The Lancet
Oct 24, 2015 Volume 386 Number 10004 p1599-1706
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Ebola: forgotten but not gone?
The Lancet
On Oct 16, two new Ebola cases were reported in Guinea, indicating the continuing danger of Ebola virus even after progress in bringing the west African Ebola outbreak under control. The outbreak in Guinea, Liberia, and Sierra Leone caught the world badly unprepared during 2013–14, resulting in more than 11 000 deaths. WHO responded slowly to this major challenge in countries with sparse health provision, and disease control measures worked imperfectly. During 2015, lost ground has been made up by provision of care for those infected and at risk of infection, yet recent developments illustrate the continuing health risks for those who have been infected.
Despite previous outbreaks in sub-Saharan Africa, limited understanding of the physiological effects of Ebola virus has compromised preventive and therapeutic efforts. However, a recent study on 100 Ebola survivors in Sierra Leone has shown the importance of continuing research by indicating that viral RNA can be detected in semen up to 9 months after overt recovery from infection. A study in The Lancet Infectious Diseases on 49 survivors of a 2007 Ebola outbreak in Uganda reported ocular deficits and hearing loss, among other health problems, which persisted for 2 years. On Oct 6, Pauline Cafferkey, a Scottish nurse who contracted Ebola early in 2015 and was thought to have made a full recovery after treatment, was rehospitalised with severe health problems. At the time of writing, Ms Cafferkey’s condition was reported to be serious but stable, with disease transmission unlikely. Post-Ebola discharge criteria are discussed by Nazaria Bevilacqua and colleagues in The Lancet Global Health.
Salutary lessons are still being learned from the west African Ebola outbreak—opportunities for and benefits of research will be greatest in the communities most affected. WHO’s Director-General Margaret Chan believes the world is “dangerously ill-prepared” for further infectious disease outbreaks spread through the air or contagious during an incubation period. Strengthening of and investment in health systems in countries most at risk of infectious disease outbreaks are key to prevention, and in the worst case scenarios control, of health emergencies.

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Comment
Essential medicines are still essential
Andy L Gray, Veronika J Wirtz, Ellen F M ‘t Hoen, Michael R Reich, Hans V Hogerzeil
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00514-0
On Oct 21, WHO published the full report of the 20th Expert Committee on the Selection and Use of Essential Medicines,1 with its new WHO Model List of Essential Medicines (EML).2 The new list includes recently developed medicines for drug-resistant tuberculosis (bedaquiline and delamanid), a number of new cancer treatments (such as imatinib, rituximab, and trastuzumab), and, perhaps most controversially, new direct-acting antiviral drugs (DAA) for the treatment of hepatitis C (sofosbuvir, simeprevir, daclatasvir, ledipasvir, and ombitasvir).