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Looking Towards a Serum from Ebola Survivors to Aid in Outbreak Treatment Efforts

The potential success of this treatment method has received attention in the international community, even inspiring calls for blood donations from survivors.

by Kayla Ruble
Sep 26 2014, 10:55pm

Image via Flickr/NIAID

Eight months since the Ebola virus showed its face in a village in Guinea in December, and with more than 3,000 total Ebola-related deaths, the international community is scaling up response efforts, which until now have been far from adequate. These new actions include fast tracking treatment and vaccine development for the hemorrhagic fever that does not yet have a medical cure.

One treatment possibility that has garnered some optimism in the last few weeks, after being given to an American doctor who contracted Ebola in Liberia and is now in recovery, is the use of a convalescent serum - or the blood plasma from a person who has recovered from the virus. The serum, which the World Health Organization calls a "safe treatment," contains antibodies and is administered as an infusion to an Ebola-stricken patient.

WHO experts decide it's ethical to offer patients experimental Ebola treatments. Read more here.

The potential success of this treatment method has received attention in the international community, and also from those in the affected countries. It has even gotten Uganda's Dr. Attai Omoruto, who runs a new treatment clinic in the Liberian capital of Monrovia, on board, according to Reuters.

"We need survivors to come and help us with blood donations," he told Reuters.

While the use of convalescent serum has not been put through wide-scale testing, anecdotal evidence from previous outbreaks has been used to support its effectiveness. Furthermore, the recovery of a recent patient has boosted the focus on this method. But at this point, not enough data exists to indicate it will be a "magic bullet" in tackling the current outbreak, as serums administration has been done on a small scale.

This mix of uncertainty and optimism in regards to convalescent serum has been joined with an onslaught of headlines about various vaccines and treatment options, with names like NewLink and ZMapp, that are in various stages of testing.

The Fight Against Ebola. Watch the trailer here.

Today, the WHO said two experimental vaccines could see small-scale use by early 2015. A candidate treatment from GlaxoSmithKline has begun trials in the US and UK, and the UN health agency's assistant director-general Marie-Paule Keny said trials would begin in Mali in the coming week. The drug TKM-Ebola was also used in the American doctor who received treatment for Ebola in Nebraska and is now recovering.

These efforts were largely kick started by WHO's decision in August that it was ethical to offer experimental or unproven intervention methods to patients - there are currently no licensed options. The health agency said at the time that "a specific treatment or vaccine would be a potent asset to counter the virus."

VICE News spoke with virologists Ben Neuman at the University of Reading and Ian Mackay at University of Queensland to explain all the medical research buzz, from treatments to serums, and from growing ZMapp to conducting human trials.

VICE News: When we're talking about a serum, what is it and how is it working in Ebola?
Ben Neuman: The serum is the liquid around the cells in blood, so everything except the blood cells. And the useful part of that is going to be antibodies. So they are part of the immune system and they help clean up immune system from virus and bacteria, they help clean up infection. And so in theory, if you had Ebola and you recovered from Ebola, then the antibodies that you have are part of what helps you recover. So taking those antibodies out of a person and putting them into a person who's sick could potentially make that person better.

The serum is sort of being looked at as the "magic bullet" for Ebola, is that the case?
Ian Mackay: So the convalescent serum certainly sounds good, it's something that's a bit easier to access, and easier to access right now, but the big caveat here is that there's no solid evidence that it's helping or hindering the recovery from an infection. So logically, as a scientist we think it probably should, but there's not really a lot of information or data to back that up. But in the meantime it's something that can be tried and as long as those blood donations, or serum donations are being really well screened for pathogens that might be in them, then it's something that can't be too harmful.

Is this something to be optimistic about?
Neuman: Absolutely, there's probably going to be no easy answer for Ebola and so it comes down to which of the potential answers you think has the most promise and trying out the ones that can be tried out the quickest. So the nice thing about this convalescent serum, serum from people who've gotten better from Ebola, is that the people are right there in Africa, there are now a lot of them and you only need very simple equipment to be able make it. So it's like an experimental treatment that's already there in country and doesn't need to come from outside and doesn't need a lot of help to get there.

What about some of the other treatments being tested?
Neuman: So it looks like ZMapp can probably clean up Ebola or at least help slow down Ebola if it's given very early in the infection. I think the evidence is pretty strong for that now. Of course all the people that are given ZMapp get it relatively late in infection, because with an experiment monkey you know what day you infected it, so you can give it pretty close after, but with a person, you don't know that they're infected until they start to show symptoms of Ebola, and that's usually about two weeks. Nobody has managed to successfully treat a monkey that far into the disease. Monkeys only survive for about one week after they get Ebola.

Is it feasible that we could have a treatment before the epidemic is over?
Mackay: I think this epidemic is going to go for quite some time, and there will be plenty of time. Which seems to be maybe months off, rather than years off, [from] being made on a large scale. I think the outbreak will still be going when those are ready to go. So there's a very good chance we'll see vaccines being used, there's also a good chance that people will go through treatment with ZMapp and the TKM as well. Unfortunately, because that means that the outbreak won't slow enough by the time these things come out. The trials in humans won't take that much longer to finish and then it's a matter of how fast these companies and their affiliates can scale up the production of those drugs. Just a few thousand though is not going to be enough to make a huge impact. So if it's a vaccine we're going to need a lot of doses some number around 100,000 to be able to make an impact and that was based on the numbers from a week or two ago, so by now those numbers have increased so the projections are increased. We'll see these things being used, but will we be able to get far enough into the virus to stop it, to create a firebreak if you like, and then work backwards to try and protect the rest of the population.

This has given us the ability to look at treatments and vaccines for Ebola that we haven't done before. What can we learn from this?
Mackay: I guess what it sadly comes down to, is that the people that have the ability to make these vaccines at large scale, need to make money, so it's a commercial entity, things aren't being done out of the goods of people's hearts, these are companies that need to make money and keep their shareholders happy. What we've seen here is people that make the drug and vaccine stop because there's no market in it. But now we've seen the scale of a particular virus where a lot of people died and quickly, and we have the ability to treat or maybe prevent those infections sitting in a cupboard. But because there weren't enough people or there wasn't enough money involved earlier on, they didn't get scaled up. So what we've learned from this is that we don't have a very responsive vaccine or antiviral system. We have something that plays chase or catch-up with an outbreak.

Neuman: Ebola was one of a large number of rare and scary diseases, and drug companies can't focus on everything at the same time. This is good because it is focusing the entire scientific and public health community on one disease and with all that focus somebody is probably going to find a way to cramp this one. If it can be done, it will be done. But I don't think that Ebola is going to change the economics, basically they have too many viruses out there and a limited number of virus researchers. Diseases that really catch the public's attention are pretty rare, and Ebola's got the public's attention right now. So let's see what can we do.

Follow Kayla Ruble on Twitter: @RubleKB

Image via Flickr/NIAID