In the wake of the world's first Ebola epidemic, efforts to develop a new treatment for the deadly disease have faced fire for moving too slowly.
In a Guardian feature today, intrepid global health reporter Sarah Boseley explains exactly why the race to find an Ebola cure has looked more like a rambling lurch.
In this paragraph, the British journalist sums up what a team of scientists trying to organize a treatment trial with the experimental drug brincidofovir in West Africa were up against:
The Oxford scientists had 15 days to visit eight potential [clinical trial] sites, spread across three countries paralysed by economic collapse, and where travel was limited by curfews and quarantine laws. They were looking for a treatment centre that fitted the exacting criteria for their trial. Horby [a researcher] described finding the right site as "like aligning the stars". They needed well-designed buildings, internet connectivity, reliable power and plug sockets. They needed to be sure the drugs could be kept securely on site. "You’ve got a long list [of possible sites], but when you look at who fits all the criteria, you rapidly cross them off," said Horby. "Finding one that’s easily accessible, got good infrastructure, international and local staff who are enthusiastic, good data management, good pharmacy, access to a good lab that’s willing to process research samples – and it’s got patients. There were hardly any that met all those criteria."
Not only was finding a trial site challenging, but there were two additional hurdles: by the time they got the necessary approvals to conduct a trial, the number of Ebola cases in West Africa was falling — meaning they wouldn't have enough patients to run a clinically meaningful experiment. What's more, they were doing something that was entirely unprecedented: testing drugs amid an epidemic of a very deadly illness.
It wasn't until August — about six months into the epidemic — that the World Health Organization gathered to discuss the ethics of treating people with experimental drugs for a deadly disease. "Given the appalling death toll, they concluded, it was [ethical] — but there was a moral responsibility to document the effects of the drugs and carry out proper clinical trials," writes Boseley.
By early September, the WHO released a list potential Ebola medicines and vaccines to try, and then came the difficult work of actually running the experiments. As Boseley shows in her piece, the scientists tried their best with the knowledge that they were probably too late getting started.
The troubling take away, for any observer of global health, is that questions about how to run trials in the middle of a pandemic or epidemic situation surface with every outbreak. And yet, as the Ebola epidemic demonstrated, we still don't have a framework in place for doing so.
There is good news, however. As one researcher writing in JAMA pointed out, the world's worst Ebola outbreak "sparked an unprecedented level of multinational cooperation to speed clinical trials of potential therapeutics and vaccines." Hopefully, with Ebola, we will get a pathway for experiments in place so that future cures aren't delayed and stifled. At the very least, this would mean that all the human suffering from Ebola wasn't for naught.
Read Boseley's piece here.