But Benjamin, of the American Public Health Association, knows better.
“I always remain skeptical and vigilant,” he said. “So while I’m hoping that we have, I still believe that we have to keep a high index of suspicion.”

AFP Photo/Chip Somodevilla

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Two Under Observation At Hospitals After Falling Ill During Flights From Liberia To O’Hare

Two Under Observation At Hospitals After Falling Ill During Flights From Liberia To O’Hare

Chicago Tribune

(MCT) — Two people who arrived at O’Hare International Airport from Liberia have been placed under observation at Chicago hospitals, under the city’s procedures for handling Ebola, after they fell ill during their flights, officials said.
Health officials stressed that “at this time there have been no confirmed cases of Ebola and there is no threat to the general public.”
In fact, the officials said they decided against testing the two for Ebola after initial medical evaluations but did send them to Lurie Children’s Hospital and Rush University Medical Center for observation. They are being kept in isolation.
The two hospitals are among four in Chicago that have agreed to take Ebola patients from other hospitals and health care providers should any cases appear in the area. The others are Northwestern Memorial Hospital and the University of Chicago Medical Center.
The child had vomited during a flight from Liberia to O’Hare, city health officials said. Upon landing, the child was screened by federal authorities and was found to have no other symptoms and no known risk of exposure. The child was taken to Lurie “out of an abundance of caution” and was undergoing observation in isolation.
Following city guidelines, the child’s family was under quarantine until the evaluation was completed.
The other passenger, an adult traveling alone from Liberia, reported nausea and diarrhea during another flight from Liberia. The passenger reported having been diagnosed with typhoid fever in August but had a normal temperature and reported no known risk of exposure to Ebola during a screening.
The person was taken to Rush for medical evaluation and observation, health officials said.
The city released no other details of the passengers or their flights.

AFP Photo/Jay Directo

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Ebola Politics: Let Obama — And Frieden — Do Their Jobs

Ebola Politics: Let Obama — And Frieden — Do Their Jobs

If the prospect of hanging concentrates the mind, then even the possibility of infection with Ebola should do the same — for all of us. Instead we seem easily distracted by attempts to blame President Obama and scapegoat the Centers for Disease Control and Prevention. Republican politicians and media loudmouths demand the resignation of Dr. Thomas Frieden, the CDC director, evidently because he refused to endorse a West African travel ban.

They’re all dead wrong.

First, Obama is following precisely the correct approach in addressing the outbreak with his order to dispatch American troops to Liberia. At this stage, no force except the U.S. military is capable of getting the situation in West Africa under control. The men and women of the medical corps can swiftly set up emergency tented facilities in every Liberian county, while security personnel begin to restore order and prevent panicked destruction.

The president didn’t foresee this outbreak, but neither did anyone else, principally because every earlier Ebola outbreak had been contained within a few rural villages. While his order to send troops isn’t popular – and nobody likes the idea of sending our troops into danger – he made a difficult but wise choice. (Our British and French allies have agreed to do the same in Sierra Leone and Guinea, respectively.)

Why are the unique characteristics and large scale of the U.S. military so vital now? Simply because no other force can adequately handle the logistical and safety requirements of this chaotic, perilous undertaking. To take just one example: Both our troops and the local health care workers will need an enormous supply of protective gear known as Personal Protective Equipment – each of which must be not just discarded, but carefully destroyed after a single use.

More broadly, the effort to contain Ebola needs very well-trained, well-organized, and well-disciplined people on the ground – which is to say, an army. Our military personnel are the best in the world, and will be able to provide leadership and guidance to the Liberians, organizing local health workers to restore order amid chaos and fear.

No organization except the U.S. military possesses the capacity to deal with such problems.

Second, the calls for Dr. Frieden to resign by Republican members of Congress more resemble cheap midterm campaigning than intelligent policymaking. Although the CDC has not functioned perfectly in the current crisis, its director is certainly the most qualified and experienced figure to stem a threatened outbreak of infectious disease. His expertise is not merely on paper, either.

During four of the worst years of the HIV/AIDS crisis in New York, when multi-drug resistant tuberculosis was taking a terrible toll, Dr. Frieden oversaw the program that eventually controlled TB and reduced cases by 80 pecent. For five years he worked in India, dispatched by the CDC to work with the World Health Organization to control TB in that country – where his efforts helped to provide treatment for at least 10 million patients and saved as many as 3 million lives. Those are among the reasons that President Obama appointed him in the first place – and why he still deserves far more confidence than the partisan screamers in Congress and on cable television now attacking him.

Now is the wrong time for politicians and pundits to harass the Pentagon and the CDC, as they address the difficult task at hand — which will require many weeks of intensive struggle. There will be plenty of opportunity for recriminations later, if that still seems necessary.

In the immediate aftermath of 9/11, when the country faced what felt like an existential crisis, many public figures, especially Republicans, urged everyone to put national unity and cooperation ahead of partisan bickering. It would be good if, just this once, they would follow their own advice.

What we will need in the months to come is a fresh assessment of our foreign aid programs. We need to understand why our traditional stinginess does both our country and our children a terrible disservice. Our best hope for survival, in the long term, is to notice how small our world has become – and to recognize that protecting our fellow human beings everywhere is the only way to protect ourselves.