Every Outbreak Is a Test; The Lessons Come After

During childhood in school, we get our lessons first and then have a test. In the public health arena, we get the test first, and then figure out what lessons we can learn for the next time. The Ebola outbreak in West Africa has provided many valuable lessons. First and foremost, the importance of public health, its attendant infrastructure, and experienced infection control practices was demonstrated. In terms of specific interventions, medical product development is an arduous and time consuming task littered with failure, regardless of clinical indications. The range of available clinical candidates currently being evaluated is the result of more than decade of dedicated resources focused on filoviruses. The first human clinical trial of an Ebola vaccine was undertaken in 2006 and the first grant award for an immunotherapeutic intervention began in 2003. Only sustained developmental funding can ensure future candidates for future outbreaks. One unique aspect to Ebola (as opposed to other recent emerging infectious diseases) is its BSL4 status requiring the highest level of biocontainment for research studies with live virus. BSL4 lab capacity is expensive to operate and maintain. Expansion of BSL4 capacity over the past decade has directly impacted our ability to evaluate, advance, and even more importantly, eliminate various candidates. Expanded capacity also allows for an expanded workforce skilled in working in BSL4 containment conditions as well as contributing to a critical mass of scientific experience and intellectual rigor needed during an evolving outbreak. Finally, the rarity of Ebola outbreaks (until this outbreak, the disease incidence was only 40 patients per year), the difficulty of working with the virus (Select Agent Rules and requirement for BSL4 containment limits even large pharmaceutical entities), and a requirement for non-human primate studies, necessitates a governmental engagement to assist developers of medical interventions. New forms of engagement, with both for profit and non-profit entities have evolved that will provide for smoother and faster responses for future outbreaks.