Clinical Trials Are Being Launched in Africa but Face Challenges in Designing Ethical Studies, Compensating Donors

WALL STREET JOURNAL                                                                                                    Dec. 5, 2014
by Betsy McKay in Atlanta, David Gauthier-Villars in Conakry, Guinea, and Patrick McGroarty in Monrovia, Liberia

...Nearly a year after Ebola began spreading in West Africa, and with a proven drug or vaccine still far off, researchers are launching clinical trials on a product at hand: the blood of survivors.

 They want to determine whether so-called convalescent plasma or serum, chock full of antibodies, can help fight off the disease. But they face a number of complexities in carrying out the trials, including persuading survivors to participate....

Additonal  Nigerian and British health workers arrive in Liberia and Sierra Leone to help counter Ebola

(Two stories, scroll down)

REUTERS  by James Harding Giahyue and Umaru Fofana   Dec. 5, 2014
MONROVIA/FREETOWN --More than 175 Nigerian medics arrived in Liberia and Sierra Leone on Friday to join the fight against Ebola, the first of 600 volunteers promised by the regional giant which contained its own outbreak earlier this year.

An army medic teaches NHS staff how to dispose of potentially contaminated waste last month, before their deployment to Sierra Leone. Photograph: Simon Davis/AFP/Getty Images

The medics will boost weak local health systems that are also struggling to contain other preventable diseases as Ebola discourages people from going to clinics for fear of contracting the fever.

"This is the African spirit you are showing, this is the Nigerian spirit,” Nigeria's ambassador to Liberia, Chigozie Obi-Nnadozie, told 76 Nigerian medics who landed there.

Another 100 volunteers landed in Freetown, Sierra Leone. Months into the Ebola response, experts say they are still short of medical personnel to staff treatment centers.

ASSOCIATED PRESS by EDITH M. LEDERER                                                                             Dec. 5, 2014

UNITED NATIONS -- Sierra Leone said Friday that between 80 and 100 new cases of Ebola are being reported every day and the country now hardest-hit by the deadly virus desperately needs over 1,000 beds to treat victims.

Sierra Leone's Finance Minister Kaifalah Marah painted a grim picture to the U.N. Economic and Social Council Friday of the challenges facing his West African nation which failed to meet a World Health Organization interim goal of isolating 70 percent of Ebola patients and safely burying 70 percent of victims by Dec. 1.

The two other hard-hit countries, Liberia and Guinea, did meet the deadline, and the U.N.'s Ebola chief Dr. David Nabarro said the number of new cases in Liberia has dropped from 60 per day in September to 10 per day. ...

VOICE OF AMERICA                                      Dec. 3, 2014

New data shows the Ebola outbreak intensifying in Sierra Leone, even as it stabilizes or drops off in other West African countries.   (Scroll down for link to WHO roadmap.)

The World Health Organization says Sierra Leone reported 537 new confirmed cases in the week ending November 30, a jump of more than 150 over the week before.  

In its latest update Wednesday, the WHO says "transmission remains persistent and intense across the country with the exception of the south."  The worst affected area was the capital, Freetown, where more than 200 new cases were reported.  

According to the WHO, the number of Ebola cases worldwide is more than 17,000, with all but a few dozen in Sierra Leone, Guinea and Liberia.  The overall death toll is up to 6,070.

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http://www.voanews.com/content/ebola-spreading-faster-in-sierra-leone/2544743.html?utm_source=December+4+2014+EN&utm_campaign=12%2F4%2F2014&utm_medium=email

THE NEW ENGLAND JOURNAL OF MEDICINE                                                                                 Dec. 3, 2014
By Edward Cox, M.D., M.P.H., Luciana Borio, M.D., and Robert Temple, M.D.

...Studying investigational therapies for EVD presents scientific, practical, and ethical challenges. Not surprisingly, there has been substantial debate about the best and most appropriate study approaches.2,3 It is generally agreed that a trial with a concurrent control group, in which patients are randomly assigned to receive the test drug plus the best available supportive care (BASC) or to BASC alone, would be the most efficient and reliable way to evaluate the safety and effectiveness of candidate products.

 Some people in the health care community, however, have argued against such trials, urging instead use of a historical control — that is, making investigational drugs as widely available as their supply allows and then comparing mortality rates among treated patients with rates that would have been expected absent the drugs, on the basis of past experience with EVD.

INSTITUTE FOR SECURITY STUDIES                                                                                Dec. 2, 2014

Morocco’s refusal to host the Africa Cup of Nations (Afcon) from 17 January to 8 February next year, due to fears of Ebola,has sparked a furore among soccer lovers across the continent.

The North African kingdom has since become the target of some of the most aggressive xenophobia from fellow Africans, notably on social media. ‘Morocco is scared of outsiders,’ ‘Morocco is not an African country,’ are some of the insults that have been directed at the country in the wake of its decision.

... The competition has now been moved to Equatorial Guinea, co-host of the 2012 Afcon with Gabon. This decision has huge financial and political implications. Morocco has also been barred from participating in the 2015 Afcon, and risks more sanctions for its national team and Moroccan clubs.

World Bank Meanwhile lowers growth forecasts.

(See link below to World Bank Report)

ASSOCIATED PRESS                                                                                               Dec. 2, 2014
By JONATHAN PAYE-LAYLEH and SARAH DiLORENZO

MONROVIA, Liberia (AP) — The international response to Ebola is still too slow and piecemeal, Doctors Without Borders warned Tuesday, as officials said the disease is crippling the economies of the three West African countries hardest hit....

"Foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing them up to national authorities, local health care staff and NGOs (non-government organizations) which do not have the expertise required to do so," said the group, which is a primary provider of treatment in the outbreak, said in a statement Tuesday.

It reiterated its call for countries with biological-disaster response teams to deploy them.

NEW YORK TIMES  By Sheri Fink and  Somini Sengupta                                                       Dec. 2, 1014

GENEVA — The World Health Organization expressed doubt on Monday about achieving important United Nations benchmarks in battling Ebola, saying the year-end goals of isolating and treating all patients and safely burying all the dead would be major challenges.

REUTERS  -- By Roberta Rampton                                                                      Dec. 2, 2014

WASHINGTON --President Barack Obama on Tuesday will press Congress to approve $6.18 billion in emergency funding to help fight the Ebola outbreak in West Africa and prepare U.S. hospitals to handle future cases.

Most of the request is aimed at the immediate response to the disease at home and abroad. But the package also includes $1.5 billion in contingency funds - money that could become a target if lawmakers decide to trim the bill.

"That is the part of the package that is most at risk," said Sam Worthington, president of InterAction, an alliance of U.S. non-governmental aid groups.

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BBC    By   Mark Doyle                                                                                                        Dec. 1, 2014

Tony Banbury declined to say if targets he had set in the fight against Ebola, to be achieved by Monday, had been met.

The targets were for the proportion of people being treated and for the safe burial of highly infectious bodies.

In October, Mr Banbury told the UN Security Council that by 1 December, "70% of all those infected by the disease must be under treatment and 70% of the victims safely buried if the outbreak is to be successfully arrested".

Mr Banbury said the 70% targets were being met in "the vast majority" of areas in the three worst-affected countries - Guinea, Sierra Leone and Liberia.

"But in some areas", he said, "including here in Sierra Leone - especially in the capital Freetown and in the town of Port Loko - we are falling short. And it is in those areas where we really need to focus our assets and our capabilities".

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DESIGN & TREND  by Randall Mayes                                                                             Nov. 29, 2014

Over the last decade, we have witnessed the emergence of Superbugs, various strains of bird flu and now Ebola, which do not have geographical borders.

Consequently, there is a pressing need for international cooperation to control these pandemics.

In a new study, researchers have identified obstacles that are currently preventing the world from sharing health data, reports Science Daily.

While performing a literature search for the study, an international group of researchers discovered over 1,400 scientific articles related to sharing public health data. From those articles, they found two broad categories that need to be addressed.

Read comlete story
http://www.designntrend.com/articles/28008/20141129/urgent-need-improved-infrastructure-share-health-data.htm

Link to article  in Science Daily
http://www.sciencedaily.com/releases/2014/11/141125102102.htm

REUTERS                                                                                                                      NOV. 28, 2014

LONDON --Men who recover from Ebola should abstain from sex for three months to minimize the risk of passing the virus on in their semen, the World Health Organization (WHO) said on Friday.

Ebola, a disease that has infected and killing thousands in a vast epidemic in West Africa, normally spreads via bodily fluids such as blood, saliva and faeces. Although sexual transmission of Ebola virus disease has never been documented, the virus has been detected in the survivors' semen.

"Men who have recovered from Ebola virus disease should be aware that seminal fluid may be infectious for as long as three months after onset of symptoms," the WHO said in a statement....

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http://www.reuters.com/article/2014/11/28/us-health-ebola-sex-idUSKCN0JC0UP20141128

Description of efforts by the big drug companies to develop an Ebloa vaccine
THE NEW YORKER    By Vauhine Vara                        Nov. 25, 2014

"...why this race to create an Ebola vaccine among Merck, GlaxoSmithKline, and Johnson & Johnson—three of the world’s biggest drug manufacturers? For years, pharmaceutical companies didn’t invest much in vaccines, partly because they were so costly and complicated to produce: they’re often made out of live bacteria, which are notoriously difficult to work with. But, over the past several years, companies have realized that the difficulties of making vaccines could be an asset, because they can make it more difficult for generic-drug companies to create copycat versions than for prescription drugs. The vaccine market has also been growing more quickly than the prescription-drug market. The World Health Organization estimates, based on various sources, that global vaccine sales rose from five billion dollars in 2000 to twenty-four billion dollars last year...."

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http://www.newyorker.com/business/currency/race-ebola-vaccine

PLOS CURRENT OUTBREAKS                                                                              Nov. 21, 2014
By David Fisman and Ashleigh Tuite, Dalla Lana School of Public Health, University of Toronto

As removal of population-level susceptibility through vaccination could be a highly impactful control measure for this epidemic, we sought to estimate the number of vaccine doses and timing of vaccine administration required to reduce the epidemic size. Our base model was fit using the IDEA approach, a single equation model that has been successful to date in describing Ebola growth. We projected the future course of the Ebola epidemic using this model. Vaccination was assumed to reduce the effective reproductive number. We evaluated the potential impact of vaccination on epidemic trajectory under different assumptions around timing of vaccine availability.

Benno Muchler - November 25, 2014 - qz.com

Ebola was one of the biggest news stories this year. What did we learn from it? Not much. Panic and fear replaced rational thinking. And there was another pernicious behavior we didn’t change.

Ebola would have been a chance to start differentiating Africa. Yet, we’re doing quite the opposite. We continue to look at Africa as one country. We act as if the whole continent is contaminated. And most sadly, outside Africa we stigmatize Africans, no matter which part of the continent they’re from, because of Ebola.

Read the whole article here:

http://qz.com/301707/people-are-treating-africa-like-a-country-because-of-ebola/