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Experimental drugs rushed to trial as Ebola effort ramps up


Health authorities and medical researchers have rushed experimental drugs and therapies to trial in west African countries ravaged by the Ebola virus as international efforts to contain the world’s worst-ever outbreak intensify.

In an unprecedented transnational initiative, research institutes, public health agencies, health departments and humanitarian organisations have collaborated to fast-track clinical trials of three different Ebola therapies at west African treatment centres operated by medical charity Medecins Sans Frontieres.

The urgency of the effort has been underlined by confirmation the deadly disease has spread to Mali, where at least five people – including two health workers – have died, in a setback for hopes the outbreak was losing momentum.

In its most recent update on the epidemic, the World Health Organisation said the rate of new infections in Guinea and Liberia had levelled off, though transmission remained intense in key districts in both countries.

The outlook is much less promising in Sierra Leone, where the virus is yet to show signs of slowing, and the WHO reported that across the eight countries where the disease has occurred, 5420 people have died so far and there have been 15,145 confirmed, probable or suspected cases.

The outbreak has taken a particularly heavy toll of health workers – a total of 584 were known to have been infected with the virus as at 16 November, 329 of whom have died.

The magnitude of the crisis was recognised by the leaders of the world’s 20 largest economies who gathered in Brisbane earlier this month.

In a joint statement, the G20 leaders declared they were “deeply concerned” about the outbreak, urged governments to commit more money and resources – particularly trained medical teams and equipment – to combat it and called on researchers, regulators and drug companies to intensify their efforts to develop safe, effective and affordable diagnostic tools, treatments and vaccines.

After weeks of resisting calls from the AMA and others to support the deployment of health workers in west Africa, the Abbott Government earlier this month announced it had engaged private provider Aspen Medical to staff and operate a 100-bed British-built treatment centre in Sierra Leone.

But its tardy response has failed to impress some, including the US Government.

President Barack Obama has pressed governments around the world, including Australia, to do more,

US National Security Adviser Susan Rice said that, “we look to Australia and other partners…to fulfil the commitments they’ve made and do more, quite frankly”.

Ms Rice said the international efforts still fell well short of what was needed to help bring the outbreak under control, and added that US Government would “continue to look to capable partners like Australia to do their part”.

AMA President Associate Professor Brian Owler said that the Association had for some time stressed that the key to controlling the Ebola outbreak was to tackle it at its source in west Africa.

A/Professor Owler said that, in addition to the Australian Government’s $20 million decision to contract Aspen to provide on-the-ground medical services in west Africa, “we must support initiatives to provide further support for these efforts in the affected nations”.

He said the AMA supported the Doctors’ Day for Ebola initiative, which aims to raise money to provide equipment and support for those combating the disease in west Africa, as “a practical way to tap the generosity and compassion of Australian doctors to save lives in Africa”.

The G20 leaders said the epidemic highlighted shortcomings in the world’s preparedness to cope with serious outbreaks, and they jointly committed to fully implement the WHO’s International Health Regulations, support other countries in doing the same, and to fight anti-microbial resistance.

The International Health Regulations are legally binding rules aimed at helping countries work together to prevent the spread of disease and other health risks while minimising interference with international trade and travel.

In Australia, the AMA has been working with the Commonwealth’s Chief Medical Office Professor Chris Baggoley to ensure GPs have up-to-date advice on the Ebola outbreak, the disease’s symptoms, and how to manage any patients suspected of being infected.

Chair of the AMA Council of General Practice Dr Brian Morton said advice from the Office of Health Protection was that it was “very unlikely” the GPs would encounter patients with Ebola.

Dr Morton said only about 10 people a week arrived in Australia from west Africa. Under upgraded processing arrangements, all such arrivals will have their temperature taken and their risk assessed before being allowed to leave the airport.

Travellers who do develop Ebola-like symptoms are advised to call the dedicated national Ebola hotline – 1800 186 815 – rather than see their GP, he said.

Reflecting the urgency of the situation, organisations from across the world have joined efforts to rush experimental treatments to trial.

In Guinea, the French National Institute of Health and Medical Research will lead a trial of the antiviral drug favipiravir, and the Antwerp Institute of Tropical Medicine will oversee tests of an experimental convalescent whole blood and plasma therapy. An Oxford University team, acting on behalf of the Internaiotnal Severe Acute Respiratory and Emerging Infection Consortium, will administer a Wellcome Trust-funded trial of the antiviral medicine brincidofovir at a location yet to be confirmed.

“This is an unprecedented international partnership which represents hope for patients to finally get a real treatment against a disease that kills between 50 and 80 per cent of those infected,” senior MSF official Dr Annick Antierens said.

The trial protocols are in the final stages of development, and have a simple target of 14-day survival.

It is intended that they commence in early December, with initial results available in February.

Adrian Rollins