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Ebola One Year On: a Wellcome Trust Research Round-Up Special

23 Mar, 2015

B0009931 Ebola virus structure, illustration

A year ago today (23 March 2014), the World Health Organization confirmed what many in the global health community had already feared. An outbreak of a deadly haemorrhagic fever that had emerged a few months earlier in Guinea was caused by the Ebola virus. What followed was an epidemic on a previously unimaginable scale, which to date has claimed at least 10,000 lives.

Over the past year, people across the Wellcome Trust have helped to catalyse an unprecedented global response to the outbreak. In many cases this has involved condensing processes that normally would take years of painstaking work into a matter of months.

Our emergency Ebola funding package has now awarded around £11.6 m to research aimed at identifying clinical and public health interventions that could save lives in this, and future outbreaks of Ebola. In this special edition of Research Round-up, we take a look at progress so far.

Since August 2014, the Trust has been working with scientists, industry, governments and agencies around the globe to fast-track the development of two promising Ebola vaccines: Merck’s rVSV-EBOV and GlaxoSmithKline’s ChAd3 (chimp adenovirus type 3).

Vaccines

Support from the Trust has enabled researchers to rapidly set up human trials of these two promising vaccines, first in healthy volunteers to make sure they were safe followed by large-scale efficacy trials of both vaccines, which are now underway in West Africa.

A ring-vaccination trial of rVSV-EBOV started last month in Guinea, and it’s possible that this will be expanded in the coming weeks to incluEbola vaccinede trials of ChAd3 with a ‘boost’ from a different type of vaccine called MVA (developed by Emergent). Initial results from the trial are expected in the second half of 2015 and there’s still a chance that this work could have an impact on the current epidemic, if one or more of the promising vaccines turns is effective at preventing transmission.

Treatments

Vaccines are the most effective way of protecting individuals and communities against the spread of infectious disease, but there is also an urgent need to develop effective treatments for Ebola.  We set up a £3.2 million treatment platform in September 2014 to help fast-track this process.

The first study set up through this platform, a trial of an antiviral called brincidofovir, unfortunately had to be stopped shortly after it began because of the dramatic decline in new Ebola infections at the study site in Liberia. But Professor Peter Horby and his team at the University of Oxford have now started a second trial of another promising drug called TKM-Ebola. By concentrating their efforts in Sierra Leone, where cases remain high, they will have the best possible chance of finding out whether any of the candidate treatments can stop people dying from Ebola. This approach will also hopefully help to develop protocols to allow clinical trials to be rapidly set-up in similar emergency situations in the future.

Cambridge-based biopharmaceutical company Kymab and Public Health England scientists are also working here in the UK to identify further promising treatment options.

Surveillance and modelling

Understanding how and why infection spreads is a crucial part of any epidemic response. Two projects funded through the Research for Health in Humanitarian Crises (R2HC) programme are working towards this goal. The first, led by the London School of Hygiene & Tropical Medicine, is tracking changes in the spread of the disease in West Africa and evaluating the impact of measures put in place to control the epidemic. As second project at Oxford University is trying to predict the trajectory of the outbreak and produce maps to help the WHO and other agencies in planning their response.

Prevention

It’s likely that many lives have been saved in the present epidemic through basic public-health measures alone. Isolating suspected cases early and encouraging people to seek treatment are key to this process, but this can prove challenging in communities where there is no established system of healthcare. Researchers from Umea University in Sweden have been working on a social marketing strategy with the goal of developing tailored public health messages specific to the cultural and societal context of this epidemic.Ian gf

Another key element of preventing the spread of Ebola in the present outbreak has been the widespread use of personal protective equipment. A team from International Rescue Committee UK is devising strategies to make sure health workers stick to the strict protocols for wearing and removing the equipment that are required for it to be effective.

Diagnostics

One of the challenges facing health workers in the three Ebola-affected countries has been the difficulty in quickly establishing a diagnosis, as symptoms of the early stages of infection are shared with many common diseases. Two diagnostic tests being developed with R2HC funding could revolutionise this process by delivering a rapid point-of-care diagnostic test for Ebola. One is developing a device to test for Ebola virus in saliva, while a second will create a solar-powered mobile suitcase laboratory capable of confirming a diagnosis within 15 minutes.

Societal factors

In the early stages of the epidemic, it is likely that certain cultural practices, such as preparing the bodies of victims for funerals when they are still highly infectious, contributed to the spread of the disease. Changing these practices requires a thorough understanding of the society in which the outbreak is taking place. The London School of Hygiene & Tropical Medicine has set up an anthropology platform to provide clear, practical, real-time advice about how to engage with crucial socio-cultural and political dimensions of the outbreak, and how best to build locally-appropriate interventions.

To find out more about the Wellcome Trust’s Ebola rapid-response research fund visit our Ebola funding page, or view  our previous post on What the Wellcome Trust is doing to tackle Ebola

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