05 August 2014 (Primary Source) US government had role in experimental Ebola treatment given to 2 American aid workers

Two American aid workers infected with Ebola are getting an experimental drug so novel it has never been tested for safety in humans and was only identified as a potential treatment earlier this year, thanks to a longstanding research program by the U.S. government and the military.

The workers, Nancy Writebol and Dr. Kent Brantly, are improving, although it's impossible to know whether the treatment is the reason or they are recovering on their own, as others who have survived Ebola have done. Brantly is being treated at a special isolation unit at Atlanta's Emory University Hospital, and Writebol was expected to be flown there Tuesday in the same specially equipped plane that brought Brantly.

They were infected while working in Liberia, one of four West African nations dealing with the world's largest Ebola outbreak. On Monday, the World Health Organization said the death toll had increased from 729 to 887 deaths in Guinea, Sierra Leone, Liberia and Nigeria, and that more than 1,600 people have been infected.

In a worrisome development, the Nigerian Health Minister said a doctor who had helped treat Patrick Sawyer, the Liberian-American man who died July 25 days after arriving in Nigeria, has been confirmed to have the deadly disease. Tests are pending for three other people who also treated Sawyer and are showing symptoms.

There is no vaccine or specific treatment for Ebola, but several are under development.

The experimental treatment the U.S. aid workers are getting is called ZMapp and is made by Mapp Biopharmaceutical Inc. of San Diego. It is aimed at boosting the immune system's efforts to fight off Ebola and is made from antibodies produced by lab animals exposed to parts of the virus.

In a statement, the company said it was working with LeafBio of San Diego, Defyrus Inc. of Toronto, the U.S. government and the Public Health Agency of Canada on development of the drug, which was identified as a possible treatment in January.

The drug is made in tobacco plants at Kentucky BioProcessing, a subsidiary of Reynolds American Inc., in Owensboro, Kentucky, said spokesman David Howard. The plant "serves like a photocopier," and the drug is extracted from the plant, he said.

Kentucky BioProcessing complied with a request from Emory and the international relief group Samaritan's Purse to provide a limited amount of ZMapp to Emory, he said. Brantly works for the aid group.

The Kentucky company is working "to increase production of ZMapp but that process is going to take several months," Howard said. The drug has been tested in animals and testing in humans is expected to begin later this year.

The U.S. Food and Drug Administration must grant permission to use experimental treatments in the United States, but the FDA does not have authority over the use of such a drug in other countries, and the aid workers were first treated in Liberia. An FDA spokeswoman said she could not confirm or deny FDA granting access to any experimental therapy for the aid workers while in the U.S.

Writebol, 59, has been in isolation at her home in Liberia since she was diagnosed last month. She's now walking with assistance and has regained her appetite, said Bruce Johnson, president of SIM USA, the Charlotte, North Carolina-based group that she works for in Africa.

Writebol has received two doses of the experimental drug so far, but Johnson was hesitant to credit the treatment for her improvement.

"Ebola is a tricky virus and one day you can be up and the next day down. One day is not indicative of the outcome," he said. But "we're grateful this medicine was available."

Brantly, 33, also was said to be improving. Besides the experimental dose he got in Liberia, he also received a unit of blood from a 14-year-old boy, an Ebola survivor, who had been under his care. That seems to be aimed at giving Brantly antibodies the boy may have made to the virus.

Samaritan's Purse initiated the events that led to the two workers getting ZMapp, according to a statement Monday by the National Institute of Allergy and Infectious Diseases, part of the U.S. National Institutes of Health. The Boone, North Carolina-based group contacted U.S. Centers for Disease Control and Prevention officials in Liberia to discuss various experimental treatments and were referred to an NIH scientist in Liberia familiar with those treatments.

The scientist answered some questions and referred them to the companies but was not officially representing the NIH and had no "official role in procuring, transporting, approving, or administering the experimental products," the statement says.

In the meantime, dozens of African heads of state were in Washington for the U.S.-Africa Leaders Summit, a three-day gathering hosted by President Barack Obama. U.S. health officials on Monday spoke with Guinean President Alpha Conde and senior officials from Liberia and Sierra Leone about the Ebola outbreak.

The Defense Department has long had a hand in researching infectious diseases, including Ebola. During much of the Cold War period this served two purposes: to keep abreast of diseases that could limit the effectiveness of troops deployed abroad and to be prepared if biological agents were used as weapons.

The U.S. military has no biological weapons program but continues to do research related to infectious diseases as a means of staying current on potential threats to the health of troops. It may also contribute medical expertise as part of interagency efforts in places like Africa where new infectious disease threats arise.

The hospital in Atlanta treating the aid workers has one of the nation's most sophisticated infectious disease units. Patients are sealed off from anyone not in protective gear. Ebola is only spread through direct contact with an infected person's blood or other bodily fluids, not through the air.

The CDC last week told U.S. doctors to ask about foreign travel by patients who come down with Ebola-like symptoms, including fever, headache, vomiting and diarrhea. A spokesman said three people have been tested so far in the U.S. — and all tested negative. Additionally, a New York City hospital on Monday said a man was being tested for Ebola but he likely didn't have it.

Writebol and her husband, David, had been in Liberia since last August, sent there by SIM USA and sponsored by their home congregation at Calvary Church in Charlotte. At the clinic, Nancy Writebol's duties included disinfecting staff entering or leaving the Ebola treatment area.

"Her husband, David, told me Sunday her appetite has improved and she requested one of her favorite dishes - Liberian potato soup — and coffee," SIM's Johnson said.

05 August 2014 (Primary Source) Ebola: BA suspends flights to Liberia and Sierra Leone

British Airways has suspended flights to and from Liberia and Sierra Leone until the end of August amid concerns over the Ebola outbreak.

The airline normally has four flights a week from London Heathrow to Freetown in Sierra Leone, with a connection to Monrovia in Liberia.

BA said the move was due to the "deteriorating public health situation" in the two west African countries.

Customers can get a refund or rearrange their flight for a later date.

'Constant review'

The Liberian government said it regretted BA's decision, but added: "We fully understand that international airlines must keep the safety of customers and crew as their highest priority."

BA said in a statement: "We have temporarily suspended our flights to and from Liberia and Sierra Leone until 31 August 2014 due to the deteriorating public health situation in both countries.

"The safety of our customers, crew and ground teams is always our top priority and we will keep the routes under constant review in the coming weeks.

"Customers with tickets on those routes are being offered a range of options including a full refund and the ability to rebook their flights to a later date."

BA's move follows a similar suspension by two regional carriers last week.

Health checks

Since February, nearly 900 people have died from the disease affecting four west African countries - Guinea, Liberia, Sierra Leone and Nigeria.

The virus spreads by contact with infected blood and bodily fluids. The current outbreak is killing between 50% and 60% of people infected.

There is no cure or vaccine for Ebola but patients have a better chance of survival if they receive early treatment.

The Liberian government statement said all outgoing passengers were receiving mandatory health checks, and that it would "work around the clock" to ensure international entry points were secure from Ebola.

It added: "We will continue to engage openly and positively with regional and international carriers so that any suspended flights can be resumed as soon as possible."

04 August 2014 (Primary Source) Ebola Drug Made From Tobacco Plant Saves U.S. Aid Workers

A tiny San Diego-based company provided an experimental Ebola treatment for two Americans infected with the deadly virus in Liberia. The biotechnology drug, produced with tobacco plants, appears to be working.

In an unusual twist of expedited drug access, Mapp Biopharmaceutical Inc., which has nine employees, released its experimental ZMapp drug, until now only tested on infected animals, for the two health workers. Kentucky BioProcessing LLC, a subsidiary of tobacco giant Reynolds American Inc. (RAI), manufactures the treatment for Mapp from tobacco plants.

The first patient, Kent Brantly, a doctor, was flown from Liberia to Atlanta on Aug. 2, and is receiving treatment at Emory University Hospital. Nancy Writebol, an aid worker, is scheduled to arrive in Atlanta today and will be treated at the same hospital, according to the charity group she works with. Both are improving, according to relatives and supporters.

Each patient received at least one dose of ZMapp in Liberia before coming to the U.S., according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

“There’s a very scarce number of doses,” and it’s not clear how many each patient needs for treatment, Fauci said. “I’m not sure how many doses they’ll get.”

Citing unnamed sources, CNN yesterday reported that the drug used for the treatment is Mapp’s.

Ebola Outbreak

Ebola, spread through direct contact with body fluids such as blood and urine, has sickened 1,603 people in West Africa, killing 887, according to the World Health Organization. The disease, first reported in what is now the Democratic Republic of Congo in 1976, can cause bleeding from the eyes, ears and nose.

The Deadliest Disease on Earth

The virus has historically killed as many as 90 percent of those who contract it. The current outbreak has a fatality rate of about 60 percent, probably because of early treatment efforts, officials have said.

There is no cure for Ebola, although several companies -- including Mapp -- are working on drug candidates that are undergoing animal testing. Normally, patients are given fluids, blood transfusions and antibiotics with the hope their immune systems can fight off Ebola’s onslaught.

The two scientists behind Mapp, President Larry Zeitlin and Chief Executive Officer Kevin Whaley, “are both brilliant,” said Charles Arntzen, a plant biotechnology expert at Arizona State University who collaborated with the two researchers years ago. “They are very, very bright guys and free spirits.”

The antibody work came out of research projects funded more than a decade ago by the U.S. Army to develop treatments and vaccines against potential bio-warfare agents, such as the Ebola virus, Arntzen said in a telephone interview.

Tobacco Plant

The tobacco plant production system was developed because it was a method that could produce antibodies rapidly in the event of an emergency, he said.

To produce therapeutic proteins inside a tobacco plant, genes for the desired antibodies are fused to genes for a natural tobacco virus, said Arntzen. The tobacco plants are then infected with this new artificial virus, he said.

“The infection results in the production of antibodies inside the plant,” Arntzen said. The plant is eventually ground up and the antibody is extracted, he said. The whole process takes a matter of weeks.

When confronted by reporters about the Ebola infections in Liberia and subsequent treatments, Whaley said he needed to get up to speed on the developing events.

“This is all new to me,” said Whaley, who was dressed in shorts, a well-worn T-shirt and flip-flops while addressing reporters’ questions outside the company’s offices in a San Diego business park. “I just don’t want to give out any inaccurate information, that’s all.”

Antibody Cocktail

Mapp’s drug is being developed with Toronto-based Defyrus Inc., which has six employees, according to Defyrus CEO Jeff Turner. ZMapp is a “cocktail” of monoclonal antibodies that help the immune system attack the virus.

Monoclonal antibodies designed to fight and block specific proteins can stop the virus from latching onto and entering cells, said Heinz Feldmann, chief of the National Institute of Allergy and Infectious Diseases’ Laboratory of Virology in Hamilton, Montana.

The key is to find antibodies that can prevent viral infection, and to attack several points on the virus so that mutants won’t “escape” treatment, he said.

“What you want is a cocktail of antibodies that target different domains on the virus so escape is less likely in treatment,” he said in a telephone interview. Feldmann said he hasn’t been involved in developing treatments.

ZMapp’s predecessor, MB-003, protected three of seven rhesus macaques in a study run in 2013 by Mapp and the U.S. Army Medical Research Institute of Infectious Diseases.

Ethical Questions

Ebola and virology experts believe the use of the Mapp drug for Brantly and Writebol is unusual in the annals of emergency drug treatments. While potentially saving lives, the cases raise questions about who should have the right to receive experimental drugs years before they gain FDA approval.

“There are a lot of Africans that are also dying,” Robert Garry, a virologist at Tulane University, said in a telephone interview. “If we are going to do it for the Americans then we should certainly step up our game for the Africans.”

Although no drugs to treat Ebola are approved by U.S. regulators, the Food and Drug Administration can approve an emergency application to provide access to unapproved drugs, Stephanie Yao, an FDA spokeswoman, said in an e-mail.

Emergency Approval

Approval for emergency drug use outside of a clinical trial can be made within 24 hours, Yao wrote. Shipment and treatment with the drug could begin even before completed written forms are submitted to the FDA, which can approve the use of an experimental treatment by telephone in an emergency.

“The FDA stands ready to work with companies and investigators treating these patients who are in dire need of treatment,” Yao said. She declined to say whether the FDA had allowed any drug to be used in the Ebola outbreak.

Erica Ollmann Saphire, a molecular biologist at the Scripps Research Institute in San Diego, worked with Mapp and the other biotechnology companies to develop models of the Ebola virus and potential antibodies.

She directs a global consortium given the job of modeling the virus and the mixture of antibodies needed to defeat it. She said the drug was approved for the two American medical workers in Liberia under a compassionate-use doctrine, because it’s not even scheduled for clinical trials until next year.

Informed Consent

“I’d take it myself,” she said in an interview in her laboratory, near La Jolla. “Absolutely. I wouldn’t think twice.”

She said the American medical aid workers were in a better position to give consent to the treatment than African disease victims.

“Do you put an untested therapy in a human or do you just watch them die?” Saphire asked. “Certainly these two Americans are medically trained individuals who knew what they were getting into. They are able to give informed consent.”

Medical care of the two U.S. citizens may take two to three weeks if all goes well, Bruce Ribner, an infectious disease specialist at Emory, said in an Aug. 1 news conference.

The Atlanta-based Centers for Disease Control and Prevention, which confirmed that Brantly and Writebol are the first Ebola patients on U.S. soil, is working with the hospital and transport company to make sure evacuation of the two patients goes safely, said Barbara Reynolds, an agency spokeswoman.

“We’re here to make sure the transportation process and the care here in the U.S. ensures there’s no spread,” Reynolds said. “It’s important to remember this is not an airborne virus, it requires close contact with body fluids. It’s minimal risk as long as the people caring for the patient use meticulous procedures.”

05 August 2014 (Primary Source) US government had role in experimental Ebola treatment given to 2 American aid workers

Two American aid workers infected with Ebola are getting an experimental drug so novel it has never been tested for safety in humans and was only identified as a potential treatment earlier this year, thanks to a longstanding research program by the U.S. government and the military.

The workers, Nancy Writebol and Dr. Kent Brantly, are improving, although it's impossible to know whether the treatment is the reason or they are recovering on their own, as others who have survived Ebola have done. Brantly is being treated at a special isolation unit at Atlanta's Emory University Hospital, and Writebol was expected to be flown there Tuesday in the same specially equipped plane that brought Brantly.

They were infected while working in Liberia, one of four West African nations dealing with the world's largest Ebola outbreak. On Monday, the World Health Organization said the death toll had increased from 729 to 887 deaths in Guinea, Sierra Leone, Liberia and Nigeria, and that more than 1,600 people have been infected.

In a worrisome development, the Nigerian Health Minister said a doctor who had helped treat Patrick Sawyer, the Liberian-American man who died July 25 days after arriving in Nigeria, has been confirmed to have the deadly disease. Tests are pending for three other people who also treated Sawyer and are showing symptoms.

There is no vaccine or specific treatment for Ebola, but several are under development.

The experimental treatment the U.S. aid workers are getting is called ZMapp and is made by Mapp Biopharmaceutical Inc. of San Diego. It is aimed at boosting the immune system's efforts to fight off Ebola and is made from antibodies produced by lab animals exposed to parts of the virus.

In a statement, the company said it was working with LeafBio of San Diego, Defyrus Inc. of Toronto, the U.S. government and the Public Health Agency of Canada on development of the drug, which was identified as a possible treatment in January.

The drug is made in tobacco plants at Kentucky BioProcessing, a subsidiary of Reynolds American Inc., in Owensboro, Kentucky, said spokesman David Howard. The plant "serves like a photocopier," and the drug is extracted from the plant, he said.

Kentucky BioProcessing complied with a request from Emory and the international relief group Samaritan's Purse to provide a limited amount of ZMapp to Emory, he said. Brantly works for the aid group.

The Kentucky company is working "to increase production of ZMapp but that process is going to take several months," Howard said. The drug has been tested in animals and testing in humans is expected to begin later this year.

The U.S. Food and Drug Administration must grant permission to use experimental treatments in the United States, but the FDA does not have authority over the use of such a drug in other countries, and the aid workers were first treated in Liberia. An FDA spokeswoman said she could not confirm or deny FDA granting access to any experimental therapy for the aid workers while in the U.S.
Writebol, 59, has been in isolation at her home in Liberia since she was diagnosed last month. She's now walking with assistance and has regained her appetite, said Bruce Johnson, president of SIM USA, the Charlotte, North Carolina-based group that she works for in Africa.

Writebol has received two doses of the experimental drug so far, but Johnson was hesitant to credit the treatment for her improvement.

"Ebola is a tricky virus and one day you can be up and the next day down. One day is not indicative of the outcome," he said. But "we're grateful this medicine was available."

Brantly, 33, also was said to be improving. Besides the experimental dose he got in Liberia, he also received a unit of blood from a 14-year-old boy, an Ebola survivor, who had been under his care. That seems to be aimed at giving Brantly antibodies the boy may have made to the virus.
Samaritan's Purse initiated the events that led to the two workers getting ZMapp, according to a statement Monday by the National Institute of Allergy and Infectious Diseases, part of the U.S. National Institutes of Health. The Boone, North Carolina-based group contacted U.S. Centers for Disease Control and Prevention officials in Liberia to discuss various experimental treatments and were referred to an NIH scientist in Liberia familiar with those treatments.

The scientist answered some questions and referred them to the companies but was not officially representing the NIH and had no "official role in procuring, transporting, approving, or administering the experimental products," the statement says.

In the meantime, dozens of African heads of state were in Washington for the U.S.-Africa Leaders Summit, a three-day gathering hosted by President Barack Obama. U.S. health officials on Monday spoke with Guinean President Alpha Conde and senior officials from Liberia and Sierra Leone about the Ebola outbreak.

The Defense Department has long had a hand in researching infectious diseases, including Ebola. During much of the Cold War period this served two purposes: to keep abreast of diseases that could limit the effectiveness of troops deployed abroad and to be prepared if biological agents were used as weapons.

The U.S. military has no biological weapons program but continues to do research related to infectious diseases as a means of staying current on potential threats to the health of troops. It may also contribute medical expertise as part of interagency efforts in places like Africa where new infectious disease threats arise.

The hospital in Atlanta treating the aid workers has one of the nation's most sophisticated infectious disease units. Patients are sealed off from anyone not in protective gear. Ebola is only spread through direct contact with an infected person's blood or other bodily fluids, not through the air.

The CDC last week told U.S. doctors to ask about foreign travel by patients who come down with Ebola-like symptoms, including fever, headache, vomiting and diarrhea. A spokesman said three people have been tested so far in the U.S. — and all tested negative. Additionally, a New York City hospital on Monday said a man was being tested for Ebola but he likely didn't have it.

Writebol and her husband, David, had been in Liberia since last August, sent there by SIM USA and sponsored by their home congregation at Calvary Church in Charlotte. At the clinic, Nancy Writebol's duties included disinfecting staff entering or leaving the Ebola treatment area.
"Her husband, David, told me Sunday her appetite has improved and she requested one of her favorite dishes - Liberian potato soup — and coffee," SIM's Johnson said.

04 August 2014 (Primary Source) Patients’ Symptoms Raise Concern About Ebola in New York

Heightened concern about the Ebola virus has led to alarms being raised at three hospitals in New York City. But so far, no Ebola cases have turned up.

The latest episode involved a man who had recently been to West Africa, and who went to the emergency room at Mount Sinai Hospital in Manhattan late Sunday with a high fever and gastrointestinal problems, the hospital reported on Monday. He is being kept in isolation at the hospital while tests are being done for Ebola, a deadly disease, but also for other illnesses that could have caused his symptoms.

But the city’s health department issued a statement on Monday saying that after consulting with Mount Sinai and the Centers for Disease Control and Prevention in Atlanta, “the health department has concluded that the patient is unlikely to have Ebola. Specimens are being tested for common causes of illness and to definitively exclude Ebola. Testing results will be made available by C.D.C. as soon as they are available.”

At NYU Langone Medical Center last week, a patient who went to the emergency room with a fever and who mentioned a recent visit to West Africa was given a mask and moved to a secluded area, said Dr. Michael Phillips, the hospital’s director of Infection Prevention and Control. But further questioning revealed that the patient had not visited any of the affected countries, “so we stopped right there,” Dr. Phillips said.

At Bellevue Hospital Center last week, a patient was placed in isolation, but it quickly became clear that he did not have Ebola.

An Ebola outbreak centered mainly in three West African countries — Sierra Leone, Guinea and Liberia — has infected more than 1,300 people and killed more than 700 of them. American health officials have advised against nonessential travel to the three countries, and have urged doctors to be on high alert for people who return from the region with symptoms like fever, diarrhea and vomiting.

A Mount Sinai spokeswoman, Dorie Klissas, said that to protect the patient’s privacy, the hospital was not making public his occupation, which country he had been in, whether he had been exposed to a patient with Ebola there, or whether he had close contacts like family members, friends or co-workers who were also at risk. Officials said they expected the results of the tests for Ebola in 24 to 48 hours.

In a statement to employees, hospital officials said that Ebola was spread only by direct contact with bodily fluids, and that infection control measures were being employed to protect patients and staff members.

In the Bellevue Hospital Center case, Dr. Ross Wilson, the chief medical officer at the New York City Health and Hospitals Corporation, said that the man had symptoms also found in Ebola patients. He had arrived at Kennedy International Airport from West Africa and was being detained by security personnel at the airport for an unrelated matter when he fell ill.

“He developed a headache and fever,” Dr. Wilson said. He was transported to Bellevue, but the people who brought him there did not suspect Ebola.

“We immediately put the dots together,” Dr. Wilson said.

Following the guidance of the Centers for Disease Control and Prevention, every patient entering one of the city’s hospitals who has fever, headache and other symptoms associated with Ebola (as well as countless other ailments), is asked two new questions.

“Have you traveled to or from West African countries in the last 10 days? Have you been in contact with an Ebola patient or with anyone who has been in contact with an Ebola patient?”

04 August 2014 (Primary Source) "Patient at Mount Sinai Has Ebola-Like Symptoms, Hospital Says"

Heightened concern about the Ebola virus has led to alarms being raised at three hospitals in New York City. But so far, no Ebola cases have turned up.

The latest episode involved a man who had recently been to West Africa, and who went to the emergency room at Mount Sinai Hospital in Manhattan late Sunday with a high fever and gastrointestinal problems, the hospital reported on Monday. He is being kept in isolation at the hospital while tests are being done for Ebola, a deadly disease, but also for other illnesses that could have caused his symptoms.

But the city’s health department issued a statement on Monday saying that after consulting with Mount Sinai and the Centers for Disease Control and Prevention in Atlanta, “the health department has concluded that the patient is unlikely to have Ebola. Specimens are being tested for common causes of illness and to definitively exclude Ebola. Testing results will be made available by C.D.C. as soon as they are available.”

At NYU Langone Medical Center last week, a patient who went to the emergency room with a fever and who mentioned a recent visit to West Africa was given a mask and moved to a secluded area, said Dr. Michael Phillips, the hospital’s director of Infection Prevention and Control. But further questioning revealed that the patient had not visited any of the affected countries, “so we stopped right there,” Dr. Phillips said.

At Bellevue Hospital Center last week, a patient was placed in isolation, but it quickly became clear that he did not have Ebola.

An Ebola outbreak centered mainly in three West African countries — Sierra Leone, Guinea and Liberia — has infected more than 1,300 people and killed more than 700 of them. American health officials have advised against nonessential travel to the three countries, and have urged doctors to be on high alert for people who return from the region with symptoms like fever, diarrhea and vomiting.

A Mount Sinai spokeswoman, Dorie Klissas, said that to protect the patient’s privacy, the hospital was not making public his occupation, which country he had been in, whether he had been exposed to a patient with Ebola there, or whether he had close contacts like family members, friends or co-workers who were also at risk. Officials said they expected the results of the tests for Ebola in 24 to 48 hours.

In a statement to employees, hospital officials said that Ebola was spread only by direct contact with bodily fluids, and that infection control measures were being employed to protect patients and staff members.

In the Bellevue Hospital Center case, Dr. Ross Wilson, the chief medical officer at the New York City Health and Hospitals Corporation, said that the man had symptoms also found in Ebola patients. He had arrived at Kennedy International Airport from West Africa and was being detained by security personnel at the airport for an unrelated matter when he fell ill.

“He developed a headache and fever,” Dr. Wilson said. He was transported to Bellevue, but the people who brought him there did not suspect Ebola.

“We immediately put the dots together,” Dr. Wilson said.

Following the guidance of the Centers for Disease Control and Prevention, every patient entering one of the city’s hospitals who has fever, headache and other symptoms associated with Ebola (as well as countless other ailments), is asked two new questions.

“Have you traveled to or from West African countries in the last 10 days? Have you been in contact with an Ebola patient or with anyone who has been in contact with an Ebola patient?”

04 August 2014 (Primary Source) The economics of Ebola, or why there's no cure

Of all the horrific features of Ebola disease--its deadliness, its virulence--perhaps the scariest is that there's no cure.

This is not the same thing as saying it's incurable or untreatable. In fact, scientists are fairly confident they can develop effective treatments and a vaccine, given a bit of time and somewhat more money. So the question is why that hasn't happened.

The simple answer, as Beth Skwarecki of PLoS.org explains, can be found in economics. The Ebola virus doesn't rank as a major disease. As the accompanying chart shows, measles strikes about 20 million people a year and kills more than 120,000; cancer adds 14.1 million cases a year and kills 8.2 million; HIV infects 2.5 million people a year and kills 1.7 million. (The cancer statistics are from 2012 and the HIV numbers from 2011.) The current outbreak of Ebola numbered 1,323 cases and 729 deaths.

An outbreak on that scale--leaving aside that it occurs in the poorest region of the world--isn't threatening enough to grab the attention of pharmaceutical R&D departments. That doesn't necessarily make Big Pharma the villain of the piece, since it's hard to argue that a rare disease that erupts sporadically should be a higher priority than, say, malaria, which strikes 220 million people a year and kills 660,000.

Researchers says the current Ebola outbreak, which has proven especially hard to control, has focused new attention on the need for a treatment.

Three possible treatments are under study by researchers funded by the National Institutes of Health, with good prospects for a human clinical trial this year.

Some biotech companies are trying to tweak the economics of the disease by addressing fears that it could be a bioterror threat, which would turn the federal government into a well-heeled customer for their remedies. The Centers for Disease Control and Prevention lists Ebola as a "Category A," or "high-priority" threat, along with smallpox and plague, because it can be disseminated easily and has a high mortality rate.

Among the problems faced by Ebola fighters are economic and cultural factors that interfere with its treatment and containment. As Skwarecki reports, the chief weapons in limiting Ebola's spread are isolating the disease's carriers from others and quarantining and observing those thought to be exposed. Remedial actions like hydration could also reduce the death toll, and education of rural populations to keep them from eating bats (thought to be among the main carriers of the virus) or handling the bodies of deceased Ebola victims is also important.

But all those steps are difficult in West Africa. "This is not just a medical or public health problem," Margaret Chan, director-general of the World Health Organization, observed last week. "It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment." Fears of the disease and of community reactions have forced some chains of transmission "underground," she reported.

"Because of the high fatality rate, many people in affected areas associate isolation wards with a sure death sentence, and prefer to care for loved ones in homes or seek assistance from traditional healers. Such hiding of cases defeats strategies for rapid containment."