As Ebola continues to strike West Africa and other areas of the world, doctors, including several at Columbia, are stepping in and looking for a solution. Two of those doctors held a panel as part of an all day conference on Monday, and epidemiology expert Christina Clark was there to hear what they had to say.
On Monday afternoon, I attended the last panel of Columbia’s conference on the Ebola crisis, titled “Is Science Keeping Up with the Demands of Ebola and Challenges to Come?” The featured speakers were Stephen Morse, PhD (a professor of epidemiology at the Mailman School of Public Health) and Robert Klitzman, MD (Professor of Psychiatry at the HIV Center for Clinical and Behavioral Studies).
Dr. Morse was the first to give a speech, opening with a joke about how he felt like “the guest that you didn’t want to invite to the party,” given the reason for his talk. However, one of his first points was relatively positive; the fatality rates in this epidemic are 50% or less, while in previous instances rates have hovered closer to 90%. He believes that the biggest reason for this success is a greater emphasis on oral rehydration treatments in African hospitals and clinics.
Morse next began to discuss efforts to create a vaccine. While he predicted one would be available by the end of the year, he was concerned about how a vaccine would be distributed. Since Ebola outbreaks are unpredictable, it would be difficult to determine which areas have the greatest need for preventative measures. Another interesting treatment that he discussed was Zmapp, an antibody treatment produced using genetically engineered tobacco plants. Zmapp is a promising option, but has not been subjected to rigorous studies and is also difficult to mass produce.
The limited supply of Zmapp was also one of the first topics covered by Dr. Klitzman, who was very interested in the ethical questions raised by the epidemic. He noted how the first three recipients of Zmapp were westerners, which he believed sent the wrong message about how treatments would be allocated. Klitzman also brought up questions about the idea of “compassionate use,” or how many regulations are okay to dismiss in the face of an emergency like Ebola. Without the years of studies and tests normally required for the FDA to approve a treatment or vaccine, Klitzman said that we should be prepared for some interventions to fail or only be partially effective. He also noted the difficulties of obtaining informed consent in African communities, where limited education and languages that lack scientific jargon may make communicating the risks and limitations of new treatments close to impossible.Interestingly, Klitzman emphasized the importance of social science in addressing Ebola; he said an understanding of cultural practices that aid transmission of the disease is vital for stopping the epidemic.
His final thoughts were on the ethics of quarantine and the need for funding. Klitzman cautioned against mass hysteria or wasted resources due to unnecessary preventative measures. He also drew a parallel to the HIV epidemic by recalling how grassroots activism led to increased funding for research. Since Ebola, like HIV, largely affects the most vulnerable people in society, Klitzman thought that similar activism may also be necessary to get funding for Ebola research.
After a brief Q&A session with both men, the conference ended with a Skype presentation by youth activist Chernor Bah. Bah had recently traveled to his home country of Sierra Leone and met with Ebola survivors, doctors, and NGOs. He had been following the conference via online streaming and was quite impressed with what he had learned, while also noting the need to remember the human element of the crisis. He said he wished to contribute that part by sharing the story of a 17-year-old girl he had met whose parents and sister had passed away from Ebola. She survived the disease, but had to drop out of school to take care of her younger siblings. Bah said that he heard many stories like hers and the most common phrase he remembered hearing was, “They’re all dead.” He claimed that shaking hands, taking care of the sick, and burial rituals are fundamental parts of Sierra Leonian culture, which makes addressing the crisis and preventing transmission extremely difficult. Bah was well aware of the challenges ahead for his country and in the conclusion of his speech, he stated, “My big takeaway is at the end of the day, Ebola is not a health crisis. It’s a poverty crisis…In the next year or two, if it’s not Ebola it’s going to be something else.” He did not have a concrete solution for these issues, but believed strongly in the potential for education and grassroots efforts to shut down the crisis.
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