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19 Jul 2019

WHO declares Ebola outbreak in DRC a Public Health Emergency of International Concern

The World Health Organization (the WHO) has declared the Ebola virus disease outbreak in Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC).

A Public Health Emergency of International Concern is defined by the WHO as ‘an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response’.

The declaration followed a meeting of the International Health Regulations Emergency Committee for Ebola virus disease in the DRC. The Committee cited recent developments in the outbreak in making its recommendations, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.

It’s been a year since the start of the epidemic in North Kivu, DRC, there have been 2512 cases of the disease and 676 deaths.

The below article examines what would happen if Ebola testing was required in Victoria and the Doherty Institute's involvement. This article first appeared in the University of Melbourne's alumni magizine, 3010

Ebola: The lab report

Here, at the heart of Parkville’s renowned biomedical research strip, Catton, Druce and other scientists helped design and develop the nation’s only high-security PC4 (physical containment level 4) lab for human specimens. They can now test pathogens requiring the highest international standard of bio-safety.

Just outside the lab, Druce shows off a line of the so-called “space suits” that protect staff from pathogens during the diagnostic process, in which the virus is deactivated so it can be safely tested. “It’s a little bit like being deep-sea divers,” he says of the white, rubbery suits, which swell up with air pressure to push out any contaminants.

When scientists step into the lab, they hook into a bright-yellow air cord that hangs from the ceiling and enables them to breathe. Their main concern is sharp objects, which could puncture suits or gloves, or getting caught up in the cord.

They work with specimens in safety cabinets that push a curtain of air up and away from their bodies and through a special air filter.

When scientists leave the lab, they are showered with powerful chemicals that kill viruses. “It’s a 10-minute car wash,” Druce says.

The PC4 lab feels strangely familiar. You might have seen something like it in films: the unnatural chill of purified air, the heavy snap of airtight submarine doors and the almost unnatural quiet of scientists at work. Druce describes the mood as “surreally calm”.

Unlike the movies, in which something invariably goes wrong, the team is at pains to emphasise the practical, careful and methodical nature of their work. These are scientists who have trained at the highest level of bio-safety – something only a handful of people in the world can claim.

“We’re not exactly hipsters,” Catton says of their years of training.

So few people in Australia are qualified to handle Ebola and other infectious diseases that the Doherty diagnosticians regularly seek support from international counterparts. They trained for the space suits at the Galveston National Laboratory in Texas and modelled the PC4 lab after similar facilities in the US and Europe.

Professor Lewin describes the recent Ebola outbreak as the first test of the collaborative atmosphere they hoped the Doherty would create. “We had the scientists who work on other viruses like dengue and flu, the immunologists, the public health guys and the epidemiologists all kind of sitting together brainstorming ideas around Ebola,” she says. “You can do that for a lot of diseases but it doesn’t usually sit in one building.”

Enter Dr Wendy Winnall, a vibrant, enthusiastic member of the Doherty’s Kent Laboratory. She is on the hunt for a vaccine for HIV and has been working with a Melbourne biotech company to produce antibodies that would help human immune systems combat the virus.

Like HIV, Ebola is a virus that can mutate. Both are made from a simple form of genetic material called RNA. When the recent Ebola outbreak hit, Winnall thought her research could also be used to develop antibodies that fight the disease. “Antibodies are, in my opinion, the next big thing,” she says. “But they’re very, very expensive.”

Winnall found a new type of antibodies made in bacteria can be produced relatively cheaply, making it plausible to treat large numbers of people when an epidemic hits. Though the protection would last only two or three weeks, this could nonetheless help healthcare workers travelling to Ebola front lines.

As for the collegiate environment at the Doherty, Winnall says proximity to other scientists inspires her. “You can meet people in the lift who say, ‘I test for Ebola in a PC4 facility,’ or something like that, and you can come up with these collaborations,” she says.

Another lesson underscored by the Ebola experience, according to Professor Lewin, is the need for public health infrastructure, such as the Doherty, capable of managing the constant threat of infectious disease.

“You need strong leadership to make sure that people are on the same page,” she says. “And I think everyone struggled with that with Ebola. Not just in Australia but in the US and globally. And probably it gave us a warning sign of how to do it better next time.”

Catton also points to the way dealing with the potential for Ebola has left Australia better prepared to deal with other, more likely outbreaks. “All that preparation for Ebola gets you in good stead if you’re later having to deal with the new SARS or flu pandemic.”

Outside the laboratory hang framed magazine covers marking the epidemics of years past: SARS, H1N1, Ebola. Whatever comes next, the scientists here are prepared.

“I didn’t go into it thinking I’ve got to don my white coat and save the world,” Catton says. “But having arrived here, I think it’s something that’s really worth doing.”

About Ebola

Ebola is a rare but serious disease marked by fever, headache, vomiting and fatigue. It can lead to severe weight loss, bleeding, organ failure and death. The virus first appeared in 1976 in the Democratic Republic of the Congo. Scientists believe that it originated from fruit bats.

Ebola has surfaced occasionally since it was discovered, though the most recent outbreak, the 2014 West Africa epidemic, has claimed more lives than all previous outbreaks combined. Nearly 10,000 people have died, mostly in Sierra Leone, Guinea and Liberia, and isolated cases have sprung up in the US, Spain and Britain.

Officials say they have traced the 2014 outbreak to a small village in Guinea. Another 1,000 people died by the time the World Health Organisation declared it a global emergency, in August last year.

Humans can contract the virus from close contact with the bodily fluids of infected animals or humans. Only those who are already showing symptoms can pass the virus to others.

Ebola is not as contagious as diseases such as measles, influenza or HIV, but it has a high fatality rate, ranging from 25 to 90 per cent of those who contract it. There is no proven cure for Ebola, but symptoms can often be treated with intravenous fluids or other basic care methods.