Three years ago in December 2013, a toddler named Emile was the first known person to contract Ebola in Guinea, West Africa. No Ebola outbreaks had ever taken place in West Africa and it took months before medical professionals and government officials knew what they were battling. By spring 2014, this growing Ebola epidemic slowly came to the world’s attention. It quickly took hold in three countries: Guinea, Liberia, and Sierra Leone. The lack of efficacious vaccines or serums soon proved an obstacle to containing the epidemic.
It was just announced that an Ebola vaccine created by Merck, Sharp, and Dohme and used in trials in West Africa in 2015—is 100% effective in preventing Ebola. This overdue vaccine is a game changer. Thousands of lives would have been saved if it had been available earlier, but the new vaccine still has the potential to save countless lives in the future. Understanding how that vaccine came to be entails tracing the history of the outbreak, a story that should serve as an example for those who aspire to “cure” other emerging diseases
During the late summer and fall of 2014, the West African Ebola epidemic spiraled uncontrollably. Sadly, almost 29,000 people were infected and more than 11,300 died. The epidemic threatened to spread from three small West African countries throughout the world. And spread it did—with cases in Nigeria, Mali, Senegal, the United States, and England. Ebola’s mortality rates range from 25-90% so wherever it spreads makes it very deadly. In West Africa, the mortality rate was about 60%.
Ebola was unprecedented in West Africa. There had only been one human case prior in Cote d’Ivoire when a researcher became infected from an animal. Ebola was also unprecedented in significant numbers in urban areas. In 2014, all of this would change. Within months, Ebola had spread to the capitals of the three hardest hit countries: Conakry, Monrovia, and Freetown respectively. As the year continued it would spill out of these three countries into the subregion with and into the world.
By April 2014, it was clear that the numbers infected were rising at a rapid pace and this outbreak could quickly morph into a regional epidemic or a global pandemic. While Ebola infections were first recorded in 1976, past epidemics were mostly relegated to rural areas in Central Africa where they quickly burned themselves out, never building to the point that could sustain widespread outbreaks or the mobility to propel it very far. A modest number of private and public laboratories had research teams working on vaccines and serums. However, in the broad quest for biomedical progress, Ebola was not a funding priority.
The 2014 West African Ebola pandemic illuminated the need for an Ebola vaccine. Reports of the Ebola virus began to slowly spread in spring 2014. By May, dozens were infected and the country had moved from the border of Guinea into Sierra Leone and Liberia. Trends from previous outbreaks clearly showed that this epidemic had the propensity to blossom. Western media coverage (especially the U.S.) was sluggish for several months. Most of what we knew about the outbreak in the early weeks came from West African media sources, independent media, government officials, and locally-based public health NGOs. As the numbers grew, mainstream European media coverage grew with it and U.S. media began to pay closer attention. There was a great deal of misinformation about the crisis in the first few months. In West Africa, people already knew that it was spreading beyond Guinea but in the Western media you really did not get a sense of that.
Similarly, the global public health response was tepid during the early months of the outbreak. NGOs that were already in the hardest hit countries: Doctors Without Borders, Wellbody Alliance, the Last Mile and local public health teams were doing their best to respond. Healthcare workers were working with limited supplies, limited public health infrastructure and a dearth in human staffing. Because the numbers seemed small to most observers, I believe that many public health officials outside of the epicenter thought that the epidemic was manageable. It was evident to me in May that the numbers were moving quickly and that move efforts were needed to contain the spread. By June, the numbers had surpassed previous outbreaks and continued to grow. Spread to urban centers and porous borders helped to propel the spread. By this point more assistance was coming from the broader global health community and foreign governments, both within and outside the African continent. As the summer progressed, CDC sent more staffing and the global response included military regiments that were deployed to build temporary medical facilities and help to manage security. Though the process was slow to start, the world was beginning to galvanize in its response to contain the spread, especially as cases spread to the Europe and North America.
By the late summer, efforts became more pronounced as the numbers infected continued to rise, British and American health care workers were infected alongside their African counterparts and Ebola began to spread into the larger West African region and into the West. By the fall of 2014, monetary investment and human resources in the form of staffing from several African countries, the African Union, several European countries, Cuba, the United States, converged to battle to contain the epidemic more vigorously. However, because the initial response had been tentative, Ebola was well-entrenched by the fall. For example, by November— 13, 241 had been infected and almost 5,000 had died. To put this in greater perspective, in late September 6,574 had been infected while in June the cases were still in the hundreds. These figures were alarming at the time and each week brought new infections.
If the West African Ebola epidemic had not unfolded the way it did, an Ebola vaccine would not yet be available. This epidemic underscored the interconnectedness of global public health and how the Africa continent is a major player in global health security. Once Ebola became a threat to the Global North, it spurred investment into efforts to stop the spread and preventing future catastrophes.
In addition to increasing resources and staffing to the subregion, there was a rush to find a “cure” for Ebola. Money was infused into existing studies while other scientists and pharmaceutical manufacturers started new trials. This new vaccine developed by Merck has received additional R&D support from GAVI to fast track production. Now it is up to the manufacturers to produce and stock supply of the vaccine to prevent another Ebola epidemic of this magnitude. This game-changing vaccine is important and shows the fruits of efforts of global health collaboration. It took four decades and a catastrophic outbreak to achieve this medical advance. The West African Ebola epidemic taught us that Africa is significant to global health security, that global health collaboration is important, and that emerging epidemics and pandemics need to be responded to swiftly.