“We are not close to seeing the beginning of the end of the epidemic,” says Wellcome Trust Director Jeremy Farrar, writing in The Guardian recently, but there is hope that we “may have reached the end of the beginning”.
At the Wellcome Trust our focus is on helping tackle the crisis in the worst affected areas in West Africa, and supporting research into techniques, treatments, and vaccinations that could help stop the spread of this deadly virus.
The first official cases of Ebola, in what has now become an epidemic in West Africa, were confirmed in Guinea and then Liberia in March 2014. Despite obvious concern that the virus had surfaced in a number of humans, no-one was prepared for the scale of this outbreak.
With the number of cases – and countries affected – increasing, we realised that the Wellcome Trust was well placed to help. We worked to highlight the voices of infectious disease specialists with experiences of other outbreaks – with Jeremy Farrar joining Prof David Heymann, head of the Chatham House Centre on Global Health Security, and Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine in the Wall Street Journal, to call for Africans to be given access to experimental Ebola medication. In August the World Health Organisation (WHO), having already declared Ebola an international health emergency, agreed that due to the scale of the outbreak, it was indeed ethical to use experimental drugs in West Africa.
Since then the confirmed death toll from Ebola has increase to almost 5,000 (at the start of November), although the true number is likely to be much higher, and we have committed approximately £10 million to fund vital research. This funding has helped enable unparalleled international collaboration across public, private, and not-for-profit sectors to tackle this public health emergency.
There is no simple solution to the Ebola crisis. That’s why we are supporting research into vaccines, treatments, public health and social science. We are also looking at the ethics of conducting research during an epidemic and ensuring that treatments are developed rapidly, in an ethically and scientifically sound manner. There are many pieces to this jigsaw and we are lucky to have experts from a range of disciplines – from infectious disease to medical ethics – at the Wellcome Trust.
Although systematic infection control and isolation practices will remain a key method of disease control, it’s clear given the scale of this epidemic, that we need to consider how other options, such as vaccines to prevent infection, may also impact the spread of the disease.
Through our fast-tracked Ebola funding scheme we have already funded researchers at Oxford University to conduct a vaccine safety trial to evaluate the GSK-NIH Ebola vaccine in human volunteers. Healthy volunteers in Oxford and Mali are currently being given the vaccine, which is based on a type of chimpanzee cold virus, called chimp adenovirus type 3 (ChAd3). Alongside this we are also funding an international consortium, overseen by the WHO, to conduct trials of the Canadian VSV Ebola vaccine in Europe and Africa.
Developing vaccines to protect front-line health workers and others at high risk from Ebola infection is a priority, but treatments may also play an important part in getting the outbreak under control. While effective therapies are unlikely to directly reduce transmission, they would encourage people who are infected or exposed to seek treatment, which is critical to containment. Treatment, of course, also has immense humanitarian value.
The Wellcome Trust has therefore funded a clinical trials platform in West Africa to fast-track tests of candidate treatments at existing Ebola centres. Dr Peter Horby of the Centre for Tropical Medicine and Global Health at the University of Oxford will lead an international team of partners, including the WHO and Médecins Sans Frontières (MSF), working on the platform, which will allow the rapid evaluation of potential treatments. Candidate treatments will be prioritised based on factors such as which is likely to work best, the availability of the intervention, the ability to safely administer the intervention in treatment centre settings, and the capacity for manufacture to a useful scale. We have also pledged to support research into convalescent serum, a possible treatment option using antibodies from the blood of people who have survived Ebola.
“It is a huge challenge to carry out clinical trials under such difficult conditions, but ultimately this is the only way we will ever find out whether any new Ebola treatments actually work,” says Farrar.
The Trust is also supporting public health and humanitarian research into the outbreak, and we will be announcing projects we are co-funding via the Research for Health in Humanitarian Crises (R2HC) scheme in the next few days.
The current outbreak of Ebola is now bigger than all the previous outbreaks combined, and with cases in urban, as well as rural areas, it is putting an incredible strain on already fragile health systems. We have therefore made funding available to support UK researchers who want to volunteer to travel to West Africa to undertake work related to the current Ebola outbreak.
Ultimately, we must also do what we can to help Africa develop and strengthen its own research capacity. Which is why the Trust is supporting the African-led development of internationally competitive researchers working across sub-Saharan Africa with the DELTAS scheme. This scheme is aimed at developing the infrastructure and capacity to enable African research excellence in the long-term.
Gradually the pieces are starting to come together, and Farrar is cautiously optimistic that recent developments, research, funding commitments and global collaboration will create a turning point in the Ebola outbreak – but only if we all keep to our promises and keep pushing for progress.
The Wellcome Trust mission to “improve human and animal health” has rarely felt more vital. We will continue to monitor the ongoing situation and evaluate grant applications that we receive. We look forward to working with other global partners make a real difference.
This week we announced five projects that we are funding via the R2HC scheme, in collaboration with the Department for International Development (DFID) and ELRHA (Enhancing Learning and Research for Humanitarian Assistance). £1.34 million has been released for the projects that include a portable diagnostic tool for Ebola, mapping and modelling the spread of Ebola, and looking at training for health workers that could help them communicate health messages effectively and improve infection prevention and control.
In addition, the UK Collaborative on Development Sciences (UKCDS), has developed a database to collect information on all current academic research relevant to Ebola that they been informed about. The aim is to reduce the risk of duplication of research and enable research funders across the globe to better align their activities to achieve the biggest impact. Details of how to share information to be included in the database can be found on their website.