Sustained US preparedness needed for Ebola and other pan-epidemic threats

Sustained US preparedness needed for Ebola and other pan-epidemic threats

The new Ebola Virus outbreak reported Aug. 1 by the World Health Organization in a conflict-zone in the Democratic Republic of the Congo (DRC) near the border with Uganda and Rwanda is the third Ebola outbreak in the DRC in the past 16 months and poses unique as well as urgent challenges.

Armed conflict in the region will challenge efforts to trace contacts of those already infected, and has led to the displacement of more than one million persons in the outbreak region as well as movement of refugees to neighboring Uganda, Tanzania, and Burundi.

Sustained American leadership and multi-sectoral coordination will be essential for responding to this outbreak and predictable future outbreaks of Ebola and other threats that can travel to this country as Ebola did in 2014.

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As a volunteer with Doctors-Without-Borders in 2014 I was fortunate to have the opportunity to provide hands-on care for more than 200 patients in Liberia. The lessons that crisis offered were tragic in their nature and scope, unforgettable, and yet illustrated that we have forgotten all too often the lessons that history has taught us.

 

Because of what I saw in West Africa, in August 2014 I proposed an exhibition on epidemics to the Smithsonian National Museum of Natural History. That exhibit opened May 18, 2018, and has an online-accessible version translated into five languages.

A major goal of this three-year exhibition is to help educate the general public in the United States and abroad about working together to help prevent, detect, and respond to epidemics that include Ebola, influenza, Zika, HIV/AIDS, and more, from the integrated triad view of “One Health” i.e., human, animal, and Eco health.

The exhibit highlights a reality that the current outbreak in North Kivu illustrates once again — outbreaks of pandemic potential comprise a major part of humanity’s history, and are not about to go away on their own. In fact, as the current outbreak shows us, some of the factors that lead to the wide spread of infectious agents that have jumped from animals to humans are only increasing. This means our efforts, and our focus must increase as well.

We have made significant progress. Improved disease surveillance and laboratory capacities, developed with international support over the course of the DRC’s previous nine Ebola outbreaks, continues to enable earlier confirmation that an outbreak is occurring.

An effective vaccine against Ebola, developed during the West Africa crisis was used to control the most recent previous DRC Ebola outbreak, and health officials have just confirmed that it can be used in this outbreak.

An Ebola vaccine campaign is scheduled to begin today with health workers. If sufficient armed protection and community trust can be established, then this investigational vaccine could be offered to thousands of others, including the already 1,000 persons — that include health workers — identified as being in contact with the 43 patients having Ebola reported by WHO as of Aug. 7.

From 2014 to 2015 more than 510 health workers died due to Ebola in the West African urban and rural pan-epidemic. The new vaccine offers the hope of preventing a toll of that magnitude from being repeated. In addition to the vaccine, investigational antiviral drugs and antibody treatments, some developed in the United States, are likely to be offered to patients for the first time in the DRC.

But the enormity of the potential challenges in the current epidemic should not be underestimated. Several laboratory-confirmed Ebola patients have been identified in the city of Beni, well-connected by road to the village of Mangina where the initial patients were identified, according to the WHO’s Dr. Peter Salama.

An immediate and well-coordinated response is needed to prevent the multifocal urban outbreaks and international spread that occurred in West Africa. That is possible, in part, because of the support added to the U.S.-initiated, international partnership of the Global Health Security Agenda — launched before the West Africa crisis, and strengthened as a result. We need to remember the role that effort has played in strengthening current responses when its funding comes up for renewal in the coming year.

Similarly, the Pandemic and All Hazards Preparedness Act helped build community capacities at home to address public health threats while supporting needed biomedical innovation. Up for reauthorization this year, its purpose remains critical, and Congress should act swiftly to ensure that it contains provisions that ensure a prepared public health workforce and drives the development of medical countermeasures that include vaccines, diagnostics and therapeutics.

American leadership in West Africa and in the USA was essential in stopping the 2013-2016 Ebola pan-epidemic, including HHS, CDC, NIH, USAID, DoD, NGO’s and multiple others. Sustaining U.S. leadership in the perpetual war against outbreaks, pan-epidemics, and truly global pandemics is essential for our own protection as well as a more secure and stable world outside our borders.

Daniel Lucey MD, MPH, is an infectious diseases physician and adjunct professor of infectious diseases at Georgetown University Medical Center, a senior scholar at the Georgetown University O’Neil Institute and a member and spokesperson for the Infectious Diseases Society of America.