The work of controlling, learning from deadliest Ebola outbreak, preparing for future continues, amid uncertain funding for ongoing responses to crisis
A study of men who survived Ebola and have continued to show evidence of the virus in their semen will determine the effectiveness of what Dr. Anthony Fauci hopes will be “another weapon in our arsenal against Ebola virus disease,” in the form of an experimental drug hoped to prevent resurging illness and transmission of the disease.
While the World Health Organization in March declared an end to the international public health emergency posed by Ebola that began in December 2013 and that the agency recognized in August 2015, continued “flare-ups” of the disease sparked by residual virus among survivors have added to the impacts of crisis that sickened more than 28,000 people and killed more than 11,000.
The PREVAIL IV trial is one of a series of studies launched by the U.S.-Liberia Partnership for Research on Ebola Virus in Liberia examining questions and potential future responses to Ebola following the most deadly outbreak of the disease so far. The PREVAIL III study, examining how Ebola affects the health of survivors and the people they live with, including in persistence and transmission risk to close contacts, as well as mental health and eye issues, began in April 2015 and is set to continue until 2020. For the upcoming study announced today, from 60 to 120 men recruited from PREVAIL III will be given either a study drug that has been shown to reduce Ebola viral loads and improve survival rates in animal testing, or a placebo, to compare impacts of the drug on traces of the virus in semen. The drug, manufactured by Gilead Sciences, has been tested for safety among healthy men and women in the United States, but the upcoming trial, set for six months will also monitor effects on liver and kidney function.
While the trial seeks a solution to one of many health and disease control challenges highlighted by the most recent outbreak of Ebola, a report issued by an independent panel examining the U.S. Department of Health and Human Services response to the crisis highlights systemic challenges to pandemic preparedness. Finding that failures in leadership from the World Health Organization hobbled international action in response to the outbreak from the outset, the report also recommends that U.S. build, and continue to strengthen its capacities to respond to the spread of infectious diseases abroad and at home.
The panel found that communications efforts, critical to both educating communities on risks and averting unnecessary restrictions, were not agile enough to meet the demand of a rapidly shifting health crisis. In addition, the U.S. was not adequately prepared to send trained and equipped teams of medical responders, supply protective wear and equipment, or release and use the funding necessary to respond quickly and appropriately. Noting that the HHS does not have an emergency response fund, as other government departments do, the report finds that legislative appropriations delays slowed needed local efforts and added complications to medical responses domestically. Including among its recommendations that the Department have sufficient and readily accessible resources to respond to disease outbreaks, the report notes that its findings are applicable to current and future epidemics, including the ongoing spread of Zika virus in the Western Hemisphere and other countries.
Whether resources will be maintained, let alone bolstered, however, remains the biggest question surrounding U.S. pandemic preparedness. In April, with no response from Congress to its request two months earlier for $1.9 billion in emergency funding to respond to Zika and accompanying rising rates of severe birth defects and neurological disorders, the White House moved $510 million from funding dedicated to Ebola responses, and $79 million from Department of Health and Human Services programs responding to emerging and resurging health threats, for responses to the new outbreak. A Senate bill passed in May allocated new funding for Zika responses, but did not replace the dollars that had already been moved. A House bill passed last month would reallocate still more of the HHS budget. With the two bills unreconciled, funding for resources to confront both ongoing health threats remains uncertain.