Ebola Vaccine: What’s the hype all about? PART 2

Ebola Virus is a scary illness.

And there are a lot of scary accusations, rumors, half-truths…and even accurate facts about Ebola floating around right now.

It’s often hard to sort out the facts from the hyped-up fiction.

So if you have been concerned about the Ebola Vaccine, and wondering whether you should get it for your kids (or whether you’ll be forced to get it for your kids…), here’s some info to help you out.

Research and Availability of Ebola Treatments

Over the years, researchers have seen success with treating HIV/AIDs, another virus that originated in Africa, using anti-viral medications. To give you a point of comparison, though, it takes HIV about 10-years to wipe out a person’s immune system and transform into AIDs.

Ebola, on the other hand, conquers an immune system in only 7-10 days…

…then can kill the infected person within 3-7 days after that.

Traditional anti-virals simply don’t have the time to be very effective against the quick-moving Ebola virus. So what other treatment options are available?

Containment of an Ebola outbreak

First, you need to understand that viruses aren’t technically alive (even though they sort of “act” like it when they are active in a host body (human OR animal…even bacteria can get viruses, apparently!).

And since they’re not really alive, you can’t really kill them.

That’s why antibiotics are useless against Ebola. And all viruses, for that matter.

So what other options do we have to deal with this infectious and deadly disease?

The first line of defense is trying to contain the spread of Ebola. This can be done by:

  • Education about how Ebola is spread: This was especially important during the West African outbreak, where traditional African funeral practices played a huge role in spreading the illness, since the bodies of the deceased continue to be contagious.
  • Encouraging people with Ebola to go to hospitals for treatment, rather than be cared for at home: Another huge factor in the West African outbreak was that the native Africans initially were very mistrustful towards the foreign medical personnel that came to help.
  • Providing medical personal with appropriate personal protective gear, along with the training of how to properly use it: third major factor in the West African outbreak was that there was both a shortage of personal protective gear AND of training on how to use it.

These 3 things are important, but they only help to prevent or contain the spread of Ebola. They do nothing for patients who already have Ebola.

Current treatment options for Ebola

For Ebola infected patients, supportive therapies such as IV rehydration and blood transfusions DO seem to improve survival rates. It helps prevent the patient from going into shock or bleeding to death.

But IV therapy is a very non-specific treatment…you’re basically trying to keep the patient alive long enough for their own immune systems to fight off the Ebola virus. While it does seem to improve the death rate, it does not actually doing anything to actively destroy the Ebola virus.

Future treatment options for Ebola

There are, in fact, a couple of experimental medications for Ebola that show a lot of promise. They were first administered as part of the “compassionate use” protocol during the 2014-2016 West African Ebola outbreak. “Compassionate Use” protocol allows medications that are not currently approved for human use to be used immediately on humans, so long as they give informed consent.

Can you imagine being the first person to take the first dose of a medication that no other human had ever taken? The medication itself could kill you…if the Ebola doesn’t kill you first, of course.

Luckily, these drugs have shown great promise, and most of the people who have chosen to take them have ultimately survived their encounter with Ebola.

However, these medications are extremely expensive to produce and are still in the research phase, therefore patient access is extremely limited.

In addition, there is still plenty more testing that needs to be done. Like many medications in use today, researchers have only a general understanding of why these medications are effective against Ebola. …they don’t yet completely understand how or why they work.

The research process can be frustratingly slow, even during the best of times. Testing Ebola drugs is even more difficult because of how rare the illness is. In fact, the first few people who took the medication during the West African outbreak were actually taking samples that had been made. Full-scale production of the drug had just begun…when the outbreak ended.

For all those reasons, these medications are not a great “Plan A” if you happen to catch Ebola, because there’s no guarantee that you would have access to a research study that used them.

This is scary news for anybody living in the middle of an Ebola outbreak, and especially for healthcare providers working on the “front lines”.

In fact, they are some of the people at highest risk of contracting Ebola from patients they care for…before anybody even knows the patient’s diagnosis.

And that leads us to…

Prevention of Ebola: The Vaccine

Vaccines are a hot topic nowadays, and feelings often run high. Questions abound regarding their safety, effectiveness, how well/long they’ve been researched…and who’s making the money, of course.

Ebola Vaccine Research

Like the experimental Ebola medications, the Ebola vaccine can only be tested when there is an active outbreak of Ebola. And also like the medications, it first earned permission to be tested on humans due to the “compassionate use” guidelines.

The official research study began in 2018 during one of the recent outbreaks in Congo.

The study used a “ring” methodology: once an Ebola patient was identified, the researchers attempted to identify Every. Single. Person. that patient possibly had contact with while contagious. This makes up a “ring” of contacts.

Some of the ring contacts were vaccinated. Some of the ring contacts were not vaccinated. At least, not until after 21-days had passed, which is the full incubation period possible for Ebola.

The researchers then compared the rate of Ebola in the vaccinated rings to the rate of Ebola in the unvaccinated rings. The results seemed fairly clear:

“The estimated Ebola attack rate for vaccinated individuals was about 0.017%, compared with an estimated 0.656 %in unvaccinated individuals.”

https://www.who.int/csr/resources/publications/ebola/ebola-ring-vaccination-results-12-april-2019.pdf?ua=1

Those are both small numbers, but remember we’re also dealing with a rare illness. So let me put it in more understandable terms:

  • If you took a group of 1000 people who were exposed to Ebola but vaccinated soon after, only 0.17 people would develop Ebola (and since you can’t have only 0.17th of a person, that’s effectively zero).
  • On the other hand, if you took a group of 1000 people who were exposed to Ebola and NOT vaccinated, then 6-7 people would develop Ebola (and statistics suggest that between 2-4 of them would ultimately die from it).

If you were a researcher, scientist, or medical professional trying to save lives, and you saw those results…

Could you sleep at night knowing that by withholding the vaccine for a research trial, you had inadvertently allowed 6-7 people to go through a horrifying physical experience…and resulted in the death of 2-4 people?

Would you want to continue withholding the vaccine?

Challenging Ethical Issues with Vaccine and Medical Research

Think about the following Ebola facts:

  • Really horrible symptoms
  • Relatively high death rate
  • Essentially no effective treatment (aside from supportive care)
  • Limited resources for supportive care in areas where Ebola is endemic
  • Healthcare workers at great risk of exposure before diagnosis can be made (and even greater risk of exposure when without access to personal protective gear)

Is it any surprise that many people would want to rush this vaccine to market?

And if an American healthcare worker wanted to travel to Africa for a humanitarian aid mission during the current Ebola epidemic, should the FDA deny them the option of getting the Ebola Vaccine?

Here’s another heartbreaking fact: During the 2014-2016 Ebola outbreak, 8% of Liberia’s doctors, nurses, and midwives died of Ebola.

That’s almost 1 in 10. It crippled the country’s healthcare system.

Basically, the single biggest thing that I learned while studying Ebola and the Ebola Vaccine is that…

…it’s complicated. Very, very complicated.

There are sooo many ethical issues involved, and it’s easy to forget that real people are involved. And they are being forced to make hard, sometimes impossible, choices.

Frankly, it’s difficult to know for sure what you and I would do in those same, sometimes horrible, situations.

Which leads me to the million dollar questions…

Would I get the vaccine for myself (or my family)?

After learning what I now know, would I choose the Ebola Vaccine for myself (or my family)?

Would you be surprised to learn that my answer is “it depends”?

Given our current lifestyle, no. I would not choose to get the Ebola Vaccine for the following reasons:

  1. We live in the United States, where sanitation is good, funeral practices are general hands-off, access to supportive medical care is relatively easy, and Ebola is not endemic.
  2. My family has no international travel plans, especially not to any countries where Ebola is endemic (aka Africa).
  3. I’m not currently working in a healthcare setting with sick patients.
  4. I’m currently pregnant.

That being said, there are certainly some circumstances in which I would consider getting the vaccine:

  1. If I was traveling to Africa, but not to an active Ebola epidemic area (I would also be considering the Yellow Fever vaccine for African travel, FYI)
  2. If I was working in a healthcare facility that would be likely to care for Ebola patients should an outbreak in the United States occur.

And guess what else? There’s actually a few situations where I truly believe I would choose to get the Ebola Vaccine:

  1. If I were a healthcare worker in Africa.
  2. If I had close and extended contact with a sick person later diagnosed with Ebola.
  3. If I were a researcher working regularly with the Ebola virus.

Basically, I think that the Ebola Vaccine is an excellent option for some situations, and that the FDA probably made the best decision possible. Especially given that there were literally no other effective Ebola treatments available to the general public before this vaccine.

Will the CDC add the Ebola Vaccine to the pediatric schedule?

Nobody can tell the future, but here’s my opinion:

Don’t give in to the fear mongering.

I see no reason why the CDC would have any reason to add the Ebola Vaccine to their current pediatric schedule of vaccines.

After all, if they added Ebola, then they would also have reason to add the vaccine for Yellow Fever, since Yellow Fever is actually much more common than Ebola: there were an estimated 84,000-170,000 severe cases in Africa during 2013. And, like Ebola, it has a relatively high death rate of 30%-50%…and also like Ebola there are no specific treatments for it.

That number is significantly more than the under 29,000 Ebola cases that occurred during the worst 2-year epidemic ever recorded.

Especially when Yellow Fever that actually occurs IN the United States is as rare as Ebola. We only see approximately 1 “travel associated” case of Yellow Fever every 10-years within American borders.

Given the rarity of ebola, and the track record of how the CDC has treated the Yellow Fever vaccine, I sincerely doubt that they will be adding either one to the pediatric vaccine schedule.

Where to go for more information

As part of my research, I read two books by Richard Preston that provided a fascinating overview of the history of Ebola:

  • The Hot Zone: A Terrifying True Story: That subtitle is not an exaggeration. This well-researched book covers the history and human drama of Ebola from when it first emerged during the 1970’s until the early 1990’s. It’s non-fiction, but so well written that it reads like a novel…I couldn’t put it down. Fun Fact – The star-packed, 1995 fictional film Outbreak was loosely (very loosely) based on this book.
  • Crisis in the Red Zone: This is a “sequel” that focuses mostly on the Ebola outbreak in West Africa that occurred between 2014-2016. He also updates the Ebola research from his first book, and paints an often heartbreaking portrait of the impossible situations many healthcare workers were in. This was definitely another page-turner.

Richard Preston is a fantabulous storyteller (yes, that’s a real word, because I just made it up!). He absolutely excels at painting the human side of Ebola. Both the heroes AND the “villains” (who may not actually be villains after all, but merely imperfect people faced with impossible situations).

You can also get a good overview of Ebola at the World Health Organization’s Ebola FAQ page.

So, can we have a civil conversation about vaccines nowadays?

Vaccines in America are fraught with controversy, and for many good reasons…

…that I will NOT be going into in this article 😉

But if you only remember one thing about the Ebola Vaccine, I hope that you remember that sometimes (most times…) there are risks and benefits to both sides of the debate. And different people will weigh those risks and benefits differently based on past history, current situation, personal values, and yes…even straight-up emotion.

  • So whenever you discuss the Ebola vaccine, please have some compassion for the researchers who developed and tested it…they have seen things that they can never unsee.
  • And have compassion for the healthcare workers who administer the vaccine, and choose to get it for themselves…they have put themselves at high personal risk in order to care for others.

Sometimes, both sides of the debate are only pushing their agenda because they are equally passionate about it.

And that’s OK.

There are very, very few health decisions that are completely clear-cut with one obvious answer. For the rest of those decisions, we have to realize that we can never eliminate 100% of the risk in our lives. So we make the best decision we can, accept the outcomes, and then move on with our lives…

…always remembering to be kind to others who decided differently from us.

Because given different life experiences, different knowledge, or a different situation…there’s a good chance we would have made the same decision they did.

Leave a comment! What is your biggest concern about the Ebola Virus/Treatments/Vaccine?

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