The news from Guinea and Sierra Leone has been unrelentingly horrific. Despite encouraging signs from Liberia, overall things will get worse. Today the official toll of the Ebola epidemic reached 13,703 cases, though the true figure is higher. By Christmas there may be thousands of new cases every week. More countries will probably report introduced infections, as in the US and, more worryingly, African neighbours. Several bleak months lie ahead.
Yet through this darkness it is finally becoming possible to see some light. In the past 10 days the international community has belatedly begun to take the actions necessary to start turning Ebola’s tide. The progress is preliminary and uncertain; even if ultimately successful it will not reduce mortality or stop transmission for some time. We are not close to seeing the beginning of the end of the epidemic. But three developments offer hope that we may have reached the end of the beginning.
The first advance has been a step change in urgency from the rich world, which is finally starting to commit resources and people on the scale required. The first priority in containing Ebola is breaking the chain of infection, by ensuring that people who have or might have it are isolated, while being treated with respect and dignity; and that if they die their bodies are disposed of safely and with cultural sensitivity.
Trust has to be re-established between communities and authorities. The people of Guinea, Liberia and Sierra Leone are making heroic efforts, but need help: clinical facilities to hold and treat confirmed and suspected cases, and trained people to run them. Deployments by the UK, the US, China, Cuba and France are now starting to add capacity, hitherto left to charities such as Médecins Sans Frontières.
Major recent investments, including an EU contribution that has almost doubled to €1bn and large UK and US donations, mean that money should no longer be a barrier. The World Health Organisation, so slow to recognise and respond to Ebola’s threat, is now showing leadership and coordinating these efforts.
There is also good progress in the search for treatments. A therapy that improves survival would not directly reduce transmission, though it would have immense humanitarian value. It could nonetheless play a vital indirect role. A key to controlling Ebola is persuading more people who have had contact with a patient, or who have symptoms, to seek medical care. At the moment, they have few incentives to do so. A better therapy, even trials of one, would make a real difference. Such trials are now close to beginning.
A team supported by the Wellcome Trust has made a successful visit to the affected countries, visiting communities and clinics to discuss trials, and is now almost ready to start work. Another group in Antwerp has been funded to assess a serum made from the blood of Ebola survivors. A sticking point was overcome last week by a WHO ethics meeting, which agreed that trials need not follow the standard placebo-controlled model: this can be unethical and impractical in an epidemic context.
Finally, and potentially most significantly, vaccine development has changed up a gear. While public health remains pivotal to containing Ebola, the outbreak is so advanced that this might not be enough. A safe and effective vaccine could transform the situation. Just a few weeks ago, there was widespread scepticism that one could be produced in time. There is now agreement from industry, governments, philanthropy and regulators that this can and must be done.
Mass production of three vaccine candidates will now proceed in parallel with trials, so that if results are promising, hundreds of thousands of doses could be deployed in the first half of 2015. The costs must be shared even if trials fail, and liability and trial design issues are being resolved. If one or more of these vaccines is viable, west Africa must get it quickly enough to make it count.
This progress does not justify complacency. While the elements of a successful containment strategy are starting to crystallise, huge challenges lie ahead. We should also be advancing with still greater urgency and ambition. The accelerated schedule for vaccine deployment, for instance, rests on conservative projections that could be beaten given sufficient will, and provided we clear logistical and regulatory hurdles now. If science shows a vaccine to be safe and effective, issues such as customs, shipping or refrigeration cannot delay it.
The pressure must not let up. The constructive diplomacy of recent days has not saved a single life, nor protected anybody from infection. The epidemic’s exponential curve means it will get worse before they get better. We have not yet begun to control Ebola, and the new interventions could yet fail. But if the world lives up to its promises, the past week may come to be seen as the turning point.
Dr Jeremy Farrar is director of the Wellcome Trust, a global charitable foundation dedicated to achieving extraordinary improvements in health by supporting the brightest minds.