‘Ebola is just one of many neglected diseases’
Tests with vaccines on humans to treat Ebola will probably be carried out in Switzerland. Marcel Tanner of the Tropical and Public Health Institute in Basel told swissinfo.ch why it took nearly 40 years to find an antidote to the disease sweeping West Africa.
It is the worst Ebola epidemic in history, with West Africa reporting more than 6,600 cases so far. The virus was first found about 40 years ago but neglected as it was considered minor compared with other diseases. But now it is urgent to develop a vaccine to protect the health staff working in the crisis zones.
The World Health Organization (WHO) on Friday said there should be thousands of doses of experimental Ebola vaccines available in the coming months and they could eventually be given to health care workers and other people who have had contact with the sick.
However, officials cautioned that no vaccine has yet been proven safe or effective in humans. Testing has now begun to make sure they are not harmful to people.
swissinfo.ch: The Federal Health Office last week announced the first suspected case of Ebola in Switzerland. Initial tests suggest found it was a false alarm. Are you concerned about the disease spreading to Switzerland?
Marcel Tanner: No. This case in Lausanne shows that our health system is capable of coping with the situation. All the measures of intensive care will be applied if further tests were to prove positive.
We had a case of Ebola in Basel 20 years ago. Very much like today there were no vaccines or medication. We know that even minor measures, including the isolation of the patient and careful hygiene, help reduce the mortality rate.
swissinfo.ch: Are you saying that the risk of the Ebola virus spreading to Europe is minimal?
M.T.: Exactly. Our health systems can deal with the problem. It is interesting to observe Nigeria where no new cases of Ebola infection have been registered for quite a while. If the correct measures are taken quickly, even a health system which might be less than top, can block the spread of the disease.
swissinfo.ch: Two vaccines against Ebola will most likely be tested on humans in hospitals of Lausanne and Geneva. Why are the decisive stages of research occuring in Switzerland?
M.T.: It is primarily the idea of the WHO which is based in Geneva. It is best to test the vaccines under the same strict conditions and compare the outcomes. Our hospitals provide the necessary infrastructure to carry out these tests.
The aim of the clinical experiments is to find out whether a vaccine is able to provoke an immune response in a human.
swissinfo.ch: What about possible unwanted side-effects which can appear even after years?
M.T.: It is a risk we have to take. We cannot consider safety aspects exclusively, otherwise no medication would be produced at all. For example: Five or six years ago we had to withdraw a drug against sleeping sickness in Congo because there were unusual side-effects. As a result the disease can no longer be treated with a drug that was developed 50 years ago because it is lethal for up to five patients among 100 people.
Assessing the risks for a vaccine against Ebola has to take into account both the benefits and the urgency of a situation. We want to immunise health workers as soon as possible. The most important aspect is not the people dying of Ebola, but the fact that the health systems are collapsing.
It is a huge problem as the personnel in hospitals in the suburbs are afraid of going to work. There is no protective clothing, no disinfectants. Who would want to work in such conditions?
swissinfo.ch: The first Ebola epidemic dates back to 1976 but no vaccine or treatment has been developed in nearly 40 years. Why is that?
M.T.: Ebola is one of the many diseases that are neglected, like malaria, sleeping sickness and parasite infections. Promoted by the Médecins Sans Frontières group, the Drugs for Neglected Diseases Initiative (DNDi)External link [aimed at combating such diseases by developing the necessary medication] has helped a lot.
But as available funds are limited, it is crucial to set priorities. About $1 billion (CHF947.2 million) per year is invested in the fight against malaria. If we could, we would use as much to combat Ebola. We have always considered Ebola as a minor epidemic which can be contained with hygiene measures and isolation of the victims. That’s how we treated patients in the Democratic Republic of Congo about 20 years ago to fight a particularly aggressive version of the virus. At the time nobody said it was necessary to have a drug as these measures were good enough. Now, the situation has changed of course.
swissinfo.ch: Several potential vaccines and other treatments for Ebola have emerged seemingly out of nowhere over the past few months. Have these drugs been kept in the closet or has research been particularly fast?
M.T.: First of all, it has to be said that there are always researchers working out of the spotlight who are making progress, particularly in the field of hemorrhagic viruses, such as Ebola. Secondly, in the context of biological warfare, the Americans had a treatment at their disposal which was developed by the military.
swissinfo.ch: Has the pharmaceutical industry lost interest in diseases which ultimately generate only small revenues?
M.T.: That’s what many said and what even I thought in the 1990s. But by launching the DNDi, the cooperation between industry and the public sector was boosted. Not all the pharmaceutical industries are equally zealous. But the public sector is also responsible for setting priorities.
The main criticism concerns the fact that we could not achieve quicker results. But criticism can also be leveled at academic circles. Maybe we did not do enough to draw attention to the disease. But bear in mind, the problem of Ebola is small compared to other diseases. It is a neglected disease among other neglected diseases.
As I said before, it is always a question of setting priorities and society also has a say on that. A consensus has to be found on what, and where, we want to invest. To give an example: we need vaccines against Alzheimer’s and other old-age related diseases. Why is nothing done in this field of research?
swissinfo.ch: What other viruses exist that quickly demand a vaccine?
M.T.: A disease that is often forgotten is dengue. The experimental vaccine has a limited efficiency rate of about 50%. That is not enough.
Malaria also springs to mind, which causes the death of one person every minute.
Most victims of the current Ebola epidemic are aged between 15 and 44.The mortality rate is 70.8% according to the New England Journal of MedicineExternal link. The findings are based on cases reported by September 14, 2014.
The course of the infection and the incubation period – 11.4 days on average – are similar to previous Ebola epidemics in the past. Guinea, Sierra Leone and Liberia are the countries most affected by the epidemic which could result in up to 20,000 victims according to WHO.
WHO has identified two vaccines considered promising against the latest Ebola epidemic. The first is an adenovirus found in chimpanzees, developed by the United States health authorities and the pharmaceutical company, GlaxoSmithKline. The second is the vesicular stomatitis virus. It is owned by NewLink Genetics and licenced by the same US company.
Clinical tests with the two vaccines will be carried out on about 100 volunteers in Lausanne and Geneva hospitals. They are awaiting permission by Swissmedic, the country’s agency for therapeutic products and the government’s advisory ethics commission.
(Adapted from Italian by Urs Geiser)
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