A glimmer of hope, finally

For the first time, a combination of an effective vaccine and two drugs that seem effective offers hope to Ebola victims

There could be a cure for the deadly Ebola virus which has plagued Africa since the 1970s. The disease was first seen in 1976, in a town close to the Ebola River in what is now the Democratic Republic of Congo (DRC). Almost simultaneously, there was an outbreak in South Sudan about 1,000 km away.

The virus has several strains. Most are dangerous to humans. It’s believed to have been first transmitted by a bite from a fruit bat. It also infects monkeys, pigs and apes and people have been infected by eating meat from infected animals. Ebola causes fever, colds, vomiting, rashes and dementia. It has a very high mortality rate, of anywhere up to 85-90 per cent. It can be transmitted via sweat, blood and other body fluids. It has even been transmitted to people handling corpses.

Ever since that first discovery, there have been random outbreaks in the central African nations of DRC, South Sudan, Gabon, with some cases in Uganda, and another cluster of cases in West  Africa, in Nigeria, Ivory Coast, Sierra Leone, Senegal and Mali.

Currently, DRC is suffering an outbreak. This started in April 2018 and it has killed at least 2,800 people. Since July 2019, the WHO has declared this a global health emergency. According to local health services, around 80 new cases are discovered every week. Ebola causes fear and panic to the extent that health workers have been attacked or chased out for fear they will be carriers. It doesn’t help that this is an extremely disturbed region, more or less in the middle of a civil war.

Until 2019, there was no real hope of a cure. A vaccine made by Merck & Co is estimated to be 97.5 per cent effective. But once infected, the only way to handle the disease was to strictly isolate victims until they either recovered or died. Since the early symptoms are like flu, victims often don’t realise that it’s Ebola until it’s much too late. By then, they have infected others.

Reports say that two experimental drugs may be effective. Infected people, who participated in a clinical trial seem to have 66-71 per cent survival rates, compared with 30 per cent for those who were not vaccinated and did not receive medication. Over 90 per cent of those who received treatment upon showing early symptoms survived.

The drugs are part of a combination developed by Dr Jean-Jacques Muyembe Tamfum, who’s researched Ebola since the first 1976 outbreak. Two individuals treated in Goma, DRC, have been officially declared cured. The two drugs, named REGN-EB3 and mAb114, were developed by Muyembe by using antibodies harvested from blood samples taken from Ebola survivors.

The drugs were being tested as part of a randomised clinical trial in four DRC towns. Two other drugs were also being tested. But the trial was concluded early when it was found the REGN-EB3 and mAb114 seemed to lead to a 94 per cent recovery rate. This means that delivery to the general population could be accelerated.

The clinical trial began in November 2018, with 681 people and four drugs. The mortality rate for REGN-EB3 was 29 per cent, and for mAb114, it was 34 per cent. The mortality rate for the other two drugs was higher at 49 per cent for ZMapp and 53 per cent for Remdesivir. The mortality rate was much lower for early treatment, at 6 per cent for REGN-EB3 and 11 per cent for mAb114.

The trial was co-sponsored and funded by the Institut National de Recherche Biomédicale where Dr Jean-Jacques Muyembe Tamfum is the director general. The US’ National Institute of Allergy and Infectious Diseases (NIAID) also put up funding, while the WHO coordinated the research teams. REGN-EB3 is a mixture of three synthesised monoclonal antibodies and produced by Regeneron Pharmaceuticals. The mAb114 is a monoclonal antibody developed after being drawn from an Ebola survivor, who recovered from an outbreak in 1995. It is licensed by Ridgeback Biotherapeutics from NIAID.

Drugs based on monoclonal antibodies take years of research. Ebola is a large virus and like many viruses, it has the ability to change shape, making it difficult for any one antibody to block infection. That’s why a cocktail approach is used, with REGN-EB3 a combination of three monoclonal antibodies generated first in mice.

For the first time, a combination of an effective vaccine and two drugs which seem effective offers hope to Ebola victims. While the local political instability makes it hard for medical personnel to function in the DRC, there’s hope that this will be the final large Ebola outbreak.