At the Seventh Annual Health Law Year in P/Review symposium, leading experts discussed major developments during 2018 and what to watch out for in 2019. Speakers covered hot topics including health policy under the current administration, pharmaceutical policy, and public health law. Featured panels explored "Challenges Facing Health Care General Counsels" and "AI in Health Care." For more, go to: http://petrieflom.law.harvard.edu/events/details/seventh-annual-health-law-year-in-p-review

1. BUCKLE UP:
EBOLA IN A
CONFLICT ZONE
Helen Branswell
senior writer
Infectious diseases and global health
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2. A bit about STAT (& me)
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STAT:
 Health news website that launched in November 2015.
 Part of Boston Globe Media Partners.
 www.statnews.com
Me:
 Cover infectious diseases & global health
 Write both about disease outbreaks & the development of
countermeasures (vaccines & drugs)

3. Ebola outbreak now underway 2nd biggest ever
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As of 12/6/18:
 4?? Cases
 2?? deaths

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Ebola basics
Containment tools
The current outbreak
The crystal ball

5. Ebola 101
• Six types of Ebola viruses:
— Zaire, Sudan, Bundibugyo, Reston, Taï Forest, Bombali
Human disease:
— Zaire, Sudan, Bundibugyo, Taï Forest (only a single case)
Animal Disease:
— Reston (named after Reston, VA,
where it was first recognized)
Too soon to know:
— Bombali
Case fatality: 25% - 90% (varies by virus & outbreak)
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Photo credit: Fred Murphy/CDC

6. 6
Known source
countries:
Africa:
DR Congo, South Sudan,
Congo Brazzaville, Uganda,
Gabon, Guinea,
Ivory Coast,
Asia
The Philippines
(Ebola Reston)

7. Ebola Facts
An epidemic is anything more than expected cases. Expected
cases of Ebola = 0. So 1 case of Ebola is considered an
outbreak
First recorded Ebola outbreaks were in 1976 in the
Democratic Republic of the Congo and Sudan
Ebola outbreaks have ranged in size from 1 — +28,800 cases
Most outbreaks involve a few dozen cases
DRC has had the highest number of outbreaks, 10.
Followed by: Uganda (5), Congo-Brazzaville & Gabon (4) &
South Sudan (3)
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10. How is Ebola stopped?
Tried & true containment strategy:
 Find & isolate all cases
 Identify people who’ve had risky interactions with them
 Monitor the people who have had risky interactions & isolate them
asap if they become sick
 Key Ebola fact: People with Ebola only transmit when they
have symptoms. The sicker they are, the more infectious
they are
 Care for the sick with appropriate infection control measures
(Hazmat-like equipment)
 Bury the dead safely
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11. Difficulty of developing new tools
Researchers have been working on Ebola vaccines & drugs for
several decades
There’s no traditional market for these products. Even with the
massive West African outbreak, <35,000 people over the past 42
years have been known to contract Ebola
Pharma doesn’t make what it can’t sell
Most of the funding comes from governments interested in
stockpiling for biodefense purposes
Gavi, the Vaccine Alliance, has agreed to maintain a stockpile for
use in outbreaks
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12. Difficulty of developing new tools
A number of experimental vaccines & drugs have shown efficacy
in non human primates BUT…
The only time you can test if something works in people is during
an outbreak
Outbreaks are sporadic and unpredictable. (Which country?
Which virus?) Conducting clinical trials in outbreaks is extremely
difficult
A number of trials were attempted during the West African
outbreak. Only 1, for a vaccine, succeeded in showing efficacy
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13. Finally, progress
As of this year, Merck’s Ebola vaccine — though still unlicensed — is a
standard outbreak tool. A rolling FDA licensure filing has begun.
Who gets vaccine?
 Contacts of cases & their contacts (ring vaccination)
 Health workers in DRC
 Health workers in Uganda
 Burial teams
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14. More progress
Experimental Ebola drugs are being tested in a clinical trial
now underway in DRC. It is comparing:
3 antibody compounds (Mapp BioPharmaceuticals, NIH,
Regeneron)
1 antiviral drug (Gilead)
The RCT is not placebo controlled, which may make data
hard to interpret.
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15. Still more progress — The Cube
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16. North Kivu
2nd largest Ebola outbreak ever
Occurring in an area of decades long conflict
UN peacekeeper force has been in the region since 1999
Constant threat from the ADF, a rebel force, and various
local militias, called Mai-Mai
Some roads are unsafe to traverse, some villages unsafe to
enter.
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17. The price of insecurity
People don’t trust the DRC government or the Ebola
response teams.
First Ebola outbreak in this part of DRC; Ebola was not
known there.
People have been slow to accept the containment efforts.
 Refuse vaccine
 Refuse follow up
 Flee when they receive a positive diagnosis
 Balk at safe burials
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18. What the response team is up against
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19. What the response team is up against
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20. What the response team is up against
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DRC MOH, 10/20/18

21. Risk to Ebola responders is high
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 Multiple violent incidents
 Safe burial workers have been
stoned, beaten
 Peacekeepers & DRC soldiers
have been killed
 Ebola responders’ hotel caught
in the crossfire

22. So high, in fact ....
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CDC, USAID
aren’t allowed to
work in North
Kivu

23. Crystal ball time
This outbreak could spread into neighboring countries or
other parts of DRC
If it spreads, WHO will be under intense pressure to declare
it a Public Health Emergency of International Concern, a
tool of the International Health Regulations (2005)
It could be well into 2019 before it is contained
There will be more urban Ebola outbreaks & more in conflict
zones
There will be a push to vaccinate healthcare workers in
countries where Ebola outbreaks occur
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24. THANK YOU
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