By Susan J. Blumenthal, M.D., and Jennifer Sherwood, M.P.H.
The doctors, nurses and other health care workers who responded to the Ebola epidemic in West Africa were recently named Time magazine's "Person of the Year." The courageous individuals who dedicate their careers and risk their lives to help in times of global public health emergencies such as Ebola deserve this recognition. A new report shows that health care workers have more than 100 times the risk of being infected with Ebola in Sierra Leone as the general public there. The World Health Organization (WHO) estimates that 622 health care workers have acquired the virus and 346 of them have died in the affected countries. The recent death of a physician in the United States, who had been working in Sierra Leone and had tested negative for Ebola days before testing positive, underscores the urgent need for new technologies to detect, treat, contain, and prevent this and other infectious illnesses. These illnesses account for one of every four deaths annually, and 27 new infectious illnesses including Ebola, AIDS, West Nile encephalitis, Lyme's disease, and MERS, have emerged since 1972.
In an interconnected, interdependent 21st century world, where 2 million people travel across national borders every day, a state-of-the-art toolkit is required to battle infectious disease threats worldwide. Here are 10 key elements important to improving global health emergency preparedness that would benefit from innovation:
Strengthen infectious disease research and surveillance. Studies examining the clinical course of Ebola, including the effects of co-infection and treatment for other diseases such as AIDS, are needed. Research to fast track the gene sequencing of Ebola and other contagious diseases is underway and will help determine mutation patterns that might affect transmission routes and lethality as well as identify who may have immunity because of their genetic makeup. This kind of molecular information could lead novel treatments and prevention approaches. Additionally, a more detailed understanding of the spread of the epidemic is needed so that efforts can be adapted to its course and locations, which can rapidly shift. Mobile technologies and social media should be leveraged to pinpoint cases as new outbreaks occur, monitor changes in people's health, rapidly disseminate health information, perform contact tracing, and refer people to medical services. Mobile devices present an enormous untapped opportunity to instantaneously share information, provide virtual health professional training, and conduct consultations as well as collaborate on research in real time.
Rapid diagnostic tests for Ebola that provide results in minutes at point of care are currently in clinical trials. Currently available FDA-approved blood tests detect presence of the virus at about the same time that serious manifestations of the disease emerge. As a result, sometimes the test produces false negative results when administered early in the course of the illness. Detection methods using biomarkers of the virus, that can reveal its presence before significant symptoms occur, might improve treatment outcomes and reduce transmission to others but will require safety and effectiveness testing.
Lightweight, portable, and inexpensive personal protective gear is needed for use in the field and in hospitals. This equipment should be designed for the challenges of working long hours in hot, humid climates by being less cumbersome, more comfortable, and easier to remove than currently available gear. Currently, experts recommend that staff spend only short shifts in protective gear, acknowledging that when working in stifling heat, even the most fastidious health care workers can make mistakes.
Advanced manufacturing hubs to accelerate the development, deployment and scale-up of a new generation of protective gear, mobile clinics, and equipment, as well as conventional resources that could be efficiently, flexibly, and rapidly distributed to affected regions of the world.
Temperature-safe vaccines and refrigeration technologies powered by renewable energy sources, including solar power, for the storage of vaccines and other supplies in communities without electricity and in clinics with inconsistent power sources. The development of temperature change safe vaccines would be an important breakthrough. Vaccines are very sensitive to temperature variations needing to be stored within a range of 2-8C. In the absence of electricity and refrigeration, these lifesaving immunizations can be damaged before they can be administered to protect people from disease.
New disinfection and protection methods for hospitals and homes such as ultraviolet light, sprays, and robotics for site de-contamination, moving supplies, and assistance in the burial of people with contagious diseases.
Novel vaccines and therapies are urgently needed and are now underway for Ebola, as are methods of rapidly mass-producing vaccines, such as cell-based and nucleic acid approaches, to replace conventional egg-based methods that can take 4-6 months from strain identification to vaccine availability. This time frame could be lethal in the face of a highly infectious pathogen. New antibiotics and antiviral treatments for infectious disease threats have been on the back burner, but investments in new product development are critical now. Financial incentives and public-private sector partnerships should be encouraged to accelerate the development and manufacturing of these medications.
Behavioral research and interventions are vital in the effort to help people adopt healthy behaviors and hygienic practices, adhere to medical regimens, and overcome the panic and stigma that often occur with an emerging disease threat. New medical technologies and therapeutics alone will not be sufficient to combat infectious disease outbreaks without effective behavioral interventions to boost their use and to increase the community's trust in adopting them.
Stronger, resilient health systems have made all the difference in containing Ebola and preventing its spread. Even in the United States, the Ebola outbreak has underscored the importance of public health preparedness revitalization. To expand the availability of coordinated, expert care across America, regional Ebola clinical treatment hubs were recently announced. Vital to the prevention and containment of future infectious disease outbreaks globally is a robust investment in building health systems infrastructure in the developing world where these illnesses often first emerge. Coordination of efforts and communication are cornerstones of public health preparedness. A ready reserve of well-trained health professionals, an International Health Corps, armed with medical supplies that can be mobilized to respond to a disease outbreak anywhere in the world is also essential.
Establish an End Ebola Fund. Private sector charitable contributions in response to the Ebola epidemic have been limited compared to other public health emergencies such as the tsunami in Indonesia, Hurricane Katrina and the Haiti earthquake. The establishment of a well-publicized fund to receive contributions from individuals, businesses and foundations, chaired by high profile people, could help to accelerate Ebola research, control and relief efforts.
Throughout the 20th century, infectious diseases have killed millions of people -- more deaths than from all wars combined during this time period. The current Ebola outbreak underscores that pathogens remain clear and present dangers to humanity, economic development, and national security in an interconnected 21st century world and we must remain vigilant against them.
Funding for the fight against Ebola has increased sharply as a result of FY15 Omnibus Congressional spending legislation that includes $5.4 billion to fight the disease globally. These funds as detailed in the Global Regulatory Enforcement Law Blog will support public health preparedness and response in America and abroad. Funding allocations include:
- $112 million will be appropriated to Department of Defense for Ebola response and preparedness. Of this, $45 million will go to the Defense Advanced Research Projects Agency's (DARPA) long-range research programs; $50 million to nearer-term research programs of the Defense Threat Reduction Agency; and $17 million for procurement of equipment.
- $25 million will be appropriated to the FDA for Ebola response and preparedness including "increased medical countermeasure activities."
- $2.742 billion will be appropriated to the U.S. Department of Health and Human Services (HHS) to respond to the Ebola epidemic in the United States and other countries threatened by the virus. Funding will be used to (1) develop vaccines and treatments; (2) train health care workers; (3) bolster quarantine stations at ports of entry; (3) create isolation units; (4) reimburse hospitals providing care; and (5) send CDC personnel to countries affected by Ebola.
- $238 million will be appropriated to the National Institutes of Health (NIH) for Ebola-related research.
- $2.5 billion will be appropriated to the U.S. Department of State "to respond to the Ebola epidemic in West Africa and to strengthen public health capacity in other countries threatened by the virus."
Investing now to strengthen the scientific knowledge base and develop new global health technologies that can be deployed in combination with proven public health practices, will ensure our ability to fight Ebola and other emerging infectious disease threats more swiftly and effectively worldwide, moving from peril to progress, in the years ahead.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research in Washington, D.C. Dr. Blumenthal also serves as a Clinical Professor at Tufts and Georgetown University Schools of Medicine and is a Senior Fellow in Health Policy at New America. Admiral Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award. Her work has included a focus on infectious diseases including HIV/AIDS since the beginning of the epidemic in the early 1980's and she was involved in the federal government's response to bioterrorism in 2001.
Jennifer Sherwood serves as an Allan Rosenfield Public Policy Fellow with amfAR, The Foundation for AIDS Research in Washington, D.C. She conducts research analysis, develops policy briefs, infographics and writes scientific articles. Jennifer received an MSPH from Johns Hopkins Bloomberg School of Public Health. She has worked in West Africa, in collaboration with local ministries of health, to understand the social and structural factors related to STIs/HIV. Her research interests include the health impact and prevention of gender-based violence, sexual and reproductive health and rights, and HIV.