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SPEED READ #
– The worst outbreak of Ebola virus disease ever is causing havoc in West Africa, with death toll exceeding a thousand people. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), WHO declared the outbreak a “public health emergency of international concern”.
– Certainly not a top global health priority before, Ebola has been largely ignored, with no investment in research or treatment really made, despite the fact that it has been around for some 40 years.
– The only sustainable long way out is the development of local research and innovation systems for health, in the framework of global research partnership. The Council on Health Research for Development (COHRED) wants to call to action African countries to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional and international collaboration on the basis of their own priorities. This will help prevent not only Ebola, but also many other conditions prevalent in low- and middle-income countries that are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.
# see Notes at the end of post for updates and further information
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Ebola strikes back
The worst outbreak of Ebola virus disease since the first appearance of this foe in 1976 in the Democratic Republic of Congo and in Sudan, is currently on stage. At the time of this writing, some 3069 suspect cases with 1552 deaths have been reported by the World Health Organization (WHO), of which 1752 cases and 897 deaths have been laboratory confirmed to be Ebola. First hitting the remote south-eastern forest region of Guéckédou in Guinea at the end of last year, it did not take much for the infection to spread to Guinea’s capital Conakry and then to neighbouring Liberia and Sierra Leone. More recently, Nigeria has also reported several suspect cases and at least six deaths, and infected people leaving the epicentre area have travelled as far as Saudi Arabia, Spain, Turkey and the United States. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), on 8 August 2014 WHO declared the outbreak a “public health emergency of international concern“.
Although it has been around for some 40 years now, not much is known about Ebola virus, its origin, ecology, and transmission. Evidence has accumulated suggesting that fruit bats are the likely natural reservoir for Ebola virus, but humans can become infected upon close contact with a number of other animals, including chimpanzees and monkeys. Human-to-human transmission occurs from direct contact with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. There is currently no specific treatment to cure the disease, although several drugs are under development. Patients are (or should be) kept in isolation and given intensive supportive care.
Research is key to prevention
“The precise factors that result in an Ebola virus outbreak remain unknown, but a broad examination of the complex and interwoven ecology and socioeconomics may help us better understand what has already happened and be on the lookout for what might happen next, including determining regions and populations at risk,” recently wrote Daniel Bausch and Lara Schwarz in a PLoS Neglected Tropical Diseases’ editorial. “Although the focus is often on the rapidity and efficacy of the short-term international response, attention to these admittedly challenging underlying factors will be required for long-term prevention and control,” these authors continued.
Most likely, the relationship between Ebola and underdevelopment has played a major role in the outbreak emergence. Although rich in natural resources, Guinea is one of the poorest countries in the world, and precarious living conditions might well have caused people in search of food and wood in the forest to come into contact with infected animals, favouring viral spillover. The effect of environmental change on Ebola outbreak in West Africa and disease dynamics is another obscure issue. “So intriguing puzzles remain. Untangling these – through research that combines environmental, epidemiological, virological, veterinary, and social science with local knowledge – will be key to predicting and preventing future outbreaks of Ebola – in this and other regions,” remarked Melissa Leach.
So, consensus is growing around a pivotal point: research is needed in order to prevent even more devastating Ebola outbreaks in the future. And the Ebola story that is hitting worldwide headlines nowadays might serve as a paradigm for many other conditions prevalent in low- and middle-income countries (LMICs), but that in a shrinking world might rapidly become of international concern. Ebola has been largely ignored, with no investment in research or treatment really made, because a few hundred cases in a tropical country are not enough to end up on the ‘global health priority’ list. On the other hand, the failing status of health system in the outbreak region has been known and described for many years. In other words, nothing is new in this outbreak other than its magnitude and spread beyond West Africa.
What is the long way out? The answer lies in the development of local research and innovation systems for health, in the framework of global research partnership. Building national research capacity in LMICs will help improve health systems–not only for Ebola, but for a number of other ailments that are, or might become tomorrow, ‘under the radar’ globally speaking–through health systems research. Strengthening health systems in LMICs will also help to address questions that are locally relevant but do not show up in global ‘burden of disease’ statistics, possibly tapping into local knowledge and experiences, as suggested for Ebola. Finally, this approach can create innovative environments for global health because new researchers, new innovators, new business get active in global health research and innovation, attracting investments and spurring international collaborations.
A call to action
COHRED expresses the deepest condolences to all who lost family and friends, and countries who lost citizens to a neglected disease that has caused epidemics since four decades.
COHRED’s work is totally relevant to the future prevention of this condition, both in terms of building national capacity in this region for ‘health systems research’ and in terms of making sure that countries for whom this is a priority will actually treat it like a research priority, unlike the rest of the world who pays attention because it now spreads outside a well-contained area. In the medium-to-long term, developing such research capacity can potentially lead to innovation capacity, in which solutions to priority problems come from the countries where the priorities are.
While Ebola virus is now under the spotlight, COHRED wants to call to action African countries (and other LMICs) to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional (and international) collaboration on the basis of their own priorities. Looking beyond the immediate horizon and, say, Ebola, this effort must comprise all major reasons for morbidity and mortality in LMICs, most of which are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.
This is where COHRED can add value, with our ‘technical support’, ‘practical tools’, and ‘global action’ that support LMICs to build their own research and innovation systems for health, aiming at locally relevant, sustainable systems, not only to fight Ebola, but to tackle all health problems facing countries.
Carel IJsselmuiden and Gerald Keusch
Note: The devastating Ebola outbreak has been recently featured in the September issue of TDR news.
Note: “There’s never been a big market for Ebola vaccines,”…..that’s why Ebola Vaccine, Ready for Test, Sat on the Shelf…..until now!
Note: Since the appearance of our post on the necessity of fighting Ebola by building national health research capacity, others have shared this view in the ongoing public debate. Here follows what recently expressed on the topic by South Africa Science and Technology Minister Naledi Pandor (the original press release can be found here):
Urgent need to build research capacity in Africa
Pretoria – Science and Technology Minister Naledi Pandor says the Ebola outbreak in West Africa has illustrated the urgent need to accelerate focused investment in research in Africa.
This as the world is grappling with containing the virus that is devastating West Africa, with a death toll standing at over 4 000 currently. Most of the victims are in Guinea, Liberia and Sierra Leone.
Speaking at the European Organization for Nuclear Research (CERN) celebration of 60 years of peace and development in New York on Monday, Minister Pandor said science has been a significant contributor to social development in many parts of the world, citing breakthroughs to eradicate diseases such as polio and smallpox as a result of drug and vaccine development.
“It is imperative for Africa’s scientists to work in Africa if they are to support development on the continent, if they are to play a role in smooth technology transfer and if they are to drive innovation,” the Minister said, citing the example of the Square Kilometre Array, which was resulting in brain gain for Africa for the first time in four decades.
Sub-Saharan Africa contributes about 2.3 percent of world’s Gross Domestic Product, but is responsible for only 0.4 percent of global expenditure on research and development. With 13.4 percent of the world’s population, it is home to only 1.1 percent of the world’s scientific researchers.
Minister Pandor said it was thus logical to propose that focused, well-designed investment in science and innovation could offer Africa new opportunities for development in a range of sectors, as African countries were the major consumers of products of advanced scientific discovery.
“Building world-class research infrastructure was one of the pillars for building competitive, knowledge-based activities to attract the best human capital resources,” she said.
The Minister added that she was pleased by the significant contribution CERN had made to increasing world knowledge in new areas of scientific research.
“We are pleased that several African countries have scientists who have participated in the Large Hadron Collider (LHC) research initiatives and we congratulate the leadership of CERN, who have been true world scientists seeking to attract scholars from the global community to the LHC,” she said.
The CERN event celebrates the values of science and promotes the role of science in international debates and decision-making, and it actively supports science, technology, engineering and mathematics education.
Other speakers included Ban Ki-moon (UN Secretary-General), Prof. Carlo Rubbia (Nobel Physics Prize winner and former Director-General of CERN) and Kofi Annan (Nobel Peace Prize winner and former UN Secretary-General).