Ebola

The international humanitarian aid group Doctors Without Borders will start testing three new Ebola therapies at their sites in Africa in December

The health group Doctors Without Borders said Thursday that it will begin testing three therapies it hopes will prove effective in treating Ebola, as the death toll from the disease’s worst outbreak ever surpassed 5,000 and with and with more than 14,000 still affected in West Africa.

The group, which is leading the on-the-ground care of Ebola patients in Guinea, Liberia and Sierra Leone, is partnering with researchers and clinicians who want to learn more about the most promising treatments for Ebola, so that their doctors can provide patients more than the supportive care they deliver now.

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“We are on the front line, and when you have a disease that kills 50% to 70% of patients, then we have a certain responsibility to try to do our best to host trials for treatments in our facilities,” says Bertrand Draguez, medical director of Doctors Without Borders.

None of the therapies have been tested in the traditional way of moving through all stages of animal models and then into safety and efficacy trials in people. Instead, they are jumping from animal trials and early human safety studies in healthy people directly into patients. But given the urgency of the escalating epidemic, Draguez says, “the worst case scenario would be to not test anything.”

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One trial, spearheaded by the French National Institute of Health and Medical Research (INSERM) will see how well the antiviral drug favipiravir fares against Ebola in Gueckedou, Guinea. Another, headed by the Wellcome Trust, will test the antiviral drug brincidofovir at one of Doctors Without Borders’ treatment centers in the region that hasn’t been designated yet. Finally, the Antwerp Institute of Tropical Medicine will look at the effects of whole blood and plasma from Ebola survivors at the Ebola treatment center in Conakry, Guinea.

Why these three therapies? Draguez says they rose to the top of the list because of a combination of their promise in controlling the Ebola virus and their availability. Other treatments, such as ZMapp, a combination of antibodies that helped at least two U.S. aid workers survive their infections, are worth studying but won’t be available in enough doses to properly test in West Africa. “We said ‘OK, even if a drug looks promising we have to start with what we have,’” says Draguez. Both brincidofovir and favipiravir also have the added advantage of being oral pills and therefore more easily given to and taken by patients, many of whom are too weak to eat.

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Patients at the trial sites will be asked if they want to participate in testing new, experimental therapies for treating Ebola, and will be given detailed information about the drugs and their potential risks. Any patient can refuse to participate, and his care will not be affected by his decision.

The trails will focus on how well they help patients to survive for 14 days after the therapies start—enough time, the researchers hope, to suppress Ebola’s activity and encourage the patients’ own immune systems to fight the infection and begin to clear the virus.

MORE: WHO chief says Ebola response ‘did not match’ scale of the outbreak

The trials represent an important first step in gathering critical information about how best to treat Ebola infection. To date, such data is sparse—most of the information comes from case studies, and those primarily involved supportive care such as hydration and nutrition, which are important for patients in the early stages of infection, but can’t help those who are sicker. The handful of cases involving some of the experimental therapies aren’t enough to guide doctors on proper dosing, nor are they sufficient to give physicians confidence that they aren’t doing more harm than good when they use them.

The World Health Organization (WHO) and the countries’ Ministries of Health are also working with Doctors Without Borders and the study leaders to conduct the trials. WHO also recently announced plans to test two vaccines in West Africa as well.

All of these trials are designed to finally provide some order in the house of Ebola treatments. While the goal is to turn the results around quickly—the first data are expected in February 2015—it’s possible that much of what is learned from these trials may come too late for those currently infected. But they will prove invaluable for the inevitable outbreaks that emerge in the future.

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Experimental trials to find an Ebola treatment will begin next month in West Africa

An international health organization that has been leading the fight against the Ebola outbreak said Thursday that it will start experimental trials of treatments in West Africa next month.

MORE: Ebola death toll passes 5,000

There is currently no known cure for the virus, which has claimed at least 5,160 lives in the current epidemic. Doctors Without Borders, along with three different research partners from Belgium, France, and the U.K., will be leading the trials, which will test two antiviral drugs in Guinea and an unconfirmed location. The third trial in Guinea’s capital, Conakry, will use the blood of recovered Ebola patients to treat sick patients.

The World Health Organization and regional health authorities are also collaborating with the research partners.

Conducting clinical trials during a humanitarian crisis is unprecedented but MSF and partners have set up the trials with exceptional speed in an attempt to quell an outbreak with a fatality rate of around 70%.

MORE: Republicans grill Obama officials on Ebola funding request

“We need to keep in mind that there is no guarantee that these therapies will be the miracle cure” says Dr Annick Antierens, coordinating Doctor Without Borders’ investigational partnerships. “But we need to do all we can to try the products available today to increase the chances of finding an effective treatment against Ebola.”

The trials are expected to begin in December and initial results could be available as early as February 2015.

Republicans Grill Administration Officials on Quarantine, Czar

A Senate panel took a skeptical look at President Obama’s request for $6.2 billion to combat Ebola Wednesday, with Republicans grilling the Administration on its quarantine protocols and the role of Ron Klain, the President’s Ebola czar.

The ranking Republican on the Senate Appropriations Committee, Richard Shelby, criticized the Administration’s “confusing and at at times contradictory” claims about the effectiveness of a quarantine. He and other GOP Senators questioned why the Pentagon has ordered a mandatory 21-day isolation period for all military personnel returning from the affected West African countries, while the federal government took months to add enhanced airport screenings for civilians and other non-military personnel traveling to the region.

Health and Human Services Secretary Sylvia Burwell responded that while she respected the Pentagon’s quarantine directive, the military’s decision “was not based on the science.”

Shelby also questioned the role of Ebola czar Ron Klain, saying that “all reports indicate that he has no actual authority.” The witnesses responded that they had been in frequent contact with Klain. Burwell said she had been in touch him “every day” and touted the “added value” Klain brings to coordinating policies with the departments and the White House.

Senate Appropriations Committee Chairwoman Barbara Mikulski, who will lose her gavel to Shelby in the new Republican-majority next year, said the emergency request to contain and eradicate Ebola met her criteria.

“It’s sudden, unanticipated, unforeseen, urgent and temporary,” Mikulski said. The country, she added, needs to “face very clearly the fear that it generates” and repeated that America has had nine, “N-I-N-E,” cases while West Africa has dealt with thousands. Mikulski added that she wants the Ebola funding to go into a year-long omnibus bill, which must pass by Dec. 11 to avert a government shutdown.

Nearly $3 billion of Obama’s request will be allocated to USAID and the State Department, which will use the money for additional training of health care workers and burial teams and to build and maintain more treatment centers. Heather Higginbottom, Deputy Secretary of State for Management and Resources, told the panel the U.S. anti-Ebola effort is “the largest-ever U.S. government response to a global health crisis,” with more than 1,800 Pentagon officials, 36 USAID workers and 163 Health and Human Services personnel in West Africa.

Much of the rest of the requested spending—$2.4 billion—would go to the Department of Health and Human Services, which will continue to ramp up U.S. hospital training. HHS says that more than 250,000 health care personnel have participated in the department’s informational events. Hundreds of millions of dollars would be allocated to the Center for Disease Control and Prevention and the National Institutes of Health, which would, respectively, hire more officers to investigate and monitor the disease and invest in research and development of vaccines.

The World Health Organization announced Wednesday that there were 14,098 reported cases and 5,160 deaths in the current outbreak, with the vast majority in Sierra Leone, Guinea and Liberia. This week the last known Ebola patient in the United States was cured and released from a New York hospital.

Silicon Valley's humanitarian aid doesn't normally come in the form of cash — it comes in the form of tech

Until last week, there was one group largely missing from the list of Ebola donors: Silicon Valley companies.

Facebook’s and Google’s donation campaigns arrived months into an outbreak that in early summer had already been deemed “the worst Ebola outbreak in history.” And while their giving initiatives are generous — Facebook leveraged valuable online real estate for donation banners, while Google has already raised $5.1 million with its double-matched donations — it’s hard not to ask a lingering question: Why not sooner?

The question has plagued most humanitarian efforts in the Ebola fight. The World Health Organization’s chief criticized the timing of international support, mostly from governments, NGOs and international groups, as being “too little, too late” as far back as September. Some critics have even stepped forward to blast Silicon Valley companies over their timing directly — a Washington Post column noted that multimillion dollar gifts from Silicon Valley figureheads like Mark Zuckerberg and Bill Gates highlighted the silence from the companies themselves. Another critic argued that Silicon Valley corporations, so-called promisers of change, were hypocritically “sitting out” the Ebola fight.

But companies like Facebook and Google weren’t really “sitting out.” Silicon Valley’s humanitarian aid doesn’t normally come in the form of cash — it comes in the form of tech. Google’s Ebola donation campaign was a product of its nonprofit arm, which funds innovative groups using technology to change the world, a Google spokesperson says. Facebook has used its site to show its massive audience how to support nonprofits fighting Ebola, says a spokesperson at the U.N. Foundation, which has worked with Facebook for months to promote Ebola aid.

Tech has been at the forefront of Silicon Valley’s aid in previous crises too. Google launched crisis maps to aid emergency preparedness and response, while Facebook’s social network, recently a platform for the ALS Ice Bucket Challenge fundraising phenomenon, has facilitated communication during disasters. Still, while both companies have used their platforms to invite donations in the past, like during last year’s Typhoon Haiyan in the Philippines, neither had ever asked their users for help so directly — especially Facebook, which just last week followed Google’s example and started asking users to donate to various humanitarian organizations. That move, a Facebook spokesperson says, was way to amplify Facebook’s other ongoing humanitarian-contribution efforts.

Facebook and Google’s Ebola donation requests are just two ground-level examples of humanitarian efforts from an industry that’s better known for long-term, moonshot-style tech for a cause. Google has plans for a pill that can diagnose cancer and a smart contact lens that monitors diabetics’ glucose level, for example, while Facebook is developing solar-powered drones that beam down Internet access to less developed regions of the world. And few people in the humanitarian community really expect Silicon Valley companies, flush with cash as they are, to solicit donations or shell out their own money, but they very much welcome Facebook and Google’s efforts here.

“Silicon Valley companies have been very generous, as companies, to respond to different disasters. But for them to take a public stand and campaign like they’ve done is unprecedented,” says Rebecca Milner, vice president of institutional advancement at International Medical Corps (IMC), one of three nonprofits on Facebook’s Ebola donation banner.

IMC and other public-health organizations say they don’t consider Facebook’s and Google’s efforts to be too late. That’s partly because Silicon Valley isn’t usually involved in large coordinated efforts with humanitarian organizations, which work mostly with governments, NGOs and nonprofits. But that’s something that’s starting to change. Still, health experts believe that looking back — especially tempting now when we hear the best time for aid would’ve been before the Ebola outbreak even began — isn’t as useful as discovering how Silicon Valley’s humanitarian-engagement methods can be a powerful tool in the Ebola fight moving forward.

“This is something we’ve been chasing the whole time, and it’s hard to get in front of,” says Kate Dodson, vice president of global health at the U.N. Foundation. “It’s a learning process for all of us who are trying to support those on the front lines of the Ebola response.”

Unconnected to previous incidents

(BAMAKO, Mali) — Malian authorities on Wednesday reported two new deaths from Ebola that are not believed to be linked to the nation’s only other known case, an alarming setback as Mali tries to limit the epidemic ravaging other countries in the region.

The announcement in this city of about 2 million came just a day after Malian health authorities said there had been no other reported cases — let alone deaths — after a 2-year-old girl who had traveled to Mali from Guinea succumbed to the virus in late October.

A nurse working at a clinic in the capital of Bamako died Tuesday, and tests later showed she had Ebola, Communications Minister Mahamadou Camara said Wednesday. A patient she had treated died on Monday and was later confirmed to have had the disease as well.

The patient — a Guinean national — came to the Clinique Pasteur on Oct. 25 late at night and was so ill he could not speak or give information about his symptoms, said the head of the clinic.

“His family did not give us all the information that would have led us to suspect Ebola,” Dramane Maiga told The Associated Press.

Government health officials were slow to act, Maiga said. The nurse was hospitalized on Saturday and hospital officials did not call the health ministry until Monday morning. Health officials did not arrive at the clinic until 6 p.m. and by the time the test results came back, the 25-year-old nurse was already dead, said Maiga.

The new Ebola cases come just as public health officials started to think Mali had avoided the worst. The cases are stark reminders that the disease is hard to track and the entire West Africa region remains vulnerable as long as there are cases anywhere.

Nearly 5,000 people have died this year in the region from the virus, which first erupted in Guinea, on Mali’s border.

Mali’s first case initially caused alarm because officials said the toddler was bleeding from her nose as she traveled with relatives by public transport from Guinea to Mali, passing through Bamako and other towns en route to the western city of Kayes, where she died. Ebola is transmitted through the bodily fluids of people who are showing symptoms, which include bleeding, vomiting and diarrhea.

On Tuesday, officials said nearly 30 members of a family that was visited by the sick 2-year-old girl have been released from a 21-day quarantine after they showed no symptoms of the disease. Ebola can take up to 21 days to incubate.

About 50 other people who had possible contact with the girl remain under observation in Kayes, 375 miles (600 kilometers) from Bamako. They will be released from quarantine on Nov. 16 if they don’t show symptoms.