Q&A: Ebola spreads in Africa, an in-depth look at the outbreak and future of emergency response planning

As the current Ebola outbreak spreads from one country in West Africa to the next, the epidemic is raising awareness of the vital role that public health and emergency response play in such scenarios, and the need for future planning to mitigate similar threats. Dr. Scott Lillibridge, infectious disease expert and assistant dean at the Texas A&M School of Public Health, and Dr. Gerald Parker, vice president for public health preparedness at Texas A&M Health Science Center, talk about the current state of the outbreak and the future of biosecurity efforts to combat the next one – whether in the form of Ebola or another life-threatening pathogen.

Q: How would you characterize the current state of public health in Africa, and more specifically, the infection control infrastructure?
Dr. Lillibridge: Swelling populations, rapid urbanization and lack of infrastructure characterize many aspects of life in Africa. Civil conflicts only add to this burden. Consequently, United Nations agencies, nongovernmental organizations (NGOs), and faith-based entities play a critical role in maintaining the health of these populations and in supporting ministries of health in many of these countries. For example, the NGO Doctors Without Borders has a long history of relief and developmental work in these affected regions. However, despite being rich in resources ranging from petroleum products to diamonds, many regions in Africa are not improving with respect to the health of their populations. Due to poverty and diseases such as HIV, life expectancy is reduced in many countries, and their health systems lack the infrastructure to reach the standards of medical practice that would be considered essential in developed countries.

Q: What does the fight to control the Ebola epidemic look like “on the ground?”
Dr. Lillibridge: Among the many factors needed to mount a successful campaign to address the situation in West Africa, controlling the spread of infection in hospital settings, education of the public, and enhancing disease reporting will form critical aspects of the current Ebola emergency response. This framework is needed because there are few specific remedies and it is nearly impossible to spread the disease unless you have contact with bodily fluids from an infected and usually very ill individual. Consequently, rigorous infection control measures along with proper personal protective equipment in clinical settings are key to controlling Ebola. While there is a high probability the current outbreak will be controlled, there are no guarantees that classical infection control measures are the entire answer.

Many countries and the World Health Organization (WHO) are assisting with this complex health problem in West Africa. These entities are providing technical assistance and training a workforce capable of controlling the spread of disease long after relief agencies have returned home. Additionally, the United States is sending Epidemic Intelligence Service (EIS) specialists and other staff into the region to assist WHO and ministries of health to implement these important prevention and control measures.

Q: How should America address the Ebola outbreak in Africa in the long-term?
Dr. Parker: Up until recently, there has been limited interest by the private pharmaceutical industry for fully developing an Ebola vaccine or even specific commercial medical treatments for Ebola victims. The reasons for this have somewhat to do with the high cost of drug development and the time required to make and test a vaccine to be licensed, along with the lack of perceived benefit to the population for seemingly rare diseases. However, based on the current epidemic, health care workers, researchers, and emergency responders who perform work related to the Ebola virus could benefit greatly from a licensed vaccine and other medical remedies.

*Many believe the United States government’s vaccine factories, the network of Centers for Innovation in Advanced Development and Manufacturing, could play a valuable role in accelerating the development and manufacturing of the most promising vaccine therapeutic candidates. This network is designed to work “hand in glove” with early research efforts to identify possible vaccine candidates by the National Institutes of Health (NIH) and other United States and allied government research partners. It is encouraging to learn that a promising therapeutic candidate utilized in one of the recent Ebola victims may have been responsible for a patient’s improvement. Of course, more studies and work are needed.

*The Texas A&M Center for Innovation in Advanced Development and Manufacturing is one of three government-funded biodefense centers aimed at building the national countermeasure stockpile to stand ready with a near-immediate response to the next national public health threat. Additional information on the center’s efforts can be found here.

Q: How does the recent Ebola outbreak relate to the future of biosecurity?
Dr. Parker: While strict infection control measures are key to controlling this outbreak, we must be prepared for the next national public health threat, whether naturally occurring or a deliberate attack, to mitigate potential damage and save lives.

Many different voices within the United States government speak for different aspects of this outbreak based on agency or department authorities. However, no single person or agency has the authority to galvanize research, deal with the public health community, oversee public health capacity building, mobilize an emergency response, and line up the drug product developmental pipeline from innovation to a new licensed pharmaceutical product with downstream distribution logistics. While the threat of Ebola is paramount in the news today, it is not a new threat or an unexpected threat. It is time for the United States to have a single strategic agency with cross cutting authority focusing on strategic biological threats. Just as the National Laboratory System was borne to deal with strategic nuclear and radiological threats, the United States needs a system that deals exclusively with all the interstate, cross-border, and global health threats related to infectious disease, particularly those biological threats that are contagious in nature and can be proliferated for use as agents of bioterrorism.

Whether the threat is human-made or suddenly appears through an act of nature, an urgent scientific and organizational push is needed to develop and manufacture critical vaccines and medical countermeasures in the United States to close this strategic vulnerability.

Dr. Scott Lillibridge, infectious disease expert at the Texas A&M Health Science Center and chief scientist at the Texas A&M Center for Innovation in Advanced Development and Manufacturing, previously served as medical director of the U.S. Office of Foreign Disaster Assistance during the Ebola outbreaks in the 1990s in Africa. Dr. Lillibridge also previously served as founding director of the Centers for Disease Control and Prevention Bioterrorism Preparedness and Response Program.

Dr. Gerald Parker, vice president for public health preparedness and response at the Texas A&M Health Science Center and principal investigator at the Texas A&M Center for Innovation in Advanced Development and Manufacturing. Dr. Parker previously served as deputy assistant secretary of defense in Washington, D.C., leading chemical and biological defense; and former Commanding Officer of Fort Detrick.