Epidemic. The rapid spread of an infectious disease to a large number of people in a certain area within a short span of time. This was what afflicted Western Africa in 2014-15, with 28,600 people affected and 11,310 individuals succumbing to the Ebola disease. This far exceeds the total number of deaths since the discovery of Ebola in 1976.
Why were there so many deaths? Ebola is not new, outbreaks have occurred previously but were of a shorter time span and in isolated areas. This time, parties involved in international aid and affected countries did not quite comprehend how quickly and how far the virus was spreading. They assumed this was no different from the previous outbreaks. Affected countries themselves did not want to admit that there was a crisis, and international organisations were slow to send in aid. What made this round of Ebola outbreak different was the ease of travelling as compared to the past. People moving across borders in the African region simply became walking carriers of the Ebola virus, driving its inevitable spread. And because Ebola is a highly contagious virus causing impaired kidneys and liver, and internal and external bleeding, with a high (25-90%) fatality rate, many casualties were stricken with the Ebola disease.
Were no vaccines being researched on based on previous cases of Ebola? Several vaccines were indeed tested, but were limited to the Phase 1 of clinical studies, and could not be further tested for efficacy and safety due to the limited timespan and extent that the Ebola cases lasted. So in this 2014-15 Ebola case, the proportion of the epidemic lent the opportunity for more extensive trials. However, research response to the epidemic in Western Africa was slow. Several factors contributed to this:
- Lack of clinical experience in dealing with Ebola;
- Poor surveillance and laboratory capacity;
- Lack of sufficiently trained people in conducting clinical research;
- Lack of ethics review boards with enough experience, resources, training to assess the clinical research proposals;
- Little knowledge and skills to negotiate contracts
- for conducting clinical trials
Even when trials started, there was messy coordination of trial designs and locations, and it was difficult to choose priority candidates for the trials.
Furthermore, the major countries affected by Ebola – Sierra Leone, Liberia and Guinea, were among the most ill-equipped to deal with such a large scale epidemic. Owing to low GDP per capita and buildings wrecked by many years of civil war, they had a deficiency of crucial healthcare infrastructure and lacked well-trained healthcare workers. In addition, international aid was delayed, and many volunteers were strained from the abundant Ebola cases and not adequately trained to limit themselves getting infected with Ebola.
Much misunderstanding between response staff and affected communities hindered help as well. Due to lack of proper engagement with the communities, there were wild rumours circulating that the Ebola virus was purposely introduced in the African region by foreigners. People were also upset that the mandatory cremation of Ebola victims ran afoul of their long-established religious beliefs.
The Ebola epidemic episode highlighted the need for preparedness and cooperation from both countries and international organisations. For these, investment is not only needed in the practicalities of vaccine trials, manpower and infrastructure, but also in the human aspect of community engagement. A ready team of trained staff to conduct trials and care for the affected patients in well-equipped hospitals, is only as effective as to how well patients respond to the care. As the familiar adage goes, “It takes two hands to clap”. Patients that comply with health orders to minimise the disease spreading and cooperate with health workers, will allow efficient maximisation of resources to deal with the epidemic. Similarly, international aid has to respond quickly to such situations, to dole out resources and help to the affected communities in future epidemic episodes. 
An effective vaccine available to cure patients of the disease will be beneficial too. Here is the progress on the Ebola vaccine.
Ebola vaccine updates:
There are currently no approved vaccines or treatments for the Ebola viruses. Current antibody therapies (E.g. ZMaPPTM) target only one specific Ebola virus, but do not work against the other two Ebola viruses. In May 2017, researchers from the Albert Einstein College of Medicine have discovered the first human natural antibodies that can work against all three Ebola viruses, albeit in animals . However, this can pave the way for a multi-effective vaccine for Ebola in humans.
By Cheryl Lee Zhi Qin
Cheryl likes to write and learn new things, especially on topics related to public health and science. She hopes to travel to as many countries as possible.