On Thursday 19 November 2015, the Bodleian Library, in collaboration with the Department of Politics and International Relations at the University of Oxford, hosted a one day event for Oxfordshire Sixth Formers to learn more about parliamentary representation and the work of select committees. It formed part of ‘Parliament Week’, a programme of events and activities that connect people across the UK with Parliament and democracy.
Members of the Committee joined the seminar in the Divinity School of the Bodleian Library, with four Oxford academics discussing the UK’s response to, and their experience of, the Ebola outbreak. The sixth formers present were also able to ask questions.
The panel comprised:
The topics covered during the discussion included:
Ebola vaccine and drug trials
The panel outlined how the Ebola vaccine and drug efficacy trials were conducted on the ground in West Africa and discussed some of the practical challenges that they faced. These included coping with running a trial in a very hot region while wearing protective clothing, as well as difficulties with getting patients to come forward for treatment during the early stages of the trial. It was suggested that this reluctance was linked to a suspicion of local medical staff, and Western agencies, combined with a cultural preference for keeping and treating unwell family members at home.
Funding for trials
Essential funding for the Ebola response in West Africa came from the Wellcome Trust, the Medical Research Council and DFID, with the Ministry of Defence providing logistical support, including transport, medical care, infrastructure and storage. Medical staff also volunteered from the NHS. Panellists noted that there was not a huge incentive for pharmaceutical companies to invest in drugs and vaccines for Ebola, and similar diseases, and that this problem needed to be addressed through alternative funding mechanisms. As a result, licensing processes had to be fast-tracked during the Ebola outbreak with sufficient trialling to establish their patient safety, to establish the immune response for given intended dosages, and their efficacy.
Co-ordination of trials and volunteers
Coordination of multiple trials taking place in West Africa was described as ad hoc and informal, with an overall lack of high-level oversight. There was a suggestion that while some trials were prioritised by the World Health Organization, researchers went away and ‘did their own thing’, taking patients from prioritised trials without any repercussions.
Data collection and results
Systems for data collection on Ebola cases were set up in theatre, with NGOs and local government departments. While the treatment field trials had good monitoring data, the response plans for tackling new outbreaks were described as less well-developed. Since the treatment regimes varied between the trials, panellists also described how it was difficult to produce hard conclusions about the efficacy of particular treatments and interventions. Monitoring patients and providing follow up was also highlighted as difficult.
Looking to the future, panellists were clear that treatment protocols needed to be agreed in advance, so that they were ready to use before the next disease outbreak, and that this required phase 1 trials to be undertaken too. It was suggested that ‘ring vaccination’ could provide a good model for future trials during disease outbreaks. There had been discussion during the outbreak about the ethics of particular trial designs and the use of placebos. Trial protocols included a commitment to ensuring the local population had access to the results. Many NGOs and agencies were therefore content to use new drugs in trials during the outbreak on the basis that they were very inexpensive (or free) and would continue to be so. Ethical questions may have been raised if the drugs involved were expensive for local people.
Following the scientific method
Since there were very few clinicians with knowledge of Ebola before the outbreak began, when scientists differed in their opinions about optimal treatments and interventions the solution was to adhere, as much as possible, to well-founded scientific principles for producing and interpreting evidence. It was also stressed that they undertook a lot of public engagement with the local population.
Ebola was described as a global health problem that required a global response, our understanding of which suffered from a historic neglect of tropical diseases. For future disease outbreaks, it was suggested that all those involved needed to recognise that the cost of preventative measures, including vaccines, would be cheaper (both in financial terms as well as the human cost) than responding once an outbreak occurs. However, there appears to be a continuing lack of international interest in preventing some tropical diseases.
Prepared 21 January 2016