Adrian Hill: fighting Ebola in Oxford

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Professor Adrian Hill opened with the assertion that had his talk taken place just a year earlier even the front row was unlikely to have been filled. Yet the Professor’s talk, given in Magdalen College, had a full audience; with medical students resorting to perching on tables. Ebola has become a much more serious business.

The talk began with the debunking of several myths that the Ebola outbreak has accrued. It is little known that there have been 30 outbreaks of Ebola since 1976 that, all bar the 2013 outbreak, have been contained through isolation. Additionally, the origin of the first case of this epidemic is as of yet unknown; Hill speculated that the first death from the Guinea strain could have resulted from transmission from fruit bats, consuming the meat of an infected ape or even contact with another infected person. The Jenner institute developed a vaccine, which thus far has tested ‘safe and possibly useful’, with the trials showing significant strengthening of immunity following an additional MVA boost.

Yet for the non medical-literate students at Oxford, the ways in which Ebola has touched our lives are finite. Some may have participated in vaccine trials in the past; the Jenner Institute normally dedicates considerable energy to the recruitment of volunteers on which to test its vaccinations. Professor Hill recounted how his inbox had already been full when it came to the normal stage of enlistment, on this occasion, and how the motivations of this batch of volunteers diverged from participants in other vaccine trials. The standard motivations include compensation, the hope of protection or the interest of willing science students. In this instance, members of the public were ‘emailing [him] directly, so that [they] were fully subscribed by the time applications opened’. He isolated the cause of this to a willingness to help with the crisis; many had seen the images that had bombarded each news outlet, and wished to help combat Ebola in any way they could. There were a handful of moments like this in Professor Hill’s talk, moments where the florescent squiggle of Filovirus on the screen became connected to the apocalyptic images that had penetrated our lives.

Another such moment occurred when Professor Hill discussed the task of finding volunteers for trials in West Africa. The authorities in Gambia declined to have the trials carried out there, they ‘would not have Gambia and Ebola in the same headlines in Western papers’, recognizing that it would spell disaster for tourism. Hill reflects that this assumption was correct as the industry has collapsed not just in West Africa but also in Kenya, which he takes care to highlight ‘is further from West Africa than the English coastline is’.

The ethical impasses in the next stage of the vaccine development are striking. Two vaccines have been developed, there is a third but it is not yet ready, so the next phase of the Oxford-developed ChAd63 trials is use in the field. 9,000 volunteers will be given the ChAd63 and 9,000 a placebo; the ethics of leaving a group unprotected are fraught. Hill reconciled this with the recognition the vaccines could indeed make the patient ill or at risk; to test the efficacy of the injection, that is to recreate the conditions of Ebola, is demanding in a lab, not least because of an unwillingness to infect volunteers with the disease, but also because of the difficultly in recreating the low levels of exposure that are often intrinsic to an adenovirus.

Hill presented a slide that listed two columns of fifteen other outbreak pathogens, and he asked ‘how many of these do we have ready vaccinations for?’ The question was suspended ominously in the air, as one hesitant student wagered there are no inoculations prepared. The Professor confirmed this. Hill speculated that to develop vaccinations for each of these would cost half a billion pounds, which he quickly trumped with the proclamation Ebola has thus far cost three to four billion. He opined that the development is ‘eminently do-able’ yet as with many contemporary issues it boils down to a matter of finance. In response to the question of where the funding comes from he urged ‘we are responsible for our own health’. There is a need to inform people of this situation and it is remarkable what can change if the taxpayer and consumer demand it.

 

PHOTO/ Adrian Hill