Ebola could be transformed from a terrifying disease into something that can be managed at home if drug trials in the Democratic Republic of the Congo are successful, a leading scientist believes.

Four experimental drugs are starting to be used as part of a groundbreaking trial under extremely difficult conditions in an outbreak in conflict-ridden eastern DRC.

But, says Jeremy Farrar, an infectious diseases expert and the director of the Wellcome Trust, any data gleaned from the use of those drugs will be put together with evidence from future outbreaks in a five-year programme that may lead to effective and licensed treatments. That could take Ebola out of the isolation units where patients are cared for by nurses in masks and allow them to be looked after at home.

“You could turn Ebola from something that really is feared and horrific in communities to something that is preventable and treatable,” Farrar said, adding that if a drug could be produced in pill or injection form “you could start thinking about home care”.

And if it could be done for Ebola, he said, the model could be used to find treatments for other diseases such as Nipah and Lassa fever that also manifest in sudden lethal outbreaks.

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A blueprint for a five-year programme to trial drugs against Ebola is close to being signed off by the World Health Organization, the National Institutes of Health in the US, the Department for International Development in the UK, the Wellcome Trust, the pharmaceutical companies making the drugs, as well as Médecins Sans Frontières and the Alliance for International Medical Action (ALIMA), organisations running field clinics.

Facebook Twitter Pinterest Health workers inside the red zone at a Médecins Sans Frontières Ebola treatment centre in Bunia, DRC. Photograph: John Wessels/AFP/Getty Images

Farrar, who is chair of the WHO scientific advisory group, said: “We need to move away from seeing these as discrete episodes – DRC in 2018 and then it stops. Then maybe Uganda in 2020 and it starts again. The plan in place would be essentially to say this is a five-year programme: multi-epidemic, multi-country, multi-partner. The world tends to make drug trials really complicated. They are really simple. You have a protocol, people give consent and you randomise them.”

The design will be adaptive, so if another drug comes along or one of those in the trial is found not to be working at all, they can be brought in or ruled out.

This sort of flexibility is a new approach. Most trials are designed around the information drug regulators require to license a new treatment. During the west Africa outbreak in Sierra Leone, Liberia and Guinea, the US Food and Drug Administration argued that a placebo would need to be included in trials to establish how well any drug worked. Other experts and doctors in the field refused to accept this, saying it would be unethical to give drugs to some Ebola patients and nothing to others.

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That argument has now been buried. In the DRC, the four drugs to be trialled will be randomly given to patients and information collected on how well they work in reducing the death rate compared with each other. ZMapp, which was used in west Africa, is one of them. The others are mAb114, Regeneron’s Regn-EB3 and remdesivir. Patients have already been given some of these drugs on a compassionate basis.

The trial is beginning in record time. Researchers from Oxford University’s centre for tropical medicine and global health finally managed to launch a trial in Liberia in January 2015, after five months of negotiations over the ethics and how it should run. By the time it began, the epidemic had waned to the point where there were not enough cases to show whether the drug they had chosen, called brincidofovir, actually saved lives, and the manufacturer withdrew it.

The drug and vaccine trials in that huge outbreak had changed people’s thinking, said Farrar. “The biggest thing out of [the west Africa outbreak] was acceptance by everybody that research is an integral part of the response. That was hugely controversial. It is now mainstream.

“Also there was a success story: 35,000 or 36,000 people have now been vaccinated. The commonsense view is that it is the reason why this epidemic has not gone horribly wrong so far.”

One of the vaccines used in Guinea, made by Merck, is now being deployed in DRC to immunise a “ring” of contacts of any person who becomes ill. to immunise a “ring” of contacts of any person who becomes ill.



Everyone in the family and neighbourhood is offered the vaccine. In a departure from that protocol, neighbouring Uganda, where it is feared Ebola may spread, has vaccinated about 2,000 healthcare workers. When outbreaks happen out of the blue, they take a toll of nurses and doctors who are the first in contact with the sick and are unprotected.

“You can’t stop Ebola. We all know that. There is an animal reservoir. To stop the initial outbreaks is impossible,” said Farrar. But vaccination, if it works, “will stop the tragedy of healthcare workers dying”.

And if the novel plan for trials of drug treatments is successful, it could take the terror out of this and possibly, in the future, other infectious diseases as well.

This article is part of a series on possible solutions to some of the world’s most stubborn problems. What else should we cover? Email us at theupside@theguardian.com

• This article was amended on 7 December 2018. An earlier version said that vaccines owned by Merck, Johnson & Johnson, and another belonging to the Chinese government, are not yet licensed but are being used in DRC to immunise a “ring” of contacts of any person who becomes ill. This has been corrected because only the Merck vaccine is currently being used in DRC, although there are hopes that the others may prove useful.