Introduction
The 2014 Ebola virus disease (EVD) outbreak continues to evolve, creating challenges for the many international partners providing support. Three affected countries — Guinea, Liberia, and Sierra Leone — struggle to control the infection against a backdrop of severely compromised health systems, significant deficits in capacity, and fear.
WHO estimates that six to nine months will be needed to control the outbreak and has released an Ebola Response Roadmap detailing what needs to be done to achieve this.1
Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear. The public needs to understand that these medical products are under investigation. They have not yet been tested in humans and are not approved by regulatory authorities, beyond use for compassionate care.
Evidence of their effectiveness is suggestive, but not based on solid scientific data from clinical trials. Safety is also unknown, raising the possibility of adverse side effects when administered to humans. For most, administration is difficult and demanding.
Safe administration of some potential interventions requires facilities for intensive care, which are rare in West Africa. WHO has advised that the use of experimental medicines and vaccines under the exceptional circumstances of this outbreak is ethically acceptable (summary of recommendation from Ethics Panel, 11 August 2014).2 However, existing supplies of all experimental medicines are either extremely limited or exhausted.
While many efforts are under way to accelerate production, supplies will not be augmented for several months to come. This is especially true for therapies, where expected supplies are not thought likely to have a significant immediate impact on the outbreak. The prospects of having augmented supplies of vaccines quickly look slightly better.
Therefore, it should be noted that the potential compassionate use and further investigation of these compounds should not detract attention to the implementation of effective clinical care, rigorous standards of practice in infection prevention and control (IPC), careful contact tracing and follow-up, effective risk communication, and social mobilization, which will be crucial to terminate the epidemic.
On 4–5 September 2014, WHO held a Consultation on potential Ebola therapies and vaccines. The Consultation was convened to gather expertise about the most promising experimental therapies and vaccines and to consider their contribution in containing the Ebola outbreak in West Africa.
Issues of safety and efficacy were discussed together with innovative models for expediting clinical trials. Possible ways to ramp up production of the most promising products were also explored. Presentations about the real conditions and challenges in affected African countries informed the discussions during the consultation.