The 14-month Ebola epidemic in Liberia killed nearly 4,700 people and infected thousands more, including hundreds of health care workers, 192 of whom died. More than 11,000 people have died from Ebola across West Africa.
With the outbreak currently under control in Liberia, research priorities there are shifting toward prevention and a survivors study, said Dr. Clifford Lane, deputy director, NIAID. Meanwhile, treatment studies continue in neighboring Sierra Leone and Guinea, where Ebola is declining but still active.
Drug, Vaccine Trials
Over the past year, as Ebola engulfed Liberia, NIH partnered with the Liberian Ministry of Health to develop and test Ebola therapies and vaccines. Early on, NIAID began testing the antibody cocktail ZMapp on infected patients in Liberia and, in March, launched a randomized controlled trial to test its safety and efficacy.
“The irony was that as the study was approved in Liberia, there really were no more cases, so the bulk of enrollment has been in Sierra Leone,” said Lane.
In the ZMapp trials, all patients receive fluids, electrolytes and other supportive care. Approximately half are randomized to receive ZMapp, said Lane. “The randomization is to the local standard of care or that standard of care plus ZMapp.” In Sierra Leone, supportive care for advanced cases sometimes includes mechanical ventilation or renal replacement therapy.
NIAID also teamed up with Redemption Hospital to test vaccines. The PREVAIL study (Partnership for Research on Ebola Vaccines in Liberia) has enrolled 1,500 volunteers, randomized to receive 1 of 2 candidate Ebola vaccines or a saline placebo. Kieh said most volunteers exhibited no major side effects.
Monitoring will continue in all three countries, said Lane, and a phase 3 efficacy trial is planned for Guinea. In Liberia, plans are under way to launch an observational survivor study, PREVAIL-3. As part of this phase, NEI is helping establish an eye clinic in Monrovia to study and treat the serious eye problems suffered by a sizeable number of Ebola survivors.
Many NIH doctors, nurses, lab technicians, pharmacists and others across multiple ICs have been instrumental in launching and monitoring this clinical research. Lane and Kieh expressed gratitude to the many who have devoted countless hours toward fighting Ebola.
Liberia: A Community United
Dr. Clifford Lane said Liberians proved wrong any assumptions that nobody would volunteer or return for follow-up visits. In fact, there was an astounding 99 percent attendance rate. “I wish we could enroll our patients in our studies in the U.S. with this degree of engagement.”
Photos: Ernie Branson
Working to combat Ebola in Liberia involved the tireless dedication of lab teams and health care workers collaborating in close confines, but also an engaged local population. The same community-based model used to control the Ebola outbreak also proved effective in following patients through the vaccine studies, said Lane.
When NIAID’s vaccine trial began in February, few volunteers came forward. A Redemption Hospital worker hit the streets to recruit volunteers and a group of street boys became the first to be inoculated, recounted Kieh. Then so many volunteers came forward that the hospital had to schedule people up to 2 months out.
“It’s all been a community effort: going out there, identifying the cases and using contact trackers who were able to get the community to understand the disease, trust the health workers—that we’re here not to take their loved ones away but to teach them the right thing to do,” said Kieh. Now, he said, Liberians are more cautious to prevent the spread of infection; now they don’t hug or shake hands but greet each other by tapping elbows.
Community leaders chose these trackers to recruit and retain volunteers. “Our culture is somewhat paternal, where everybody listens to the leaders…and trusts them,” said Kieh. “These trackers are our foot soldiers, the guys going out into the community to see those participants face to face, make them feel we care about them, make sure they come to their scheduled visits and make sure they [follow up with] their physicians.”
Liberians proved wrong any assumptions that nobody would volunteer or return for follow-up visits. In fact, there was an astounding 99 percent attendance rate, said Lane. “I wish we could enroll our patients in our studies in the U.S. with this degree of engagement, with this degree of information exchange, this degree of commitment on all parts of both the investigators and the volunteers.” Community support was a huge motivating force, he added.
“The 2014 Ebola outbreak in West Africa was the largest in history and placed unprecedented burdens on our health care system and workers,” said Kieh. “It also taught us we had a broken down health system.” Liberians now are trying to rebuild and improve health care while continuing efforts to prevent future infectious outbreaks. “At Redemption, we’re so motivated to work hard to be part of this process.”
Although Ebola is coming under control across West Africa, the clinical research is far from done. Said Lane, “We’re committed to working long term in the region.”