Ebola expert: US preparing for spread of infectious diseases

Dr. Anthony Fauci discusses the lessons of the Ebola epidemic and global preparedness for the next major outbreak

WASHINGTON — With only two new cases of Ebola reported in West Africa in recent months, the worst of the crisis seems to be over. But with reports of the Zika and chikungunya viruses arriving on U.S. shores, fear of the spread of infectious diseases remains potent.

The Zika and chikungunya viruses, transmitted to humans by mosquitoes, cause diseases with symptoms such as fevers and joint pain. The Zika virus has been linked to brain damage in fetuses, and researchers are investigating possible links to Guillain-Barré syndrome, a rare autoimmune disease that leaves some victims temporarily paralyzed.

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases in Washington, D.C., and his team at the National Institutes of Health (NIH) were responsible for developing and testing an Ebola vaccine and other treatments. Currently, he and his team are undertaking a major study of Ebola survivors in West Africa.

America Tonight visited Fauci at the NIH to learn more about preparedness for future epidemics.


America Tonight: Are we globally prepared if history repeats itself?

Dr. Anthony Fauci: With regards to Ebola, things are much better now in terms of being able to respond in remote areas such as in the West African countries of Liberia, Sierra Leone and Guinea.

One underlying lesson in all of this is health care infrastructure. There would not have been an outbreak of the magnitude that we saw in West Africa if the countries involved had even minimum health care infrastructure necessary — where they'd be able to identify, isolate and contact trace, which they were not able to do early on.

Given the new infrastructure — the new doctors and nurses that have been trained — do you think it’s safe to say there's probably not going to be another Ebola outbreak on the level that we saw last year?

There may be an outbreak of Ebola, but I feel pretty confident with the experience that we've had in West Africa, you would almost certainly not see an outbreak of the magnitude that we just saw. Because people are prepared. They know what to do, they're well trained, and they have experience.

Tell us about the process of developing the Ebola vaccine.

In 2001, after the anthrax attack, there was a big movement in the United States to prepare ourselves for bioterror attacks. And we knew from intelligence from decades ago that when the Soviet Union was preparing for biowarfare, they were stocking up on smallpox, on anthrax and on the hemorrhagic fevers. So one of the logical things to do was undertake research on the hemorrhagic fevers, including Ebola.

So, from the early 2000s until around 2013, several investigators at my institute were working on concept development and preclinical studies. Coincidentally, about the time that the outbreak was recognized, we were just literally getting ready to go into a phase 1 trial in humans, to determine if it was safe and effective.

You got lucky.

Well yeah, we got lucky.

Then, as soon as it was clear that we were dealing with an outbreak, we had to go into outbreak mode, so we worked with the Food and Drug Administration, and we expedited the process. We did it right here on campus in Bethesda, Maryland — a phase 1 study in normal volunteers. We showed that the vaccine was safe. We showed that it induced a good response. Then we partnered with our colleagues in Europe and some of our colleges in Africa, and we did a phase 1 trial there. And as soon as it was ready to go, we partnered with a pharmaceutical company, and we got the vaccine made in enough quantities to go and do a clinical trial.

That process, which usually would have taken several years, was truncated into a period of less than a year because of the emergent nature. 

Do you and your team have your eye on or have an idea of what the next Ebola could be? Are there certain viruses that you're looking at that could emerge in a really dangerous way?

You can make all the lists you want, but the one that gets you is usually the one that you don't expect. So if you were to ask any public health official, including myself, ‘What do you think the next big outbreak is going to be that's going to threaten us?’ most people would say a pandemic flu because that's the thing that is always hanging over you as a threat. I think very few people would have said a massive outbreak of Ebola.

So you're dealing with two buckets of things that you have to be prepared for. What we try to do is prepare for the known at the same time as we prepare for the unknown.

What are you thinking about now?

Let's take a look at things that are not necessarily as deadly as Ebola.

There are things that are threatening the United States geographically. There's dengue fever in South America and the Caribbean. Just a year and a half ago, a disease developed in the Caribbean that most people never heard of, chikungunya, which is a serious disease causing rather significant joint problems. And now we're dealing with a virus new to the Western Hemisphere called Zika virus, which is causing a very serious problem in Brazil and other South American countries.

So right now, we're preparing to develop vaccines for dengue, vaccines for chikungunya. We haven't started on a vaccine for Zika, but we will very, very soon, and when I say very soon, I'm talking about within weeks to a month because of the seriousness of the problem in Brazil.

Anything you want to add that we haven't talked about?

Just one last point. The Ebola outbreak was an example of the phenomenon of emerging infectious diseases. New infections have been emerging since the beginning of mankind. If you just look at history of new infections — the pandemic flu of 1918, the first recognition of Ebola in 1976, HIV in 1981 — as microbes evolve with humans, there will be a continual emergence of brand new infections, and there will always be the re-emergence of infections in a new place, in a new form, in a new way. To think that it's going to stop is extremely naive, because the history of civilization has told us that this just happens in a continuum.

What can we do about it? We can try and prepare ourselves as best as we can. Each time you get challenged by something like Ebola, you get a little bit better at being able to respond to these challenges.

This interview was edited for clarity and brevity.


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