Priorities for Ebola virus disease response in west Africa In their Viewpoint,1 Annette Rid and Ezekiel Emanuel urge to “focus on strengthening of health systems and basic infra structure, rather than experimental treatments and vaccines”. Although we agree that dysfunctional health systems have contributed to the continuing amplification of Ebola virus disease in west Africa,2 we disagree that resources to address these gaps should be prioritised in the midst of an outbreak. Instead, efforts to improve patient outcomes should be the highest priority, and should target both optimisation of supportive care of patients and assessment of the added benefit of promising investigational therapeutics. As clinicians working in Ebola virus disease outbreaks in Guinea, Sierra Leone, and the Democratic Republic of Congo, we saw how the absence of health personnel to provide supportive treatment resulted in suboptimum clinical care and the devastating loss of human lives. If the tools, expertise, and human power to improve supportive clinical care were made available by governmental and non-governmental relief agencies, however, these poor outcomes would undoubtedly change. Moreover, although the minimum experience we have with therapeutics like Z-Mapp provides reason for optimism,3 small-scale, methodologically sound studies in west Africa are crucial for determination of the incremental benefit of such therapeutics above optimised supportive care. We think that currently implementable solutions, such as convalescent plasma transfusions from survivors, should be reinvestigated.4 Provision of optimised Ebola virus disease treatment is essential to obtain the confidence and collaboration of the affected

communities, which are necessary to control this epidemic. We think that the focus now should be on interventions that show positive effects, after which, the health system can be salvaged.

Published Online September 25, 2014 S0140-6736(14)61609-3

We declare no competing interests.

*Shevin T Jacob, Ian Crozier, John S Schieffelin, Robert Colebunders [email protected] Department of Medicine, University of Washington, Seattle, WA 98109, USA (STJ); Accordia Global Health Foundation, Washington, DC, USA (IC); Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, LA, USA (JSS); and Department of Clinical Sciences, Institute of Tropical Medicine, and Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium (RC) 1




Rid A, Emanuel EJ. Ethical considerations of experimental interventions in the Ebola outbreak. Lancet 2014; published online Aug 22. Krech R, Kieny MP. The 2014 Ebola outbreak: ethical use of unregistered interventions. Bull World Health Organ 2014; 92: 622. Qiu X, Wong G, Audet J, et al. Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp. Nature 2014; published online Aug 29. DOI:10.1038/nature13777. Mupapa K, Massamba M, Kibadi K, et al. Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee. J Infect Dis 1999; 179: S18–23. Published online September 25, 2014


Priorities for Ebola virus disease response in west Africa.

Priorities for Ebola virus disease response in west Africa. - PDF Download Free
30KB Sizes 3 Downloads 4 Views