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Preparedness key to preventing Ebola outbreaks, says top African scientist Nicolas Meda


Nicolas Meda
Nicolas Meda

Nicolas Meda has dedicated his entire career to public health. After studying medicine at the University of Ouagadougou in Burkina Faso, he spent several years studying epidemiology and public health in France before returning to Burkina Faso to work as a doctor in a university hospital. He then took up a post as a researcher at the Centre Muraz, a biomedical research institute, and led the institute from 2013 to 2017. From 2017 to 2019 he was Burkina Faso’s health minister. Today, he is Director of the Public Health Laboratory in charge of Research, Postgraduate and Doctoral Studies at Joseph Ki-Zerbo University in Ouagadougou. In addition, on 25 July 2019 he was appointed Special Adviser for Human Capital Development to the Burkina Faso Head of State.

When the Ebola outbreak struck, Professor Meda was tasked with organising Burkina Faso’s response to the epidemic. ‘We set up a collaboration between the Centre Muraz and [French research institute] Inserm’s P4 laboratory in Lyon,’ Professor Meda explains. ‘We put in place all the measures to take samples and get them to the laboratory in Lyon for diagnostic tests.’ During the west African outbreak, there were 11 suspected cases of Ebola in Burkina Faso; fortunately, none tested positive.

Although Burkina Faso remained Ebola free, the threat of the disease prompted the Centre Muraz to join IMI’s EBOVAC2 project, which is carrying out Phase 2 trials of the ‘prime-boost’ Ebola vaccine regimen (Ad26.ZEBOV and MVA-BN-Filo) in development at Johnson & Johnson. In a prime-boost vaccine regimen, patients are first given a dose to prime the immune system, and then a boost dose which is intended to enhance the immune response over time.

The Centre Muraz has a long history of collaborating with Inserm on clinical trials, primarily for HIV treatments. However working on an IMI project was different. ‘The collaboration that we had with Inserm was a collaboration between France and Burkina Faso,’ says Professor Meda. ‘In EBOVAC2, it’s pretty much a global collaboration. So this is a challenge and an opportunity to improve our knowledge and our skills on the conduct of vaccine trials. Because as I said, we did a lot of clinical trials, but they were for medicines. This time it was a trial for a vaccine and this experience was important and exciting for the team.’

Professor Meda is also enthusiastic about the project’s legacy in terms of the skills acquired by African scientists. ‘We have human resources who all took part in this adventure. There was an effort to provide education on the methodology of vaccine trials, and a lot of young people are doing masters and PhDs and they are the researchers of tomorrow. This critical mass of young people coming from the consortium will go ahead. I think if there are new vaccine or medicine candidates, or if there are other dangerous microbes, there are teams that can be mobilised,’ he says.

Since the outbreak, African countries have taken a number of steps to prevent future outbreaks. For example, in 2017, the African Union created the African Centre for Disease Control and Prevention (Africa CDC). Africa CDC is working to encourage countries to put in place measures to be able to rapidly detect and respond to outbreaks before they turn into full-blown epidemics. In Burkina Faso, Professor Meda led the creation of the country’s first National Institute of Public Health (NPHI). Thanks to a grant from the EU’s International Cooperation and Development funds, the country now has its own level P3 diagnostic laboratory. In the past, when samples had to be sent to France for diagnostic testing, it took 10 days to get the result. Today, the country’s NPHI can deliver results within a day. In a country where local burial customs involve touching the corpse, getting a rapid diagnosis is key to preventing the spread of the disease.

Meanwhile, a new Ebola epidemic is underway in the Democratic Republic of Congo (DRC); at the time of writing, there have been almost 3 000 cases and 2 000 deaths. Professor Meda notes that there are a number of reasons why the epidemic took hold there. Firstly, many people in the DRC hunt and handle meat that could be contaminated with Ebola. Secondly, the sheer size of the country, coupled in some areas with instability and fighting, makes it very hard to put in place measures to detect the disease and mount a rapid response. Thirdly, he cites the lack of a community approach to tackling the disease, which is essential for convincing local people of the need to accept the methods used to control the epidemic.

‘Generally, we have a biomedical approach to controlling epidemics,’ he says. ‘But the biomedical approach alone is not enough. You need a community approach, and that community approach has to be valued more highly in the response to epidemics.’

He cites IMI’s EBODAC project as ‘a model’ in this area, but highlights the need for more data as well as expertise in anthropology, sociology and psychology to move the area forwards. He also emphasises the need for more research into vaccines, treatments and diagnostics for Ebola. Of course, you also need the means to do research, and here, says Professor Meda, ‘If there are no institutions like the EU that provide resources for research, it is like a letter to Father Christmas!’

However, his strongest advice is for countries to step up the capacity of their health systems so that they can respond rapidly to epidemics. Looking back on the 2014-2016 epidemic, he notes that the countries hit hardest by the epidemic had health systems that lacked capacity. In contrast, while countries such as Senegal, Mali and Nigeria experienced Ebola cases, they were able to stop the disease from spreading because their health systems had more capacity.

‘At the political level there are measures that every country should put in place to be able to do surveillance well and detect cases early,’ he insists. ‘If you detect early, you have a good chance of limiting the epidemic. But if you don’t have this capacity in the health system to do surveillance and detect early, you will always have big epidemics that spread. So strengthening health systems so that they are capable of detecting and responding rapidly is essential.’


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