Gary Kobinger working in the lab.

Ebola expert says building up health systems is best defence

Global collaboration is the key to stop infectious diseases.
May 22, 2018

By: Matt Gergyek

If you’d walked through Freetown in September 2014, the city would have looked nothing like it does today. For three days that month the streets were ominously empty due to a nationwide lockdown. It was a desperate attempt to combat the spread of the Ebola virus that was wreaking havoc throughout Sierra Leone. Lively street vendors and open air markets were replaced with body bags and idling ambulances, leaving only a skeleton of the colourful mountainside city behind.

According to the World Health Organization (WHO), the highly contagious Ebola virus kills roughly half of all people it infects. When the WHO announced the official end of West Africa’s Ebola epidemic in January 2016 — the deadliest on record — nearly 4,000 people had died from the virus in Sierra Leone alone. Neighbouring countries Liberia and Guinea were also severely affected by the outbreak, bringing the death toll to more than 11,000 people.

But the story was dramatically different in the Democratic Republic of Congo (DRC). Although the Ebola virus was present at the same time, only 66 cases of Ebola, which led to 49 deaths, were reported during the epidemic. What made such a dramatic and live-saving difference in the DRC? Many turned to Gary Kobinger and his team to find out.

“Within three months [the DRC] shut [the epidemic] down and they did it themselves,” Kobinger said at a 2016 IDRC-hosted event about the global response to the Ebola outbreak. “Building capacity finally made a difference,” said the Canadian scientist, who specializes in infectious diseases and microbiology.

When Kobinger says “building capacity” he’s referring in part to the toolkits that were developed in collaboration with a global community of public health experts to control viral epidemics in several countries. In the DRC, for example, where there have been sporadic outbreaks of Ebola since the virus was discovered in the 1970s, public health and medical officials are trained to quickly identify, isolate, and treat individuals diagnosed with Ebola, while keeping in constant contact with the rest of the world.  

“Their communications officers… are bringing the level of anxiety down to make sure the public health message gets out. It’s one of the most efficient tools to control an outbreak,” Kobinger said. He also noted that the DRC uses advanced surveillance techniques like environmental sampling and animal testing, especially of pigs, to detect the virus.

Gary Kobinger speaking at an IDRC event.
Teckles Photography Inc.
 

Kobinger, along with the team he headed at Canada’s National Microbiology Laboratory in Winnipeg, emerged as international heroes and media superstars for their integral role in developing an experimental Ebola vaccine — partially funded by IDRC — that proved to be extraordinarily effective.

Their rVSV-ZEBOV vaccine underwent major clinical testing in Guinea in 2015, where nearly 6,000 participants at risk of Ebola were vaccinated. After 10 days, no new cases of the virus had developed, in contrast to the control group who received a delayed dose of the vaccination and recorded over 20 cases of Ebola. Their study, published in The Lancet  in 2016, concluded that the “vaccine has high protective efficacy and effectiveness to prevent Ebola.”

The trial used the ring vaccination strategy, which has been previously used to combat small pox. The first step of the ring approach, which vaccinates only those most likely to be infected, is identifying a person who is infected with the targeted virus. The infected person’s contacts, or “ring”, which includes family, friends, and neighbours, are vaccinated. Then the contacts of this ring are vaccinated, and so on.   

When another Ebola outbreak was declared in the DRC in May 2018, the rVSV-ZEBOV vaccine was put to the test once again. Up to 10,000 people are expected to receive it during the first phase of the vaccination campaign.

Kobinger and his team also developed an experimental Ebola treatment known as ZMapp, which enhances the patient’s immune response to prevent the Ebola virus from replicating. Although the antibody cocktail is still in the experimental phase today, it was dramatically forced into use near the peak of the outbreak in West Africa. It was used in Liberia in 2014 as a last ditch effort, known as “compassionate use”, to save the lives of 25 first responders and residents and two American medical missionaries.   

Kobinger is quick to acknowledge the many players in the global health community who helped to develop and implement the rVSV-ZEBOV vaccine and the ZMapp treatment. This includes research teams, those who were on the ground, the Public Health Agency of Canada, the Centers for Disease Control and Prevention, and the WHO.

In May 2018, Kobinger and his colleague Xiangguo Qiu were honoured with a Governor General’s Innovation Award in recognition of their use of cutting-edge technologies to create ZMapp. The treatment has been driving studies into the efficacy of similar monoclonal antibody therapies against HIV, Lassa, Marburg, and other infectious illnesses.

While Kobinger acknowledges that vaccines and advanced treatment methods play an integral role in curbing the spread of deadly viral epidemics, he said preparedness and cooperation are the global community’s best line of defence, which has been exemplified by the management of the outbreak in DRC. “This is why it’s worth building up health systems everywhere,” he said.

Although infectious diseases are the second leading cause of death worldwide (falling just behind cardiovascular disease), Kobinger said their importance is often understated. “It’s actually double all cancers together in terms of its weight on human society,” he said. “Infectious diseases in the minds of many people are a problem of yesterday because of antibiotics, but [they] don’t work against viruses — and viruses don’t stop at borders,” he said.

Kobinger, who now heads the Infectious Disease Research Centre at Université Laval  in Québec City, says the problem of infectious diseases has grown in the past 30 years, but he hopes the Ebola outbreak in West Africa helps to prevent a similar epidemic from occurring again. “The bottom line,” he says, “is that not only [does] African public health affect us all, but the world’s public health affects us all. We are a global community. When we go somewhere else to respond it’s not only to help others, but to help the international community that we’re all a part of.”

Watch Kobinger’s 2016 “Ebola, capacity building, and collaboration in Africa” presentation at IDRC.

 
 

 

 
Photo: Radio-Canada