WHO, Ebola-hit countries air steps to boost health systems

At a 2-day meeting at World Health Organization (WHO) headquarters in Geneva today, top health officials from the three hardest-hit Ebola countries and global health officials started formal discussions on strengthening health systems to recover from the outbreak and prepare for future threats.

In other Ebola developments, a Swiss trial of an experimental Ebola vaccine hit a snag, and US health officials announced that an American nurse potentially infected by Ebola would be airlifted to the National Institutes of Health (NIH) Clinical Center in Bethesda, Md., for observation.

WHO meeting

Marie-Paule Kieny, PhD, the WHO’s assistant director general for health systems and innovation, said at a media telebriefing today that the goal of the meeting was to discuss medium-term and longer-term steps to improve the countries' response to Ebola and other health threats. Officials have agreed on some general principles, but have noted discussions should revolve around each country’s specific needs.

Another challenge will be how to fold assets deployed in the outbreak region into a plan for future health system growth, she said. The meeting’s outcome won’t be a concrete roadmap, but rather an overall framework that will encourage countries to develop their own specific roadmaps.

Bernice Dahn, MD, Liberia’s chief medical officer, told reporters, ""We realize there have been weaknesses in the system that led to an outbreak that we couldn’t control."" Because of Ebola activity, many pregnant women haven’t been able to access healthcare, children aren’t receiving their recommended vaccinations, and about 65% of the country’s health facilities have been closed at some point.

Though the battle against the disease is far from over, Dahn said Liberia is in the early stages of post-Ebola planning, which starts with an assessment of Ebola’s impact on the country. Weak spots already identified include disease surveillance, preparedness, and response.

Dr. Abu Bakarr Fofanah, Sierra Leone’s health minister, said the country has come a long way since the first days of the outbreak, but has not been able to catch up with the disease.

Sierra Leone was ill prepared to face the challenge, he said. For example, when the outbreak first began, the country had only one lab that could diagnose the disease, and it had only 58% of the health workforce it needed. ""The challenge wasn’t just limited numbers, but also competencies,"" Fofanah said, adding that he could count on one hand the number of ambulances Sierra Leone had when the virus first emerged.

"We are making progress here and there, with support of the international community," he said. "But the fight is still on."

Vaccine trial pause, therapy news

Swiss researchers have temporarily suspended a human trial of the experimental Ebola vaccine developed by Canadian researchers after some of the participants reported mild joint pain, Reuters reported, citing a statement from University of Geneva Hospital. The vaccine, called VSV-EBOV, uses an Ebola virus protein spliced into a vesicular stomatitis virus (VSV).

The human safety trial of the vaccine, licensed by Newlink Genetics and Merck, began on Nov 10. Four of 59 vaccinees reported joint pains in their hands and feet, lasting a few days, in the second week after they were vaccinated. Researchers halted the trial as a precaution. The patients are doing well and are being monitored by the study team.

Earlier this month, the university released a statement saying no serious side effects were seen after the first few people were vaccinated.

Teams conducting trials of the same vaccine underway in the United States, Germany, Canada, and Gabon haven’t reported any inflammation symptoms in volunteers, according to the report.

When asked about the research pause at today's WHO briefing, Kieny said the trial pause would allow researchers to assess the problem, but she expects that the trial will be able to continue as planned. "It’s not a setback, not at all," she said.

Meanwhile, the Global Alliance for Vaccines and Immunization (GAVI) Alliance announced today that its board approved a plan to buy millions of doses of Ebola vaccine to support large-scale vaccination efforts in West Africa. It said the decision means GAVI will be ready to act as soon as the WHO recommends a safe, effective vaccine.

The plan would commit up to $300 million to buy vaccine to immunize at-risk populations, GAVI said in a press release. It added that an additional $90 million could be used to help countries introduce the vaccines, rebuild health systems, and restore immunization services for all vaccines in the hardest-hit countries. The money would come from both existing and new funds.

In therapy developments, ARCA biopharma, Inc., based in Westminster, Colo., yesterday announced that the Food and Drug Administration has granted orphan drug designation to rNAPc2 as a potential Ebola treatment, according to a statement from the company. It said the drug candidate has shown postexposure efficacy in nonhuman primate studies.

The drug was originally developed as a treatment for thrombosis and other conditions, for which it has already been found safe in phase 1 and 2 human trials. ARCA said the drug is a potent and selective tissue factor inhibitor, and its usefulness for Ebola could come from its potential to treat hemorrhagic aspects of Ebola infection.

Meanwhile, a report today in Emerging Infectious Diseases (EID) said convalescent plasma treatment for Ebola patients might be best accomplished by using virus-inactivated plasma. Thomas Kreil, PhD, of Baxter BioScience in Vienna, Austria, wrote that the treatment has received considerable attention, but safety and other aspects should be considered before the treatment is scaled up.

Screening donated blood for HIV, malaria, and other pathogens is daunting, considering the health system challenges in West Africa’s outbreak setting. Transfusion of plasma alone would sidestep a number of concerns, and donors could donate more frequently, Kreil wrote. Antibody testing in affected areas could identify those who had asymptomatic infections, who could be even more effective plasma donors.

Though methods to inactivate viruses in plasma could help alleviate some of the testing burden, Kreil acknowledged that even the inactivation step would face capacity challenges. He added that the interim WHO guidance on use of blood and plasma for Ebola treatment would benefit from including a chapter on virus inactivation for plasma.

Nurse to be airlifted to Bethesda

The NIH said it expected to admit to its clinical center later today a patient who was possibly exposed to Ebola. The patient, an American nurse volunteering in one of Sierra Leone’s Ebola treatment units, will be observed and enrolled in a clinical protocol.

No other details are available about the patient, who would be the second potentially infected patient to be monitored the NIH Clinical Center. Its first was Lewis Rubinson, MD, PhD, who had suffered a needle-stick injury while working for the WHO in Sierra Leone. He had some possible symptoms of the disease, but his tests were negative for Ebola.

On Dec 4, Emory University Hospital received another American health worker from West Africa who may have been exposed to the Ebola virus.

The patient arriving at the NIH today would be the eighth American worker to be airlifted from the outbreak region.

Other developments

  • Doctors without Borders (MSF) said yesterday that as part of its emergency response to the Ebola outbreak it has launched large-scale distribution of antimalarial medication in Sierra Leone. In a statement, it said teams distributed 1.5 million treatments to residents of Freetown and five districts in the western area, with the goal of protecting people during malaria’s peak season. It said malaria symptoms resemble initial Ebola symptoms and that keeping people sick with malaria from seeking evaluation at Ebola treatment centers can relieve some of the burden on responders.

  • Sierra Leone’s government has imposed a 2-week lockdown in Kono district, the site of a recent Ebola surge in cases, according to an update today from the United Nations Mission for Ebola Emergency Response (UNMEER). The response confined the virus to about half of the district’s chiefdoms, but WHO teams have been alarmed by the situation there, in which teams buried 87 people in 11 days. Also, the UN Development Program completed work on two prison isolation units in Freetown to help curb outbreaks in that population. The same group has also trained 34 workers from a military hospital to handle waste disposal and run autoclaves.

  • Saudi Arabia’s King Abdullah has donated $35 million to the Islamic Development Bank to support Ebola response efforts, Kuwait News Agency (KUNA) reported today.

See also:

Dec 11 UNMEER report

WHO meeting background materials

Dec 11 WHO media briefing audio file

Dec 11 Reuters story

Dec 11 NIH press release

Dec 11 GAVI Alliance press release

Dec 10 ARCA biopharma press release

Dec 11 EID report

Dec 10 MSF statement

Dec 11 KUNA report

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