Steve Mirsky:Welcome to Scientific American Science Talk posted on March 26th, 2016.  I'm Steve Mirsky.  On this episode—

Keiji Fukuda:     The greatest threat by far is that we don't learn lessons that we should learn.

Mirsky:      That's Keiji Fukuda, assistant director general for health security at the World Health Organization, talking about Ebola.  On March 24th, he reviewed the current Ebola outbreak in a talk at the Institute of Medicine Forum on Microbial Threats Conference held at the Pan American Health Organization in Washington.  The session concentrated on the Ebola epidemic in West Africa.  Scientific American's Dina Fine Maron was in attendance and spoke to Fukuda.  Here is an edited version of their conversation, which lasts for just under 10 minutes.

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Dina Maron:       Within the course of the response to Ebola for more than a year now, what has most surprised you or what has been most memorable?

Fukuda:    I think the most surprising thing was that even though intellectually you know that if you take something that you're familiar with and you put it in a new context, you can be dealing with a very different phenomenon.  And so here, if you take Ebola, in which we've had, again, experience with over 30 outbreaks over some decades, and you get a certain image of what it is that you're dealing with, with something like Ebola, and then if you fast-forward to this current outbreak in which in fact you're dealing with a very different phenomenon, so infections going on in cities, infections going on in multiple locations because people are very mobile, I think that seeing that in practice was really eye-opening.

But I think what I find most memorable, it goes back to just on some of the visits, some of the things that you saw were really just the worst that you can imagine, and the worst that you can imagine are situations where – I remember one mother who was infected who had a couple of very young kids.  Nobody knew whether the kids were infected, but everybody was afraid to take care of the kids.  The relatives would not take care of the kids.  There are no orphanages.  There are no – you know, there are no institutions set up, so the choice is literally to put these small kids out in a street, literally, or to keep them by their mother, who is their only caretaker.  It's an inhuman situation.  There are things like that. 

A second thing which I really remember, though, on the flip side, and in Conakry, when I visited the main hospital there, I spoke with a number of the health workers and with both the nurses and the physicians who were from Guinea, and the nurses said that among them, they had 28 nurses.  Twenty-five of them had died from Ebola, and yet they were still working.  And so it's just – it's literally the worst you can imagine, and also the best you can imagine that people can be. 

And it's that sort of breadth, which it just – it's really intense emotionally.  And so these are the kind of things that I actually think about a lot, or find most memorable.  But I think that mostly what I think about now is if you're going to have gone through so much just sheer pain, you have to get something out of it.  You have to get something which is better out of it.  And I think that something better is that in fact we do set things up both within the countries and internationally so that things like this are much less likely to happen. 

I mean, you can't wave a magic wand and make things better overnight.  I think a lot of the things that we have to do and things that we have to emphasize are pretty clear.  But how to do that is still really difficult.  You know, in many ways, we've known for a long time what to do, but it's translating – it's like infection prevention and control.  It's one thing to understand.  It's one thing to do. 

And I think that really in a lot of ways how we make that convincing case that really investing, investing in training, investing in people, investing in systems, you know, it's not just do-goodism or something.  It's somehow – it's really critical for countries, and in the overall scheme of things, it's what we need to get away from, having these kinds of, you know, awful things happen. 

Maron:      This morning, Dr.  Daniel Bausch, who is a senior WHO consultant, as you know, talked about how now there's anecdotal evidence of potential sexual transmission of Ebola, something that has never been documented in the peer reviewed literature before.  How widespread is that that you're hearing about, and are you concerned, indeed, perhaps a second or third wave of Ebola from sexual transmission? 

Fukuda:    Well, I think sexual transmission has always been a worry, because it's clear that there are compartments in the body in which the virus can survive longer than other places.  And so if you have virus survive, and then if you have sex, then it's definitely possible that you could have transmission going on in that way. 

But again, as Dan pointed out, we don't have documented cases of that, and so – and most of the cases that we know of can be attributed to more – to other forms of contact, simply touching, and not having the right prevention and control training or behaviors.  And so I think that it remains a concern, but we don't have it solidly documented yet.  So we'll keep looking, but we don't have that documentation yet. 

Maron:      Liberia seemed to be well on its way to being officially proclaimed as Ebola free next month until its most recent case was identified late last week.  What does that mean for Ebola's I guess trajectory in Liberia? 

Fukuda:    Well, I think it depends on what's the reason for this case, and then how quickly it's contained.  I don't think it's such a surprise in that we do have countries which are in contact, we do have people moving around.  We have a much I think better level of awareness among people in the country.  But like any infectious disease, things can be messy.  Outbreaks are still messy. 

So I think that it's good that it got picked up as a single case.  We'll see whether any additional cases appear.  But in the overall scheme of things, I'm not sure it changes the trajectory too much.  But anyway, we will continue the investigations. 

Maron:      In regards to treatment or vaccines for Ebola that are certainly underway and are under testing, later this week there will be embargoed findings related to a vaccine, and progress in some of the clinical trials there, which you're probably familiar with.  With those bits of progress, do you think that now with the downward slope in the numbers of Ebola counts, that that will slow down progress of a vaccine development? 

Fukuda:    I certainly hope not.  I mean, the availability of a good and safe vaccine would make an immense difference.  And we are going to see future outbreaks of Ebola.  You know, once this one is over, you know, I'm – we have it in animal reservoirs, and so there will be additional outbreaks in the future.  So the ability to have something to really cut those down would be fantastic.  So I hope that progress on getting a licensed vaccine, licensed medications, does not slow down.   

Maron:      Do you think we'll need more than one kind of vaccine, since there are parallel tracks being discussed here?  Or once we get one licensed, that's enough, if it's tested efficaciousness – effectiveness? 

Fukuda:    I think that it will be good to see what's the comparative advantages of one versus the other.  You know, there's safety considerations, effectiveness, costs.  All of these things are important.  And I think that if we have the luxury of having multiple products to take a look at and evaluate in that way, then so much the better.   

Maron:      The final question I wanted to ask you is what are your thoughts on the greatest future threats to low resource settings, and specifically to these settings in West Africa, beyond Ebola? 

Fukuda:    The greatest threat by far is that we don't learn the lessons that we should learn.  I mean, whether we're dealing with low resource settings or high resource settings, the basics are the same, the ability to detect that you have an outbreak or an infection early, the ability to communicate it, to analyze the information, to respond.  All of those things, it doesn't matter where you are in the world.  You simply need those.  It's just that they're harder to get in place in lower resource settings. 

And so I think that rather than focus on individual infections – you know, there are many different possible outbreaks or causes for outbreaks – the place really to put attention to is what is needed to deal with the broad range of them.  And this comes back to a lot of just the basic health system needs, well-trained clinicians, nurses, good facilities, good infection prevention and control practices, the requisite level of surveillance.  These are bread and butter capacities that will help deal with any number of infections.  That's the most important point.

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Mirsky:      The vaccine study referred to in the discussion came off embargo at 2:00 P.M. Eastern time today, March 26th.  It's available at the website of the journal Science.  The title is, "An Ebola Whole Virus Vaccine Is Protective in Nonhuman Primates," by Andrea Marzi, et al.  That's it for this episode. 

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