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INTERVIEW-Experimental Ebola drugs should be tried in Africa, disease expert says

Source: Reuters - Wed, 2 Jul 2014 14:43 GMT
Author: Reuters
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Diagram illustrating the life cycle of the Ebola virus disease and its route of transmission to humans
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* West Africa Ebola outbreak largest ever, with 467 dead

* Farrar says "out of control" disease needs new approach

* Drugs still in development could be offered to patients

* Normal drug testing and approval process takes years (Adds fresh quote, plus comment from virologist)

By Kate Kelland, Health and Science Correspondent

LONDON, July 2 (Reuters) - People at high risk of dying in West Africa's Ebola outbreak should be offered experimental medicines to see if they work, despite the drugs being not fully tested, the head of an influential global health charity said.

Jeremy Farrar, a professor of tropical medicine and director of The Wellcome Trust charity, said Ebola's spread in Guinea, Sierra Leone and Liberia is "out of control" and global health authorities should rethink the approach to potential treatments.

"We have more than 450 deaths so far - and not a single individual has been offered anything beyond tepid sponging and 'we'll bury you nicely'," Farrar told Reuters in an interview. "It's just unacceptable."

The normal drug development process - of years of testing new drugs in animals, then in healthy human volunteers before they go to clinical trials in sick patients before being approved by regulators - takes too long and should not apply in rapidly spreading outbreaks of diseases like Ebola, he said.

West Africa is battling its deadliest outbreak of Ebola, with 467 people killed so far by a disease that causes fever, vomiting, bleeding and diarrhoea, and can kill between 50 and 90 percent of those it infects.

The World Health Organization (WHO) has called on other states in the region to prepare for the disease heading their way, and is co-hosting a meeting of West African health ministers in Ghana this week to try to strengthen the region's response.

Farrar pointed to several experimental drugs and vaccines in development as potential treatments or preventative measures against Ebola, and questioned why they were not being tested in a situation where people at high risk might benefit.

"WOULD YOU TAKE IT?"

"It's ridiculous that we haven't got these (experimental) products out of labs and animal trials and into human testing, and at least offered to people," he said.

"If you had a 60 percent chance of dying tomorrow, and there was something that had been tested in healthy volunteers (but not yet tried in patients or approved), would you take it?"

The pipeline of drugs being developed for Ebola is far from bulging - partly due to a lack of research money for a medicine which is likely to be needed mainly in poor countries with scant healthcare funds.

But several small biotech companies and U.S. university departments are developing potential vaccines, and Tekmira Pharmaceuticals, which teamed up with the U.S. Department of Defense on an injectable drug for Ebola, started an initial Phase I trial in healthy volunteers in January.

U.S.-based Inovio and privately held Vaxart are among those with experimental vaccines in animal testing, while GlaxoSmithKline last year acquired Swiss vaccine firm Okairos with an early-stage Ebola product.

Farrar noted that while Ebola is a relatively rare disease, outbreaks have come regularly since the virus was first identified some 40 years ago, and can be predicted to happen in future - making testing potential drugs a sensible approach.

"This is not the first time this has happened, and it will happen again - we know that," he said.

"And we could all have pushed for having stockpiles (of experimental drugs) maybe held in Geneva, and they could have had WHO ethical approval, and then we'd be ready to go (when the next outbreak comes)".

TRADITIONAL BELIEFS, DENSE POPULATIONS

The WHO said on Tuesday it believed three key factors were contributing to the spread of Ebola in the region. One was the burial of victims in accordance with cultural practices and traditional beliefs. Another was the dense population around the capital cities of Guinea and Liberia. The third was commercial and social activity along the borders of the three countries.

Fear and mistrust are also driving dozens of victims to evade treatment, frustrating foreign and local doctors trying to contain the epidemic.

Both the WHO and the charity Medecins Sans Frontieres (MSF), which has been heavily engaged in handling the outbreak on the ground, have said the top priority must be containing Ebola with basic but vital infection control measures such as vigilant hand washing and hygiene, and isolation of infected patients.

Farrar acknowledged these were crucial, but said health organisations needed to consider experimental drugs in their planning for the future.

"There are candidate vaccines out there, and candidate drugs, and whilst I absolutely agree that the most important things are infection control and making sure people can't pass it on, ultimately you do have to move these things (candidate drugs) out and start offering them to people," he said.

A University of Texas Medical Branch researcher, Thomas Giebert, told Reuters in March he was developing a potential Ebola vaccine, which had shown good results in animal tests and could, he said, be offered on "compassionate grounds" to people at risk in the current outbreak.

But Ian Jones, a virologist at Britain's University of Reading, said calls for a vaccine were "a knee-jerk response".

"It's unclear if any vaccine could be delivered successfully to those at risk," he said. "Instead, a strong public health message, increased medical support and cross border co-operation are the key actions required to reduce transmission and bring the outbreak to a close." (Reporting by Kate Kelland, editing by Peter Millership)

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