For me, science is about asking not how the world is, but what it could be – asking what if.
Almost six years ago, and just a few months after I joined Wellcome as Director, a two-year-old boy died in a remote Guinean village. His death was the first in an Ebola epidemic which took more than 11,000 lives in less than two years in West Africa. It remains the world’s largest Ebola epidemic.
As 2019 draws to a close, it is in eastern provinces of the Democratic Republic of the Congo (DRC) that Ebola has been devastating communities – for 18 months, in what is now the world’s second largest outbreak.
It is not coincidence that the two largest Ebola epidemics have occurred in the last five years. This is the world we now live in, and it is this world we need to be prepared for. Each death is a tragedy, and healthcare teams face a constant threat of violence as they try to stop Ebola.
Nonetheless, something is now different – something National Geographic last week hailed among the greatest scientific achievements of the decade.
Ebola is now a disease which can be diagnosed, prevented and cured.
The toll in DRC is more than 2,200 deaths and continues to rise. But, since last August, more than 250,000 people in DRC have been protected by Ebola vaccination and, with development of diagnostics and treatments, there are over 1,000 Ebola survivors.
These advances have not, in fact, taken 10 years, but just a little over five. They are achievements made because in 2014 we dared to ask ‘what if’. What if we could make sure research was at the heart of every epidemic response?
There were many who doubted it would be possible.
Epidemics are among our greatest health threats, and they strike quickly. How could vaccine or treatment studies be contemplated, when they take years and require complex ethical and regulatory systems quite unsuited to the speed needed in outbreak responses? And, though a threat to us all wherever we live, epidemics often strike first in regions with the most fragile of health systems.
Despite these considerable challenges, there were researchers, governments, the World Health Organzation (WHO), aid agencies, charities, industry and funders, including Wellcome, willing to come together.
It is thanks to collaborations that in November the European Medicines Agency (EMA) approved licensure of the Merck Ebola Vaccine (Ervebo); that, earlier this year, trials of four potential treatments have identified that two significantly increase the chances of living after being infected with Ebola; and that responders now have detailed information to help them to understand and navigate the complex local contexts in which they are working.
And finally, in Rwanda, Uganda and the DRC trials of a second, complementary, preventative vaccine, from Johnson & Johnson, are underway.