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Lack of vaccine or lack of beds leading to the growing outbreak of Ebola?

16 October 2014 Mark Hollis

Earlier this week, I appeared in CNBC to discuss the growing challenges around treating and containing Ebola. The World Health Organization has warned that new cases of the disease are rising rapidly. Some 5,000-10,000 new cases of Ebola could be identified a week in Guinea, Liberia, and Sierra Leone by December, according to new World Health Organization (WHO) forecasts. The WHO has also suggested that mortality rates may be higher than previously thought, citing its own research that suggests a mortality rate close to 70%.

We previously blogged about the pipeline for vaccine development. However, it remains unclear if the current vaccines will actually work, and if so, how soon will they be available on a global scale. So what will work?

The WHO has reiterated calls that 70% of Ebola patients must be placed in isolation if the outbreak is to be brought under control. At present, a lack of beds in infected countries means that many patients are being cared for at home, fuelling the outbreak.

Despite the growing prevalence rate, and the international community's procrastinations, the key messages appear to be fundamentally unchanged. One of these is that the main means of tackling the outbreak on a global scale is to ramp up isolation and treatment provisions in Guinea, Liberia, and Sierra Leone. At present, the shortage of beds in treatment facilities is leading to many patients at advanced stages of the disease, when the chances of infection are higher, are being cared for at home by relatives. As indicated by the WHO, 70% of patients need to be isolated in order to bring the outbreak under control. The race is therefore on to ensure that the number of beds can overtake this percentage before the number of patients becomes so large that achieving this objective becomes impossible. It is also essential that lab services are strengthened, as there may come a point when these cannot meet the growing demand for sample testing, making it challenging for healthcare providers to establish how many beds may be needed to meet this threshold.

Outside West Africa, there appears to be agreement that isolated outbreaks are to be expected due to air travel. These outbreaks are however likely to be limited, as the risk of infection remains low when a patient's symptoms aren't severe enough to warrant hospitalization. Patients, especially those in the developed world, are likely to seek medical treatment as soon as they present with symptoms, allowing authorities to conduct timely isolation before a risk might be posed to the wider public. Healthcare staff may however remain potentially at risk from the virus due to their exposure to patients at the later stages of patient care, when the virus is at its most virulent. However, protocols have been put in place and strengthened in many countries, reducing the risk to healthcare staff.

Anthony Banbury, the head of the UN Mission for Ebola Emergency Response, stated at the United Nation's special meeting to discuss the growing Ebola epidemic "it [Ebola] is far ahead of us, it is running faster than us, and it is winning the race.'' Let's hope that the combination of an increase in beds with continued investment in Ebola vaccine development represents a viable contender in that race.



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