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The House of Commons Science and Technology Select Committee has published a report followed its inquiry into lessons learnt from the Ebola outbreak, which criticises delays at several points during the crisis.
All our previous output on this subject can be seen here.
Dr Nathalie MacDermott, Clinical Research Fellow, Imperial College London, said:
“While working for an international NGO and operating the only Ebola treatment facility in Monrovia in July 2014, the lack of response by the international community left us in utter despair, as we lacked the capacity to contain a devastating epidemic that was increasingly out of control. That it took my two colleagues, American aid workers, to contract Ebola before the international community fully perceived the gravity of the situation is a sad testament to when we determine it necessary to act. This report is a further stark reminder of the lessons that must be learned. What is important now is to ensure that we do not permit the receding threat of the Ebola epidemic to breed complacency, by ensuring strategies are in place for the future to ensure a prompt and coordinated response to epidemic situations.
“As recommended by the report, it is essential that in the future there is a clear structure for the dissemination of surveillance data from potential epidemic situations to those individuals who can escalate this information and initiate a response should the situation require it, and to hold to account those organisations, such as WHO, that should be mounting an emergency response. This was key to the delays in an early response to the Ebola epidemic.
“It is also important that investment into research of emerging infectious diseases occurs, particularly potential treatments and vaccines, in advance of epidemic situations, to ensure such options are available should an epidemic strike. Both the government’s proposed solutions for funding such research and the report’s recommendations are very welcome in this regard.
“The recommendations to develop strategies for research in epidemic situations are also crucial to ensure that in future epidemics the optimum amount can be learned whilst promptly providing potentially beneficial treatments or vaccines which may assist with interrupting the epidemic.
“Likewise the recommendation of a clear strategy for the UK’s capability to deploy a response overseas in future epidemics and the potential need for volunteers would enable a more coordinated future response and enable employers and health care professionals to develop structures in advance of such situations.”
Dr Peter Horby, Professor of Emerging Infectious Diseases and Global Health, University of Oxford, said:
“The Committee report highlights some important issues, which if addressed will go some way to improving the UK response to epidemics like Ebola. However, the recommendations are largely inward looking and procedural; focussed on communications, representation, and decision making. To an extent this reflects the terms of reference but for me the report is disappointing in its restricted vision for the scope of UK science to build global resilience against diseases like Ebola.
“The UK has world leading scientific assets both onshore and internationally. These were not adequately prepared for Ebola nor utilised during the outbreak. Whilst I very much endorse the committee view that research must be embedded in the emergency response I would go much farther and say that research for epidemic resilience must be embedded in the UK international development and security agendas, as it is in the United States. The report is also too reactive in its outlook. We need greater focus on building local and regional research and response capacity and less on deploying for an ‘in-theatre response’.
“The recommendations, such as for a disease specific emerging infectious disease strategy and to support the UK Vaccine Research and Development Network, are solutions to specific problems. What is missing is a political commitment for UK science to fulfil its potential in national and global health security, backed by sustained funding. Science delivers better intelligence and better evidence, and these are our insurance policy against the Ebolas of this world.”
Dr Derek Gatherer, Lecturer in the Division of Biomedical and Life Sciences, Lancaster University, said:
“The STC report covers many of the difficulties involved in coordinating our response to infectious disease emergencies, and illustrates how the Ebola outbreak highlighted many deficiencies in current capacities and procedures.
“Many recommendations are given, among which is the division of disease threats into categories based on their means of transmission, namely respiratory, blood-borne, vector-borne and food-borne, and the production of a separate protocol for each. This is useful, but it is disappointing not to see sexual transmission also included in this list. It should be remembered that although HIV is a blood-borne virus, sexual transmission was of crucial importance in its pandemic spread, and sexual transmission has also been a component in the pandemic of hepatitis C virus (HCV). Multi-drug resistant gonorrhoea is exclusively sexual, so would not fit any of the four recommended protocol categories, and has a distinct potential for pandemic spread if additional antibiotic resistances are acquired, especially in regions where likelihood of safe sexual practices is limited. We should also not forget human papilloma viruses (HPVs) which, although less dramatic in their clinical manifestations, present a delayed societal burden in terms of cervical cancer occurring many years after infection, and present the possibility of “quiet” sexually transmitted pandemics that pass below the radar of surveillance strategies designed for more virulent agents.”
Prof. Julian Hiscox, Professor of Infection and Global Health, University of Liverpool, said:
“The report addresses some crucial issues. However, it does not highlight the role of the European Mobile Laboratory (which ~25 UK based scientists participated in) which was mentioned in one of the written testimonies. This was the first international diagnostic unit to be deployed to Guinea at the epicentre of the outbreak and was actively diagnosing patients by the 30th of March 2014 – within seven days of Ebola being positively confirmed.
“One of the crucial lessons learnt from the European Mobile Laboratory is the value of rapid deployment of reliable diagnostic units into tented laboratories and not to wait many months for purpose-built facilities to be constructed. This allows for the rapid identification of infected individuals for isolation and treatment. The European Union made emergency funding available to provide follow-up research in support of efforts directed at helping this response work.
“The comments on data sharing are interesting but do not necessarily take into account the reality of working as a guest in a foreign country – that has its own expectations and legal frameworks. Data sharing was dictated by ethical agreements put in place by individual research teams and the appropriate governments in West Africa. In the case of our work, outputs were immediately made available to the government of Guinea and the WHO, many months prior to publication of data.”
‘Science in emergencies: UK lessons from Ebola’ will be published by the House of Commons Science and Technology Committee on Monday 25 January 2016.
Declared interests
Dr Nathalie MacDermott: “I am undertaking a PhD in Ebola virus disease at Imperial College London funded by the Wellcome Trust. I was employed by Samaritan’s Purse International Relief, working in Liberia as part of their Ebola response team, in July 2014 and from October 2014 to March 2015.”
Prof. Peter Horby: “Peter Horby is funded by the Wellcome Trust to undertake clinical trials of experimental therapeutics for Ebola.
Peter Horby is funded by the European Commission to undertake clinical studies of emerging infectious diseases in Europe.
Peter Horby is a member of the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC).
Peter Horby is a member of the secretariat of the Global Research Collaboration for Infectious Diseases Preparedness (GloPID-R).”
Dr Derek Gatherer: “no relevant conflicts of interest.”
Prof. Julian Hiscox: Julian Hiscox is Professor of Infection and Global Health at the University of Liverpool and has been involved in Ebola research for the past four years. Many of his laboratory deployed as part of the European Mobile Laboratory and he is involved in the EU funded EVIDENT (Ebola Virus Disease – correlates of protection, determinants of outcome, and clinical management) project.