To be prepared for epidemics, we need certain things in place. We need widespread surveillance systems to detect outbreaks before they can spread, and robust health systems that can give people the care and treatment they need.
The 2014–16 West African Ebola outbreak showed us how if we give the right resources to research, it can quickly give us back new knowledge and tools for containing disease that we'll use for years to come.
Professor Ian Goodfellow, a Wellcome Senior Research Fellow at the University of Cambridge, arrived in Makeni, Sierra Leone, in December 2014. Within two weeks, his 10-person team had built one of the first diagnostic laboratories in the country, diagnosing up to 100 samples every day.
But to stop an epidemic like this, he says, diagnosis alone was not enough. "You need to monitor viral transmission and evolution as fast as possible. And to track the evolution of the virus, you first need its genetic sequence."
It's only recently become realistic to sequence whole genomes in a day – and that's in a lab. In a tent during an epidemic, it was unprecedented. But Goodfellow's team were undeterred, and with funding, they brought a gene sequencer to Makeni to monitor viral evolution on the ground, uncovering information that had never been available before.
Another example is rVSV-ZEBOV, the vaccine against the Ebola virus, which was assessed for its effectiveness during the West African epidemic. If we hadn't taken the experimental vaccine into the epidemic – running clinical trials in the middle of the outbreak to test for safety and efficacy – we'd be without a key tool in our fight to contain the disease in the Democratic Republic of the Congo (DRC).
The research paid for itself in West Africa; now it pays dividends every time the vaccine gets used. This, ultimately, is the role of research in an epidemic – to give us better ways of fighting disease in the future.
Firstly, putting research into the response is often the only chance of giving those already infected the possibility of receiving treatment, because for many epidemic diseases, there's nothing currently available.
Heart of Outbreaks
"One thing we all have to remember is an outbreak is basically a bunch of people who are sick with a disease," says Professor Peter Horby. "Patients are at the heart of outbreaks." Moving quickly gives us the best chance of helping them. But a rapid response is also important because an epidemic itself is short – at least by research standards.
"Clinical trials usually take years to set up and fund," says Horby, "whereas many outbreaks last six to eight weeks." For rare diseases, this means there's only a fleeting chance to test possible treatments. So research in an epidemic response needs to be atypical, kicking into gear without delay.
"Viral load is known to be highest at point of death," says Bedford. "There are certain customary practices about burials and funerals in the DRC – washing the body, dressing the body, braiding the hair of the women – where there's a high degree of physical contact that really elevates the risk of transmission."