Ebola has no cure, no medical treatment—and in this deadly West Africa outbreak, doctors can only isolate victims and find those they had come into contact with to track the virus' spread.
Misinformation is running rampant in the countries that have been affected. Scores of newspapers urged residents of Liberia to "Burn all bodies." A pastor who claimed to have a cure for Ebola prompted Nigeria to decree that anyone spreading similar scams could face jail time. Street protests broke out in Kenema, Sierra Leone, when angry crowds attempted to burn down the city's Ebola treatment center in an effort to eradicate the virus.
To make it clear: There is no cure for Ebola.
But it's not like researchers have been sitting around on their hands, waiting for a solution to appear. Many pharmaceutical companies and researchers have been testing possible cures for years.
So what's stopping them? To begin with, antiviral therapy is an especially challenging field compared to bacterial diseases, because viruses have fewer targets for treatment (read: proteins, which drugs can work with), and they evolve quickly. If a vaccine is developed today that works, it might not make a dent in future outbreaks. And with five known species of Ebola virus, there's plenty of room for further viral evolution.
More important, Ebola is—and this should be obvious by now—an incredibly dangerous virus to handle. It requires high-level safety equipment and special facilities, deemed "biosafety level 4" or the highest level of protection, to keep labs in check. It's costly, hard to control, and a major roadblock to progress.
"Antiviral therapy has lagged behind antibacterial therapy for decades," Derek Gatherer, a bioinformatics researcher at Lancaster University in the U.K. told Fox News. "There's only a handful of places in the world where you can actually do Ebola experimentation."
But aside from the safety issues, the two predominant obstacles to having a widespread cure revolve around ethical and economical questions.
For the ethical side, it all comes down to human testing. Paul Hunger, professor of Health Protection at the University of East Anglia, broke down both arguments for the Huffington Post:
As a practicing clinician, if I was given the option to help people with a drug that isn't proven, but has been shown to have at least some effect, it's unethical not to give it to them.
[But] in the midst of such a huge epidemic, one could even argue that doing a blind controlled trial would be unethical, because if you give a placebo to some people, who will most likely die, then you are depriving them of a drug that could cure them, something that could save their life.
The economical side is more, well, deplorable, according to Dr. Stephen Morse, an epidemiologist at Columbia University's Mailman School of Public Health. "The vaccine companies of course have to be driven by the economic considerations," he told the Huffington Post. "It's a terrible thing to say, but they have to be convinced that it's economically... worthwhile to provide the vaccine."
And these two reasons have again and again driven cures away from moving further than trial stages. Here, a review of the major ones that are or have been pursued:
Description: The drug, developed by North Carolina-based BioCryst Pharmaceuticals, has proven most adept at preventing death from the Marburg virus, a strain that acts similarly to Ebola. It inhibits Ebola virus reproduction by blocking its replication of its RNA genome, a process called chain termination.
Why It's Not Available: Rob Bennet, BioCryst's vice president of investor relations and operations, put it this way: "Our challenge right now is that, in the absence of human safety data, we don't see a path to dose patients without at least some fundamental safety data. There would be some ethical issues around that, so it's a catch-22." In other words, human testing is too risky, despite the funding BioCryst has ready to go. Until there's a way to safely do so, the drug will have to wait.
Tekmira's Interfering RNA Molecule
Description: Though it doesn't have a name yet, it follows the same idea of targeting RNA in Ebola. Developed by British Columbia-based Tekmira Pharmaceuticals, these molecules are placed inside lipid nanoparticles and would fight the RNA polymerase L protein on the Ebola virus.
Why It's Not Available: The F.D.A. placed it on hold to investigate its process, which would involve an "intense dosing regimen," according to Dr. Mark Murray, president and CEO of Tekmira, in a statement. The drug is in phase 1 trials and will remain there until the FDA lifts its hold.
Description: This one's been in development for a long time, and got as far as a contract with the U.S. Department of Defense in 2010 for further testing. The AVI-7537, the sister drug of AVI-7288 targeting the Marburg virus, is specifically for Ebola viruses, unlike the BCX4430. Like the BCX4430 and Tekmira's work, however, it's also RNA-based, and uses phosphoramidate morpholino oligomers to penetrate cells and resist metabolism (Ebola metabolizes and replicates quickly, which causes hemorrhaging and eventual death).
Why It's Not Available: The D.O.D. discontinued the Ebola part of the contract with Sarepta in October 2012 and never reactivated it. According to a report in the Financial Times, budget cuts caused the scrapping of the program for Ebola, though research continues on the AVI-7288 for the Marburg virus.
Description: In a study titled Successful Treatment of Advanced Ebola Virus Infection with T-705 (Favipiravir) in a Small Animal Model, researchers tested this drug on small animals, and found that it prevented Ebola infection in all the animals tested. It's also more a broad anti-viral drug, as it uses a compound that works against viral enzymes in general, tending to flu symptoms and blocking the virus' replication. Whether it's strong enough to stop Ebola in humans remains to be seen.
Why It's Not Available: Similar to BCX4430, it's only been used on small animals, and is nowhere near testing on humans.
None of these drugs are close to widespread dissemination. Instead, the Americans infected in the outbreak have received experimental treatments. One received a dose of a serum, though little information is available on how it works. The other has been given a unit of blood from a 14-year-old patient who survived Ebola. The idea behind the blood, of course, is that if its plasma's antibodies managed to fend of the virus, it could do so in the infected doctor's body.
Yet, even with the the escalating emergency in West Africa, it's important to remember the outbreak has a slim chance of spreading past the region. Ebola requires contact with bodily fluids to spread, and the outbreak has been mostly attributed to less-than-ideal conditions.
"Ebola outbreaks [have] become so widespread because of the hospital conditions and poor resources," Barbara Knust, Ebola expert at C.D.C., told the Financial Times. "Health workers might not even have access to gloves and family members of infected people might not have running water to wash their hands."
Plus, Peter Piot, who co-discovered Ebola in 1976, told Agence France-Presse he would not be afraid to be around an infected person. "I wouldn't be worried to sit next to someone with Ebola virus on the Tube as long as they don't vomit on you or anything," he said. "This is an infection that requires very close contact."
In the meantime, doctors must continue to isolate patients in the outbreak, and pharmaceutical companies must determine whether a cure or vaccine is worth pursuing. Is more than 1,300 cases reported in West Africa enough?
Follow The Wire's timeline to learn how the disease spread the last five months.
This article was originally published at http://www.thewire.com/global/2014/08/why-there-may-never-be-a-cure-for-ebola/375452/