A multinational group of African scientists is heading the search for the source of Ebola outbreaks, as the virus continues to ravage communities in West Africa. The team, based in Johannesburg, is working against time to find ways to control and overcome the disease. Tom Nevin has the details.
A special team of African scientists in Johannesburg is playing a vanguard role in unmasking the Ebola virus that has been rampant in Sierra Leone, Liberia and Guinea. Their work is a precursor of the development of control strategies to combat the virus, one of the world’s most dangerous pathogens.
First identified in 1976, the Ebola virus is the cause of a haemorrhagic fever that is lethal for nearly half of the people that it infects. The virus has been isolated from human subjects many times, but never from bats – which are believed to be its natural reservoir – or from any other wildlife species. This is the puzzle that medical scientists must crack in the search for effective vaccination and treatment.
“It is still unknown how the first victim – known medically as the index case – is infected,” says Professor Janusz Paweska, head of the Centre for Emerging and Zoonotic Diseases (CEZD) and Special Viral Pathogens Laboratory at South Africa’s National Institute for Communicable Diseases (NICD). “Despite the fact that the Ebola virus was first discovered almost 40 years ago … the natural transmission cycle of Ebola virus still remains one of the most hunted treasures in modern virology.”
Led by Paweska, a team of 11 post doctoral medical researchers and MSc students from Zambia, Tanzania, Mozambique, South Africa and the Democratic Republic of Congo is notching up valuable gains in understanding the Ebola virus’s natural transmission and contributing to research into how future outbreaks can be prevented.
Assembled under the One Health research programme of the Southern African Centre for Surveillance of Infectious Diseases and funded by the Wellcome Trust, the team was recruited from universities and research institutions in central, east and southern Africa, undergoing training at the NICD facilities in Johannesburg. Here they conduct research into the most dangerous pathogens known to science. They undertake regular field trips into “microbiological battlefields”, the more recent being to net fruit bat species suspected of hosting the virus responsible for the current Ebola outbreak. The team was the nucleus of a rolling programme that has produced much-needed medical specialists trained and experienced in the field of dangerous pathogens. A number of the initial team members have moved on to senior and professorial positions in the public sector and their places are being taken by new recruits.
The Johannesburg team has developed an innovative mobile laboratory unit (MLU) for operation in outbreak sites. It allows on-the-ground diagnosis that saves time and lives by overcoming logistic delays that could slow down testing in remote areas and aiding in patient management.
Paweska and members of his team travelled to the Democratic Republic of Congo (DRC) and captured 44 fruit bats in Luebo, a remote area of the country where EVD (Ebola virus disease) outbreaks were recorded in 2007–2009. Blood and tissue samples were collected and brought back to the NICD’s Johannesburg laboratories for scientific study at a maximum security bio-containment unit.
The ongoing outbreak of Ebola in West Africa has so far killed more than 6,000 people.
“The [Ebola] cases in West Africa rose faster than the ability to contain the outbreak,” says Paweska. “There is a great international concern that an exponential rise in new cases could become a worldwide disaster. There is an urgent need for rapid and larger international support, including doctors, nurses, medical supplies, diagnostic support and other related aid to contain and control the epidemic in West Africa and consequently to prevent wider international spread.”
The medical science community is voicing concern that the latest flare-up of Ebola in Africa went out of control largely because of slow international reaction to the emergency and because research into the disease has faded in the last couple of decades. Had the disease emerged in the developed world, research into a vaccine/therapy would have been more generously funded, and more robustly and timeously executed and pharmacological solutions could have been arrived at long ago.
At the NICD, Paweska points out that “extensive funding was applied to primary research in the past decade, mostly due to threat of bio-terrorism after the 9/11 terrorist attacks, and progress was made in understanding the biology of these viruses, as well as in the development of potential therapies, mostly funded by bio-defence programmes in developed countries.
“However, from the perspective of those at most risk of disease, this progress has not yet been experienced,” he says.
For Professor Alan Smith, former head of virology at the University of KwaZulu-Natal medical school, “it’s a sad indictment that it took a really scary virus to threaten the developed world, even to the point of invading such wealthy strongholds as the US, UK, Europe and Australia before it was taken seriously. It was only when the virus came knocking at their door that they woke up to a biological danger that was considered a serious threat only in faraway, forgotten places like west and central Africa.”
“The severity of the outbreak caught us on the hop,” said one researcher, who preferred not to be named. “Even in the undeveloped areas, the world is a smaller place and community interaction is happening more frequently and in greater numbers than ever. Indifference and lack of funding has held back research which could have made us more prepared.”
Paweska says the outbreak was not just a public health crisis, but an epidemic that went far beyond the obvious grave implications for an individual, the patient, family or health care workers. It was also an economic, social and humanitarian problem that required an urgent international response to stop the outbreak where it started.
“Health should be regarded by governments as an investment and not as an expense, and the same applies to research,” he maintains.
Diseases of the poor
“One of the most important issues we are dealing with is that emergence of highly dangerous pathogens is unpredictable, it might be even tomorrow that we would have to deal with newly emerging and formidable microbes. There is a tendency for increased emergence of highly dangerous pathogens in recent years – almost every seven months on average, and most of them are of animal origins.
The emergence and the spillover mechanisms from animals to humans are often not well understood. They might suddenly show up and then hide again for a long time before they strike again, often in vulnerable, resource-limited settings. Many aspects of these outbreaks are a direct consequence of impoverished conditions.”
Researcher Ken Silverstein, US editor, business journalist and author of Millions for Viagra, Pennies for Diseases of the Poor, says that many people, most of them in tropical countries of the Third World, die of preventable, curable diseases. “Malaria, tuberculosis, acute lower-respiratory infections and other conditions claim 10m lives each year. People die because the drugs to treat those illnesses are non-existent or are no longer effective. They die because it doesn’t pay to keep them alive.”
The head of the UN’s World Health Organisation, Dr Margaret Chan, also criticised pharmaceutical firms for not focusing on Ebola, condemning “a profit-driven industry that does not invest in products for markets that cannot pay”.
Professor Smith observes that the cynicism in the Ebola outbreak events of the past few months was to be found in how quickly millions of dollars were mobilised from developed-nation resources when it looked as though the Ebola virus could travel the world at will and not be confined to tracts of jungle far from the well-heeled crowd.
“We have to pay more attention to the microbes, especially the highly infectious ones,” maintains Paweska, “and we must be more prepared in how we respond to these outbreaks. We need more permanent and efficient surveillance system , in remote locations, to sound the early warning alarms.