Ebola: Webchat with the Wellcome Trust TODAY

[KateMumsnet]

The World Health Organisation has described the recent outbreak of the Ebola virus as "the most severe health emergency of modern times". In response to considerable discussion of the disease on Mumsnet, we've arranged a webchat with Dr Jeremy Farrar, director of the Wellcome Trust and one of the world's leading scientists specialising in infectious disease.

Jeremy has been deeply involved in the international response to Ebola over the past few months, including coordinating several million pounds of Wellcome Trust funding for fast-track research into drugs, vaccines and other interventions. Before joining the Trust in 2013, he was Professor of Tropical Medicine and Global Health at Oxford University, and Director of the Wellcome Trust’s Major Overseas Programme in Vietnam, where he was based for 17 years. His research has contributed to better understanding, treatment and prevention of diseases such as flu, tuberculosis, typhoid and dengue fever, and he played a first-hand role in global responses to SARS, bird flu and swine flu.

Please do join us live tomorrow between 11am - 12pm, or post your question in advance on this thread. Just a quick reminder that it’s one question per person; take a look at our webchat guidelines, here.

Best,
MNHQ

Hi All

We're here with Dr Jeremy at the Wellcome Trust. He's just getting ready to answer your questions, so do keep them coming.

Katie

Hi everyone,

Pleasure to be here, looking forward to answering your questions.

@AgentZigzag

Hi Dr Farrar,

what kinds of things would you have to see taking place to get that cold grip in your stomach that says ebola is out of control and you're on the verge of panic seriously concerned for the world as it stands?

I don't know whether you being so intimately acquainted with the viral world would make you privately more or less worried about how ebola's progressing, but should we be worried?

Or is it a case of not this time, but we're due a natural cull and it's only a matter of time?

Hi AgentZigzag,

Firstly, we should be very worried for the people of West Africa, and that's where all our focus must be. The current risks to Europe are minimal and I do believe that if we now do what we say we will all do globally, that this epidemic can be brought under control. I think this will be the week that we look back on and say we promised to do the right things, and now we just have to do them.

I do remain very concerned about the situation in West Africa, the impact on the health of the people and on their societies. But I'm not worried at the moment about the impact this will have directly on the UK.

What worries you more on a global scale this winter (and why):ebola or influenza?

@ChaffinchOfMegalolz

Hi Dr Farrar

regarding underreporting of cases - surely this means all data is flawed for every mathematical analysis of the outbreak

how do you guess at amounts of underreporting to ''invent'' publishable figures?
could countries keep cases quiet / hidden to avoid all the hoo-hah? / financial negative effects?

I think everyone going to work out there is a hero, so brave.
thank you

Hi ChaffinchOfMegalolz,

You're absolutely right that it's very difficult in West Africa to be sure how many cases there have been, and everyone appreciates that the numbers being reported are an underestimate of the total number. But you can allow for that when you're working out where the epidemic is today and where it may go tomorrow. It's not perfect, and of course better data will allow us to plan in a much better way. And the data is getting better. Countries are being open about the number of cases.

"He's just getting ready to answer your questions, so do keep them coming."

If I can have another (sorry, greedy!)

Air travel: not just Ebola, but any (emergent) infectious disease. Screening: are there any measures which are likely to have much of an impact? Obviously it will depend on the disease and at what stage it becomes infectious, but are we heading for temperature testing (by heat seeking arch?) as a routine part of pre-flight procedures?

@LongDistanceLove

What is your stance on the medias sensationalism with regards to ebola, spreading panic and misinformation?

It's gotten to the point where a school in Philadelphia has stopped two children from starting school until the incubation period is over, because the kids were in East Africa.

Hi LongDistanceLove,

I think that on the whole, much of the media reporting has been very responsible. Of course there are always reports that are exaggerated or can create panic, but on the whole I think the standard of reporting on this issue has been informed.

It is very difficult to get the balance right between being honest and transparent about the risks, when none of us can be absolutely sure what's going to happen. Inevitably, that leaves in all our minds, including my own, some doubt as to where the epidemic will go. All we can do is to be open, honest, transparent and really engage with both the whole public, the media, because we're all involved in it.

@AuntieStella

You don't have to go to Philadelphia to find examples like that. There's a MN thread on a school which barred a boy, and I've also now seen this about a school in Co Durham cancelling a visit from an exchange teacher from Ghana.

Thes suggests a huge lack of trust in the HPA (as people simply would not believe in their clearance of the school boy).

Dr Farrar: Would you agree that the media has also contributed, over many years, by seeking to sensationalise science reporting (when an issue moves from proper science writers, and gets into the hands of a non-specialist on the main news desk)? Does the Wellcome Trust see a role for itself in media education? I don't mean trying to change an editorial line once an issue has grabbed the headlines, but more generally finding ways to get the word out; including on social media.

And on funding public education on science: big vote of thanks to the Trust for support to the Christmas Lectures, and long may it continue!

Hi AuntieStella,

Yes, the Wellcome Trust, all people involved have got an absolute responsibility to communicate amongst ourselves, share data with other communities, but an absolutely key responsibility is to share that with the wider public and listen to their concerns, and try to address them if and when we can. Thanks to Mumsnet for giving us the opportunity to do this today.

@OneSkinnyChip

What can we the public do to help with this? Aside from donating to the utterly fabulous MSF is there anything practical that people in Europe can do to help with this situation? Political pressure for example? ANYTHING at all?

I find it so frustrating that the situation in West Africa has been allowed to snowball because of a misguided sense that 'it's just something happening over there, it can't touch us.' As if there's no moral responsibility to do anything about it because it's not on our doorstep.

Hi OneSkinnyChip,

Yes, there is a huge amount of things we can all do- you've mentioned some of them, for example supporting what MSF, Oxfam, Save the Children and others are doing in West Africa, all of that is an enormous help and it's a fantastic thing to do.

But there's also other ways the situation can be helped. Yes, encouraging your politicians, MPs to appreciate how serious this is, and also to be responsible in the way it's discussed. For example, there is no need for schools to ban students who have been in a completely different and unaffected part of Africa.

I think it also demonstrates just how lucky we are to live in a country where healthcare is available and provided free through the NHS, and if you compare our situation to the events in West Africa today, the fragile nature of their health systems is one of the major reasons for the epidemic.

Dr. Farrar, is there any way to assess the risk / likelihood of Ebola mutating so that it becomes airborne and therefore far more dangerous?

@listsandbudgets

I have seen this article suggesting that the very low survival rate of ebola is primarily down to the poor health and other facilities in the countries affected. It suggests that if treated properly (e.g. proper clean facilities, access to reliable electricity, coagulants, sufficient rehydration fluid among other things) then the survival rate could be increased to as much as 90%.

Do you agree or do you think that the aggressive nature of the disease itself would outweigh high quality treatment?

Hi listsandbudgets,

There is no doubt that the current death rate, which is approximately 70%, could be lower if developed country healthcare was available. The death rate in the UK would be significantly lower than it is in West Africa, but this is an incredibly nasty infection for which at the moment we have no specific treatment. I hope that will change in the coming weeks.

Even in London or New York or Geneva, the death rate would still be high. My guess would be 30 - 40%, just because of how terrible the infection is.

Hi Dr Farrar, thank you so much for sparing the time to talk to us.

Could I be greedy, and ask another question. How concerned are you about the illegal sale of bushmeat in the larger cities in the UK?

@Emphaticmaybe

Hi Dr Farrar

BBC Newsnight said last week that the poor health systems and infrastructure, traditional burial practices and general poverty could not solely account for the exponential rise in cases of Ebola in the three worst affected countries.
My question - do you think it likely that this particular strain of Ebola has mutated to be more infectious than previous outbreaks elsewhere as was suggested in this programme and if so what impact will that have on our ability to end this epidemic?

Thanks

So that's a really good question. There's no evidence that this virus is mutating at a faster rate than previous epidemics. But it is clear that this particular virus does get to higher levels in the body than we've seen previously, and that may contribute to how infectious it has proved to be. However, the major driver has been the fact that this is across 3 countries, and most importantly, there has been transmission in big cities. That has not happened before. The concentration of infected people living in very, very big urban centres has been the key driver of why this epidemic has been so difficult to control.

@Stratter5

Hi Dr Farrar, thank you so much for sparing the time to come and talk to us.

Could you tell us what you think is the likelihood of Ebola becoming endemic in the affected areas? In which case, could it then possibly mutate to become less virulent? And given the WHO's projected 10,000 cases per month, unless containment is effected soon, do you think that the outbreak will be containable, or is it more a case of it eventually burning out?

I'd also be interested to know if there are any programs being set up to help the orphans of this outbreak, although I appreciate that this is not your area of knowledge.

Many thanks, Stratters.

Hi Stratter5,

If the global community can now all come together and implement all of the various things we have committed to; e.g. massive increase in clinical facilities, public health, and drugs and vaccines, then there is no reason why this epidemic cannot be brought under control.

But we do need to bring all of that together in a coordinated way with clear leadership, and for us to all live up to the promises that we've made. If we don't do that, then the epidemic will continue to increase, it could become endemic, and it could spread beyond the 3 countries currently affected. But it does not need to.

@Madrigals

My question is, does it appear that the Ebola involved in this outbreak is able to spread more easily than in previous outbreaks and is less fragile once out of the human body?

Hi Madrigals,

There is nothing to suggest the virus is more or less fragile outside the human body. As I mentioned earlier, the key driver is that there has been transmission of this infection in major cities and that's what's different compared to previous epidemics. That's what's allowed the disease to spread more widely. This outbreak is bigger than all other outbreaks put together. It's in rural areas, it's in urban areas, and it's across 3 countries plus a few number of patients in the US, Nigeria, and Europe.

@BookABooSue

Whilst working in international development, we were concerned at the increasing militarisation of aid. By sending soldiers rather than doctors, the UK and US seem to be suggesting that the focus is on containment rather than treatment.

Are you concerned that equating aid/healthcare with the deployment of military personnel may create tensions and ultimately hinder any attempts at a global response, if not in this crisis then in the future?

Hi BookABooSue,

I think it's a very delicate balance, and I share many of your concerns. But when you start to think about logistics, particularly on organisation of getting large amounts of supplies to an area quickly, to building hospitals or clinics, to delivering aid or vaccines to remote areas when roads are washed away by the rainy season, there comes a point when the essential logistical support needed can only really be provided by the military.

What we mustn't have is military-style responses in terms of guns on the streets, violence, coercion, but modern military responses can be incredibly helpful in this epidemic to support the critical work done by MSF, Oxfam, Save the Children and the very brave healthcare workers who are on the front line.

@LineRunner

Are you frustrated at the political appointment of various WHO officials in Africa, as reported by Medecines sans Frontietes?

And thank you for coming on to Mumsnet for this web chat.

All my other questions have been asked very competently above.

Yes. Global health is critically dependent on having the best people, with the best local knowledge, working where there challenges are the greatest. That means having the best people working for the WHO, whether that be in Geneva or in Africa. Those cannot be political appointments on grace and favour, they have to be on the basis of the abilities of the people to do their job that is so critical to all of us.

@Thereshallbeaspirin

In your opinion, how should the balance of G20 funding lie, between the immediacy of dealing with life-threatening diseases such as this, and the more longer term issue of global over-population (which to an ignorant layman seems to lead directly to the resultant poverty and poor health conditions that create the environments for such diseases to take hold)? And what should the G20 be doing better?

Hi Thereshallbeaspirin,

There is no doubt that overpopulation, overcrowding and limited resources are a huge strain on communities and populations everywhere that do have to be addressed. But they have to be addressed with the support of the communities involved, it's not for the G20 to dictate to everybody how societies will work.

It's about building a consensus around issues like population growth, nutrition and the environment and making sure we're making our best use of resources and using those equitably both for today and for the long term. G20 can help provide leadership for this in association with other organisations, such as the WHO, UN and regional assemblies.

And another question (apologies, I have so, so many questions to ask).

What is your opinion on the assertion that Melatonin can be used as a treatment, specifically to prevent a cytokine storm? Is this true, and being researched, or simply bunkum being peddled by quacks?

@Leviticus

The BBC reports that a serum made from the antibodies of recovered patients is weeks away from being used in Liberia. We've also heard that ZMAPP has been used in a few cases with success.

How close are we to an effective pharmaceutical tool to fight Ebola and how widely could it be used?

Hi Leviticus,

We're getting much closer, butwe don't know in fact whether ZMAPP works or how effective it might be, although certainly initial reports look encouraging. We do need to move this and other potential treatments quickly, we need to make sure they're safe, and we need to learn which ones are really effective.

We then need to stop the ones that are not effective and massively increase availability of the drugs that work. That is starting to happen now and will increase in the coming weeks.

@AnguaResurgam

What reserch projects are the Wellcome Trust funding into treatments or vaccines for Ebola or other haemorrhagic diseases caused by filoviruses (such as Marburg, outbreak recently confirmed in Uganda)?

The Wellcome Trust has played a key role in catalysing and funding the fast track development of drugs and vaccines for this Ebola epidemic. We're also supporting a range of work in social sciences, anthropology, ethics, mapping and models of the epidemic to help us provide an evidence base for policy.

This is all on top of a long history of support for research and practice on infectious diseases in lower middle income countries, as well as here in the UK. Much of my own work over the last 20 years has been on dengue, haemorrhagic fever and a number of other infectious diseases including malaria, TB and HIV.

@Tigercake

What worries you more on a global scale this winter (and why):ebola or influenza?

They both worry me. It's not a choice of one or the other, or any of the other infectious diseases or other issues that the world faces today. We have to deal with all of them, there is not a league table of things to worry about. We all have to prioritise.

At the moment, the Ebola outbreak in West Africa is having a devastating impact on the whole of the region. Malaria is worse this year, childbirth facilities are not open, and vaccinations of children are not happening in West Africa as well as they would normally do. I think we all have to be concerned about all of the possibilities but we also have to keep a calm, sensible approach and not panic. We can deal with these issues as long as we retain a sense of proportion and work together.

Thank you for answering my question. It is sad that peoples chance of surviving is so much lower in certain countries - a sort of post code lottery on an international scale.

You hinted that more specific treatments may be forthcoming in the next few weeks. Please can you tell us more about these, how they're being tested and how easily available they'll be to those that really need them?

Also (and related to this) I've noticed that some people have been treated with the blood of ebola survivors. How successful is this and is it something that can be quickly and widely utilised (provided there are willing volunteers)?