Clinical trials are set to begin in December to determine whether three different treatments can help end the Ebola outbreak in West Africa. The French-based medical relief organization Doctors Without Borders will carry out the trials. They hope that positive results will be found by February.
The news was broadly welcomed and widely reported late last week. One of the earliest to respond and deploy significant resources, Doctors Without Borders has rightly garnered praise for its work on Ebola in West Africa. However, the organization’s internal watchdog says the group waited too long to call for vaccines and did not adapt its response to the crisis as it got worse.
“We wasted time before speaking about a vaccine and treatments,” Jean-Herve Bradol, a member of the Centre For Reflection on Humanitarian Action (CRASH), told Reuters. “It’s very hard to imagine controlling this epidemic now without a vaccine.”
The organization has faced challenges adapting to the current outbreak, said Bradol. Previous Ebola outbreaks have been much smaller and easier to contain. The spread of Ebola from Guinea to Liberia and Sierra Leone, and the crowded cities of both countries, presented a completely different emergency than previously experienced. Calling for an Ebola vaccine in September was too late for an outbreak that started in December 2013 and quickly spread in the middle of 2014.
The issue came to a head when Western health workers infected with Ebola were transported back to their home countries and provided experimental treatments. Claiming that not enough was known about what would happen did not stand up when such dangers were considered worth taking for some health workers. Meanwhile, Dr. Sheik Umar Khan, a leading Ebola specialist from Liberia, died of the virus and was not provided experimental treatments.
“The CRASH said … if you argue the drugs are not safe because they are experimental but you give them to the expatriates, that makes no sense,” said Bradol to Reuters.
While it might be late, Doctors Without Borders appears to have learned its lesson. It is partnering with various pharmaceutical companies and research groups to introduce clinical trials in three different West African treatment centers. The trials include: favipiravir, an antiviral drug, in Guéckédou, Guinea; convalescent whole blood and plasma therapy in Conakry, Guinea; brincidofovir, an antiviral drug, in an undetermined location.
Doctors Without Borders hopes that the trials may soon indicate effective treatments for Ebola. It will work with the research partners to implement the trials and collect evidence so the research institutions can analyze whether or not the treatment is working. Both Doctors Without Borders and the researchers will have to learn and adapt along the way.
Conducting clinical trials of investigational drugs in the midst of a humanitarian crisis is a new experience for all of us, but we are determined not to fail the people of West Africa,” Professor Peter Horby, the chief investigator of the brincidofovir trial, led by the International Severe Acute Respiratory and Emerging Infection Consortium.
The three trial groups will coordinate among one another on an ongoing basis in order to share real-time data and adapt treatments based on what they and others are finding. Favipiravir trial lead Professor Denis Malvy, conducted by the French National Institute of Health and Medical Research, stressed the importance of the groups working together.
“Strengthening the link between our teams is all the more important as there is the possibility that, should our trials give positive results, the next phase could consist of combining interventions,” he said in a press release.
The comments reflect the lesson that the response needs to be even more adaptive than previously thought. Patients with Ebola have the option to join the trials. Doctors Without Borders made clear that patient consent is of the utmost importance in the testing. And while the group may have been late to call for vaccines, it appears that it is listening to its internal critics and finding new ways to end the Ebola outbreak.
