How Worried Should We Be About the Bundibugyo Ebola Outbreak?
Boston University researchers are helping track disease’s spread and preparing to test new treatments
A Red Cross worker disinfects after supporting a clinic treating people in Rwampara, Congo. Photo by Moses Sawasawa/AP Photo
How Worried Should We Be About the Bundibugyo Ebola Outbreak?
Boston University researchers are helping track disease’s spread and preparing to test new treatments
An Ebola outbreak in Central Africa that has already claimed more than 130 lives has become a “public health emergency of international concern,” according to the World Health Organization. Although the outbreak hasn’t yet reached pandemic levels, the WHO’s director general has said he is “deeply concerned about the scale and speed” of its spread.
The Boston University–led global infectious diseases tracker, BEACON, first flagged an uptick in Ebola cases in the Democratic Republic of Congo’s Ituri Province in mid-May, noting the possible presence of a virus species—Bundibugyo ebolavirus—that currently has no vaccine. In subsequent reports, the BEACON team monitored the disease’s rapid spread, including across the border to Uganda; the tracker is based at BU’s Center on Emerging Infectious Diseases.
BEACON is just one of the ways BU experts are contributing to outbreak response. With no ready-to-go vaccines for the current Bundibugyo virus strain, researchers at the University’s National Emerging Infectious Diseases Laboratories (NEIDL) are preparing to test new treatments. A highly secure facility, NEIDL allows researchers to safely study some of the world’s most dangerous pathogens.
To find out how concerned we should be about the current outbreak and to get the latest on research to slow or halt its progress, The Brink spoke with Robert Davey, NEIDL’s interim director and a BU Chobanian & Avedisian School of Medicine professor of virology, immunology, and microbiology.
Q&A
with Robert Davey
The Brink: The Brink: The WHO has said this is a “public health emergency of international concern.” How concerned are you?
Davey: My concern is that the outbreak has been caught late. There are a lot of parallels between where we are now and what happened in 2014, 2015, with the largest Ebola outbreak that the world had ever recorded.
It’s a type of filovirus and Ebola is a filovirus, but Bundibugyo is actually distinct; you have to treat them like they’re different to each other in a lot of ways. The tests that were detecting Ebola virus do not work on Bundibugyo. The vaccines that we have, the FDA-licensed vaccine against Ebola, is likely to have diminished effects with Bundibugyo. The monoclonal antibodies that we have for treating Ebola may not work on Bundibugyo. The fact that it’s spread more than it could have if we’d had a diagnostic test in place, and that we don’t have any frontline, validated treatments, makes it concerning.
The Brink: What can be done to slow the spread and reduce the impact of an outbreak like this?
It’s the exact same things that worked in 2014: Educating people on how to protect themselves against contracting the disease, educating people that they need to get to the hospital quickly to be quarantined and looked after. Getting the personal protective equipment to people on the ground who are dealing with the situation. And really preventing travel to and from the DRC, or the province the outbreak started in. But we’re a bit behind in all of that—and, therefore, I am concerned it’s going to escalate before it gets better.
The Brink: Although the viruses are somewhat distinct, does the fact that we have vaccines, diagnostics, and treatments for Ebola give you a foundation to work from?
We’re always working on different fronts to look at the major representatives of each virus family. If you learn enough about at least one or two of them from the family, and work out how to treat them, and how to cure the diseases that come from them, then you can transfer that knowledge to the new bug that has surfaced. And that’s exactly what’s going on now. We’ve learned a lot from Ebola and now we’re applying that knowledge to Bundibugyo—it just takes some time to work out the nuances that make those two viruses different. You really have to get to know your enemy before you can deal with it. That’s the hard bit.
The Brink: What are some of the projects BU researchers are working on to help with the current outbreak?
In the past, NEIDL has been involved in diagnostic development to detect a virus and contributed to novel vaccine ideas and small molecule drugs. We’ve even done preclinical studies in disease models that could be translated to the field. We’re applying all of that to this situation.
It’s interesting that the virus, the Bundibugyo virus, has caused two outbreaks before on a smaller scale, in 2007 and 2012. The outbreak in 2012 is, by sequence, very similar to the one we have right now; unfortunately, the stock that most people have in their containment labs to try and work on treatments is the 2007 stock, which seems a different variant. We’re working on safely obtaining the current virus, so that we can then test potential treatments.
We’re going to be testing the existing Ebola virus treatments on Bundibugyo. We’re hoping that there’ll be some overlap. We are also part of what’s called the NIH [National Institutes of Health] testing contract, a service where we test other people’s small molecules, therapies, when they provide us with their potential treatment candidates.
In diagnostics, we have a machine that can be deployed in the containment lab in the event that this escalates—and patients enter the United States with an unknown virus—so we can do the testing at BU.
We’re going to be testing the existing Ebola virus treatments on Bundibugyo. We’re hoping that there’ll be some overlap.
The Brink: Can you tell us a little bit more about monoclonal antibodies and small molecules? What are they and how can they help take on this disease?
The monoclonal antibody treatments are like the antibodies in your blood. When you get infected with a virus or something else, your immune system will react to that and produce antibodies. They protect you against getting reinfected. With modern technology, we can isolate those antibodies and reproduce them at scale. And then, if you take those antibodies and inject them into your blood, they’ll protect you for quite a long time; they’re very effective with very few side effects. The small molecules are just pills; they break an interaction between the virus and your cells, disrupting the virus’ replication life cycle.
The Brink: How do you study these viruses safely?
The NEIDL has Biosafety Level 4 (BSL-4) status, the highest level of containment. There are multiple layers of security and protection. It’s the safest environment for doing anything like this.
The Brink: How much connection do you have with colleagues like Nahid Bhadelia at BU’s Center on Emerging Infectious Diseases who are monitoring and tracking outbreaks?
I talk to Nahid every second day. Knowing what’s happening and predicting what can happen is very, very important for thinking about how we strategically use our resources to deal with what could happen next. BEACON works incredibly well. I’m always asking Nahid to tell me what’s going on with a current outbreak, asking how much we should be moving BU’s resources toward working on a particular virus. At the moment, the answer is yes, you need to strongly think about it.
The Brink: What does an outbreak like this—and the work you’re doing to fight it—say about the importance of NEIDL’s research and outreach?
The current event, particularly if it escalates, is exactly what the NEIDL is for. We’re here to protect the health of Americans. There is also a spin-off effect where anything we develop in this country will be a great benefit to those people in the endemic countries.
