Opinion: This is how to fight the Ebola Outbreak

by Dr. Bayo Okelana

The cure for Ebola has been published multiple times in medical literature.[1,2,3,7] Animal and human models have consistently shown that antiserum from convalescent and survivor patients dramatically reduces mortality in severely ill Ebola patients, from about 85% to about 10%.[2,3] This was demonstrated in the 1990s by local doctors in the Congo during the Kikwit outbreak of 1995[4] and the results were published in 2000.[3] 

The doctors used whole blood transfusions from survivors to save actively ill patients. The drug companies have no interest in championing this information, but synthetic antisera and immune modulator drugs are actively being researched—but to what end and by whom? Money for research and development (R&D) on viruses like Ebola usually comes from sources interested in bio-terrorism. Investment funds for research and development focused on drugs to be used in treating such diseases as malaria, sickle cell, and Ebola are not as financially rewarding to a profit-driven pharmaceutical industry.

Since diseases largely confined to poor African people will not attract investment from private sources that largely fund development of new drugs, the morality issue pops up. When the good Dr. Kent Brantly, the American doctor who contracted Ebola while treating patients in Liberia, realized he was dying, he sought out survivor plasma from a willing 14-year-old boy. He is now in an Atlanta hospital and on his way to a miraculous recovery. Thank God for him, but was it possible to have offered, or to still offer, the same chance to dying Africans even if it means having them sign an indemnity clause in case they died or suffered adverse reactions from ‘novel’ therapy?

ebola-guinea

Rather than clamouring and begging the US to release the drug on orphan drug status, a method that bypasses full phase and human Federal Drug Administration (FDA) testing protocols in pivotal drugs, a country like Nigeria should champion the more rudimentary but equally efficacious use of survivor antisera.

Most Africans cannot afford ZMapp, the secret serum that essentially mimics the survivors’ monoclonal antibodies and which is being used on Dr. Brantly and his equally infected nurse assistant, Nancy Writebol, right now in the US.Respiratory Syncytial Virus (RSV) is a very common cause of morbidity and mortality in children five years and younger, especially in temperate Western countries, including the US. This is less virulent but similar in structure to the Ebola Filovirus. They are both negative sense single stranded RNA viruses.

There is a possibility that bringing this caveat to the attention of the pharmaceutical industry would spur increased private funding. A vaccine against RSV would be worth hundreds of millions of dollars and could confer immunity against Ebola as an alternate benefit.

There is a critical role for African countries in the fight against Ebola. First, they must push the point that African lives are worth saving. Information about the use of survivor plasma, and active collection and stocking by primarily African governments, will save many African lives. With foreign help, expertise, and global compassion, the process would be cheaper but not as lucrative as tax-exempt synthetic drug donations.

It is noteworthy that ZMapp was immediately made available to Dr. Brantly and Ms. Writebol in the US but not to the Africans, including several health workers who have died from the current outbreak. This drug has been in Phase 1 trials long before this most recent West African outbreak of Ebola.

The US initiative called Project Bioshield, which was signed into law by President George W. Bush in 2004, funds and permits the research, development, and stockpiling of vaccines and drugs not tested for safety or efficacy in humans due to ethical concerns [5] In cases of potential agents of bio-terrorism or natural catastrophes such as Ebola outbreaks, the FDA’s animal rule for pivotal animal efficacy is followed. Essentially, if animal testing has been shown to be efficacious and human testing not practical or possible, the agent can be legally released for human use, with caution. This effectively mutes the point that the drug, ZMapp, was not given to African patients because it is not ready.

Rather than clamouring and begging the US to release the drug on orphan drug status, a method that bypasses full phase and human Federal Drug Administration (FDA) testing protocols in pivotal drugs, a country like Nigeria should champion the more rudimentary but equally efficacious use of survivor antisera.

For cultural and other reasons, including issues of security, the use of African survivor plasma in the West is impractical and subconsciously anathema compared to a synthetic product derived from tobacco plants, as is ZMapp. Beyond investing in readily available human antisera, West African countries should also immediately adopt protocols for epidemiological control and containment.[6]

Literature Cited

1. Lee J,E, Fusco ML et al (2008). Structure of the Ebola virus glycoproteins bound to an antibody from a human survivor. Nature, 454(7201),177-82. PMID:18615077
2. Preparation of rabbit antiserum to Ebola virus. Chepurnov A.A. et al.
Vopr.virusol.1994. Nov-Dec,39(6)286-8
3. Treatment of Ebola Hemorrhagic Fever with blood transfusions from convalescent patients. K. Mupupa et al (2000)
4. Muyembe-Tamfum, J.J., M. Kipasa, C. Kiungu, and R. Colebunders. 1999. “Ebola Outbreak in Kikwit, Democratic Republic of the Congo: Discovery and Control Measures.” The Journal of Infectious Diseases 179 Suppl 1 (February): S259-262. doi:10.1086/514302
5. Georgewbush-whitehouse.archives.gov/news/releases/2004/07/20040721-2.html
6. Containing Hemorrhagic Fever Epidemic, The Ebola experience in Uganda (October 2000-2001) Lamunu M et al (2002)
7. An introduction to Ebola: The virus and the Disease. C.J. Peters and J.W. Peters

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