The world's worst Ebola crisis broke out in December 2013 and swept across West Africa claiming the lives of over 11,300 people. It decimated the already fragile health systems of Guinea, Liberia and Sierra Leone and while it may be approaching an official 'end' it has raised many questions concerning global health which still need to be addressed.
Questions like why it took the World Health Organization almost six months to declare an international emergency and begin effectively responding to the crisis. Or about the way in which health systems in the North such as Britain's National Health Service, rely on health workers from countries such as Sierra Leone, leaving those countries with a bill for their training and a huge gap in their own human resources for health. And perhaps most importantly, why it took thousands of African deaths before treatments and vaccines to combat Ebola were prioritized.
Sierra Leone was declared free from Ebola in early November 2015 and Guinea just recently this month. Liberia on the other hand, continues to experience resurgence from the disease, and new cases have interrupted its countdown to zero cases twice in the last few months. The virus simply keeps on coming back.
Whilst an Ebola outbreak is caused biologically, an epidemic is due to weak and inefficient health systems. Prior to the outbreak, Sierra Leone, Liberia and Guinea had an average of only 2 health workers per 10,000 people. Misinformation about the disease in the early days of the outbreak meant many frontline health workers became infected and died, leaving an even bigger deficit. A delayed response from the international community did not help matters. This was not the first Ebola outbreak, but it was the worst, infecting and killing more people than all previous Ebola outbreaks combined. Effective treatments or vaccines would have helped to stem the devastation.
As Peter Piot, the co-discoverer of the Ebola virus back in 1976, rightly stated in an article for the Guardian recently, Ebola will keep on coming back unless we discover the tools to stop it. As of yet, there have been no approved vaccines and more research is needed.
This is despite the fact that Ebola treatments and vaccines have been in development for more than a decade. Prior to the latest outbreak, the development of treatments and vaccines to combat Ebola were stalled at the pre-clinical trials stage. Even during the epidemic, it took thousands of African deaths - and arguably confirmed cases of health workers originating from Western countries - to fast track these vaccines into clinical trials. Two of the lead vaccines didn't go to trial until September and October 2014, 6-7 months after the first case was confirmed.
Why was this? The answer lies in the fact that our international system for the Research and Development (R&D) of new medicines is based on profit rather than need. Since the market for an Ebola vaccine or treatment is concentrated mainly in African countries, where populations and governments would be largely unable to afford them, there is little profit incentive for pharmaceutical companies to invest in developing the tools needed to stop Ebola.
This is an issue not only restricted to Ebola, as the dominant profit-driven model of R&D constrains the process of developing effective, affordable vaccines and treatments for many other diseases predominantly affecting populations in developing countries, such as TB, HIV/AIDS, and (by definition) the range of Neglected Tropical Diseases.
Despite the initial delays the development of potential Ebola vaccines was fast tracked with clinical trials being conducted at a speed 'unprecedented in the history of modern medicine.' The VSV-EBOV vaccine has now proven 100% successful in trials in Guinea.
However, this is little comfort to the people of West Africa who have already lost family and friends to the virus. Their right to health and access to medicines has been denied because of an unjust R&D system that disproportionately prioritizes medicines for the wealthiest, not the poorest.
Throughout the Ebola crisis, Health Poverty Action worked alongside the communities where we have had a longstanding presence in Sierra Leone, to help prevent the spread of Ebola. We trained traditional healers and made sure remote health centres were stocked up with supplies. During these activities we met Sorie Bangura, of Kamalo town, who lost his wife and eldest daughter to Ebola. He is angry at the injustice surrounding vaccine development.
'What was done last should have been done first. My wife and daughter could have stayed alive but no vaccine was there to keep them alive,' Sorie said.
Many of those who survived the Ebola infection are now experiencing ongoing health problems. Preliminary studies have revealed widespread vision and hearing problems and severe joint pain in Ebola survivors. Although more research will be needed to determine the extent of these complications, the initial evidence indicates the possibility that the health impacts of Ebola may continue for some time, putting continued strain on fragile health systems trying to recover from the crisis. The outbreak of Ebola in West Africa provides a grave and devastating case-study of the consequences of a continued R&D system which puts profit before need. Had a suitable drug treatment or vaccine for Ebola been available at the start of, or even earlier on in the most recent outbreak, then thousands of lives could have been saved and Ebola survivors now suffering complications could possibly have been spared these ongoing health problems.
Given the ground-breaking research which has taken place over the last year, we hope that a fully effective Ebola vaccine will be ready to stop a similar Ebola crisis occurring in the future. However, this doesn't change the bigger issue that the current R&D model is broken.
If we do not reform the way we research and develop new medicines and vaccines in order to concentrate on those diseases affecting populations most in need, rather than those who can generate the most profit, thousands more lives will be lost and we remain at risk of a health crisis similar to Ebola in the future.