Ebola Viral Disease Outbreak-2014: Implications and Pitfalls

View metadata, citation and similar papers at core.ac.uk brought to you by CORE OPINION ARTICLE published: 01 Decemberprovided by 2014 Frontiers - Publisher Connector PUBLIC HEALTH doi: 10.3389/fpubh.2014.00263 Ebola viral disease outbreak-2014: implications and pitfalls Mahip Acharya* Independent Researcher, Kathmandu, Nepal *Correspondence: acharyamahip@gmail.com Edited by: Philip Arthur Mackowiak, University of Maryland School of Medicine, USA Reviewed by: Mohammad Mohseni Sajadi, Institute of Human Virology at the University of Maryland School of Medicine, USA Keywords: Ebola virus outbreak, zoonosis, pharmaceutical industries, ethics in drug approval, global health West Africa – consisting of countries hemorrhagic fever outbreak in southern numerous strains of a single virus species such as Guinea, Liberia, Sierra Leone, and Sudan and northern Zaire (5). Ebola viral and their continued mutation – as is the Nigeria – is the westernmost region of the disease, a zoonotic disease, has since been case with the current Ebola infection (8)– African continent. Afflicted by widespread observed intermittently in different regions often stymies the research for anti-viral poverty and political instability,WestAfrica of Central Africa (6), but none of those drugs. This is similar to the case with is one of the poorest regions in the world – has wreaked damage as monumental as the antibiotics, where bacterial resistance is a Liberia, Sierra Leone, and Guinea are ongoing outbreak. chief concern (9). Bacterial and viral dis- respectively ranked 174, 177, and178 out The current Ebola viral disease outbreak eases benefit from the ever-evolving genetic of 187 countries on the United Nations is turning out to be an insidious threat makeup of their agents, which are capable Development Program Human Develop- to the public health of West Africa – and of rapidly rendering a treatment ineffec- ment Index (1). This region is in the news by extension, to global health. Widespread tive. Despite advances in genome sequenc- of late, not because of the poverty per se poverty and corruption, underdeveloped ing (10), the current Ebola outbreak has but due to one of its repercussions – its health care systems,and lack of proper edu- reinforced the notion that research in ther- impact on health. The West African coun- cation in these West African countries have apeutics, especially for viral and bacterial try Guinea encountered a new epidemic been a significant factor in the eruption infections, has a long way to go. in March this year, which subsequently and spread of this disease. Due to these Diseases such as Ebola fall in the cat- encroached upon Liberia and Sierra Leone and other reasons, most of these African egory of rare diseases, which do not con- and turned out to be an unprecedented nations have been unable to stem the out- tribute significantly to disease burden in event in health sector of West Africa (2). break. One exception to this has been Nige- the affected areas, let alone globally. That Ebola, a viral disease characterized by fever, ria, which has been able to control this Ebola, first identified in 1976, has occurred diarrhea, vomiting, and hemorrhage (3), epidemic (7). A lot of effort has been sporadically in the last three decades does entered this region and started a disease put into reversing this epidemic, primar- not encourage the discovery of drugs outbreak. So great has been the havoc of ily from developed nations and interna- for the disease. Far fewer people have this outbreak that 3685 cases and 1841 tional organizations. The outbreak, how- been affected by Ebola as compared to deaths have been reported as of 31 August ever, still remains to be brought under con- some global diseases such as tuberculo- 2014 (4). These are mere tangible effects of trol. This has raised issues regarding our sis or malaria (11). The lack of incen- the disease; it has stirred a monumental fear health systems, state-of-the-art research tives for treatments of such intermittently in people around the globe, to say nothing facilities, and regulatory laws pertaining to occurring diseases, rather than the inabil- of people from these suffering countries. health. This outbreak stands out as a health ity of pharmaceutical industries, has been Ebola virus is a filamentous virus, five emergency and also displays some of our pointed out to be the reason for non- species of which have been identified; three collective limitations. existence of efficacious treatments for the of these species have been responsible for disease (12). There is not much mone- outbreaks in sub-Saharan African coun- IMPLICATIONS OF THE OUTBREAK tary benefit for pharmaceutical industries tries such as Sudan, Republic of Congo, The ongoing outbreak has raised con- in this line of research. As a result, phar- Gabon, and Uganda (3). Zaire ebolavirus, cerns about the flexibility and timeliness maceutical industries are not foraying into also known as EBOV, is responsible for of research and development of drugs research for therapeutics for such rare dis- the ongoing Ebola hemorrhagic fever out- and vaccines. We have come a long way eases (11, 12). This issue has been raised break; its clinical manifestations closely in regards to technological development earlier with respect to the unwillingness resembles Marburg viral disease, a disease and innovation, especially in the last few of pharma industries to get involved in native to Africa and caused by another decades. Yet, an efficacious treatment or antibiotics research (13). The culpability filovirus named Marburg virus (3). Its first prevention for Ebola could not be made of pharma industries, however, is not as appearance – and detection – harkens back available in the hour of need, despite black and white as it is claimed to be. to 1976, when it was observed during a vigorous research efforts. Existence of Innumerable rare diseases are prevalent www.frontiersin.org December 2014 | Volume 2 | Article 263 | 1 Acharya Implications of Ebola outbreak-2014 throughout the world, and taking initia- burial, for instance), which have been for human infection? Although these ques- tives for developing drugs for each of instrumental in perpetuating the outbreak tions sound cynical, it is high time that these diseases is not always possible or (2). Further, the lack of proper education these questions were asked. In fact, con- financially advisable. On the other hand, in the people and their unwillingness to cerns were raised earlier about the negli- neglecting these diseases could lead to seri- accept the existence itself of the disease gence of Ebola outbreaks in the past, with ous consequences, as indicated by cur- have been major threats in checking its warnings that a bigger outbreak could arise rent Ebola outbreak. The current outbreak spread. (18). We are not well-informed about the has fueled the criticism of pharmaceu- The current outbreak has underscored entire arsenal of microbes in nature, as tical industries for being market-driven. a certain flaw in handling ethical issues at this outburst of a zoonotic disease demon- More significantly, it has highlighted the the time of emergency. The ethical require- strates. Moreover, urbanization and glob- predicament of health and drug research ments surrounding the approval of new alization are in full swing, and have forced domain. drugs have come under scrutiny, cour- people to exploit the nature for sustenance The economic and political implica- tesy of the current outbreak. Drugs that (18). With greater delving into the nature tions of the current outbreak have grabbed have shown positive effects against Ebola for resources, there is enhanced possibil- more attention. The fact that the outbreak virus in laboratories and on animal sub- ity of transmission of newer and possibly has occurred in West Africa and that these jects are waiting for their use in Ebola more threatening diseases. We have already regions possess threadbare socio-economic patients – this long wait has resulted from been grappling with HIV, which is a global framework, highlights the relationship of rigorous requirements of safety and effi- health issue at the moment. This outbreak weak economic and political systems with cacy testing in human subjects. One such could well point to a future marred with the ongoing epidemic. Guinea, Liberia, and product is ZMapp – a combination of such other health threats, if serious delib- Sierra Leone – the epicenter of the cur- three monoclonal antibodies – which has erations are not performed by professionals rent Ebola outbreak – were at the receiv- shown successful abortion of Ebola infec- of different backgrounds, including econ- ing end of civil conflicts (in Liberia and tion in non-human primates (monkeys) omists, political leaders, and public health Sierra Leone) and an inefficient govern- (15). It has been successfully employed in experts. ment (in Guinea) for decades. This has left the treatment of two United States health- The current Ebola spread, which could these countries with debilitated infrastruc- care workers, the therapy being driven by have been limited to few people and to tures, health sector being no exception (1, compassionate use rather than substan- a small area through public health mea- 2). Political upheavals indeed disrupt the tial evidence – efficacy and safety testing sures alone, has snowballed into wide- very fabric that holds a country together, have not been carried out on human sub- spread havoc. Non-pharmaceutical inter- and this disruption has spilled over to jects (16). With limited data about effi- ventions have been shown to be effective the economic and health sectors in these cacy and toxicity of the therapy, its effect in curtailing the spread of a disease, as African countries. That Nigeria, a com- on treating Ebola infection has not been observed with Influenza pandemic in the paratively developed and more stable West well-established. This raises an important United States (19). In order to implement African country, has been able to check question about design of clinical trials and public health measures,however,the health the spread of Ebola bolsters the impor- its modification based on urgent needs.

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