EBOLA/EVD [to 2 April 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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New positive case of Ebola virus disease confirmed in Liberia
WHO statement
1 April 2016
Lab results confirm a new case of Ebola virus disease in Liberia — a 30-year-old woman who died yesterday afternoon while being transferred to a hospital in the capital Monrovia.

Liberia’s Ministry of Health, WHO and partner agencies immediately sent a team to the community outside Monrovia where the woman lived and the clinic where she was being treated to begin case investigation and identification of individuals who may have been in contact with her.

Liberian health authorities convened an emergency meeting early this morning with key partners to coordinate and plan a rapid response…

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Ebola Situation Report – 30 March 2016
SUMMARY [excerpt]
:: The International Health Regulations (2005) Emergency Committee regarding Ebola virus disease (EVD) in West Africa met for a ninth time on 29 March. On the basis of the Committee’s advice and her own assessment of the situation, the WHO Director-General declared the end of the Public Health Emergency of International Concern regarding the Ebola virus disease outbreak in West Africa. The Committee noted that since its last meeting Guinea, Liberia, and Sierra Leone have all met the criteria for confirming interruption of their original chains of Ebola virus transmission. The Committee also noted that, although new clusters of EVD cases continue to occur as expected, including a recent and ongoing cluster in Guinea, all clusters to date have been detected and responded to rapidly…

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Statement on the 9th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa
WHO statement [Editor’s text bolding]
29 March 2016
The 9th meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the Ebola virus disease (EVD) outbreak in West Africa…

The Committee was requested to provide the Director-General with views and perspectives as to whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC) and whether the current Temporary Recommendations should be extended, rescinded or revised.

Representatives of Guinea, Liberia and Sierra Leone presented the epidemiological situation, ongoing work to prevent Ebola re-emergence, and capacity to detect and respond rapidly to any new clusters of cases in each country.

The Committee noted that since its last meeting all three countries have met the criteria for confirming interruption of their original chains of Ebola virus transmission. Specifically, all three countries have now completed the 42 day observation period and additional 90 day enhanced surveillance period since their last case that was linked to the original chain of transmission twice tested negative. Guinea achieved this milestone on 27 March 2016…
…The Committee further emphasized the crucial need for continued international donor and technical support to prevent, detect and respond rapidly to any new Ebola outbreak in West Africa. International support is required in particular to maintain and, where needed, expand diagnostic laboratory and surveillance capacity, sustain vaccination capacity for outbreak response, and continue relevant research and development activities (e.g. on therapeutic options to clear persistent virus excretion). The Committee gave special attention to the need to ensure that sufficient and appropriate clinical care, testing capacity and welfare services are available to all survivors of this extraordinary health crisis.

Based on the advice of the Emergency Committee, and her own assessment of the situation, the Director-General terminated the Public Health Emergency of International Concern (PHEIC) regarding the Ebola virus disease outbreak in West Africa, in accordance with the International Health Regulations (2005). The Director-General terminated the Temporary Recommendations that she had issued in relation to this event, supported the public health advice provided above by the Committee, and reinforced the importance of States Parties immediately lifting any restrictions on travel and trade with these countries. The Director-General thanked the Emergency Committee members and advisors for their service and expert advice, and requested their availability to reconvene if needed.

WHO Director-General briefs media on outcome of Ebola Emergency Committee
29 March 2016

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WHO: Vaccination of Ebola contacts in Guinea
31 March 2016 — Hundreds of people who may have been in contact with 8 individuals infected with Ebola virus in Guinea have been vaccinated with the experimental Ebola vaccine in a bid to contain the latest flare-up of Ebola. The VSV-EBOV vaccine currently being administered was found to be highly effective in preventing Ebola infection in a large trial conducted by Guinea’s Ministry of Health, WHO and partner agencies last year.

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Wellcome Trust [to 2 April 2016]
http://www.wellcome.ac.uk/News/2016/index.htm
31 March 2016
Urgent action still needed in Ebola vaccine development
A panel of international experts today called for urgent steps to be taken to complete the development of safe, effective vaccines for Ebola, and ensure the world is prepared for future outbreaks.

A panel of international experts today called for urgent steps to be taken to complete the development of safe, effective vaccines for Ebola, and ensure the world is prepared for future outbreaks.

Although tremendous progress has been made in Ebola vaccine development in the last two years, the latest report by Wellcome and the University of Minnesota’s CIDRAP Ebola Vaccine Team B says without renewed commitment from the global public health community, progress towards approved vaccines for Ebola could grind to a halt as memories of the outbreak in West Africa begin to fade.

During the 2014-2015 epidemic, a total of 13 Ebola vaccine candidates (including different combinations of vaccines) were evaluated in phase 1 and/or phase 2 clinical trials and three phase 3 efficacy trials were initiated in Africa – one each in Guinea, Liberia, and Sierra Leone.

Vaccine manufacturers, such as Johnson & Johnson and GSK, have advanced their respective Ebola candidate vaccines well into the clinical trial process. Trials of one vaccine, Merck’s rVSV-ZEBOV, have progressed far enough to demonstrate that it is safe and effective, prompting GAVI, the vaccine alliance, to purchase 300,000 doses as a stockpile for use during future Ebola outbreaks.

However, to date, no vaccine has been submitted for regulatory review and many questions regarding Ebola vaccines remain unresolved. Today’s report from the Ebola Vaccine Team B identifies four main areas where work is still needed before the world is fully prepared for another Ebola outbreak:
.1. Filling in the gaps in data on the safety and efficacy of Ebola vaccines;
.2. Understanding the complex regulatory pathways for Ebola vaccines;
.3. Gaining direct input from African public health leaders to clarify how Ebola vaccines will be used or evaluated in respond to future Ebola outbreaks;
.4. Creating a business case for ongoing Ebola vaccine development and deployment.

The group outlines recommendations for how each of these can be achieved, including completing clinical trials of vaccine candidates to fill in the missing gaps in data, and being ready to run both phase 3 efficacy studies and phase 4 post-marketing studies from the start of the next Ebola outbreak.

Wellcome Trust Director Dr Jeremy Farrar, who co-chairs Ebola Vaccine Team B, said: “Although a global collaborative effort has moved us from having no drugs or vaccines in the early days of the Ebola epidemic to now having a safe, effective vaccine, and other promising candidates, it has taken too long, and the job is still not done.

“As Ebola infection rates come under control it’s a huge concern that complacency sets in, attention moves to more immediate threats, and Ebola vaccine development is left half-finished. Today we’re calling for a renewed commitment from the global health community. After the hard lessons we’ve learned, it would be a tragedy not to put a final stop to the current Ebola epidemic, and be prepared for the next outbreak.”

Co-chair, and Regents Professor and Director of CIDRAP, Dr Michael Osterholm added: “While many in the international public health community believe these efforts have solved ‘the problem of Ebola,’ the path forward is not quite so simple, and many unresolved challenges and questions remain. In our report, we identify the key areas in which critical additional work and effort are needed to enhance Ebola preparedness for future outbreaks, particularly in the megacities of equatorial Africa, and to address the ongoing concern that Ebola virus disease may become endemic in West Africa.”

This report from Team B follows a report published in February 2015, which set out a framework for developing vaccines for Ebola, and increasing preparedness for emerging infectious diseases. It can be downloaded from the CIDRAP website.

The group is called “Team B” in recognition of the principal role played by the World Health Organization and national governments in leading the international Ebola response.