Policy  Analysis    

Dillan  Brewer,  Cali  Foscue,  Jordan  Fuller,  Tucker  Plunkett,  Devyn  Reaid,  and  Savanna  Williams  

 Team  Topic  –  Newly  Emerging  Diseases  

 HADM3300  –  Health  Policy  

 November  19,  2014  

 I certify that I have read all guidelines for research papers for this course, both in the course syllabus and in the Web page handout "Guidelines for Research Papers", and that this paper fully complies with them, except for any waivers made by explicit prior

agreement with the instructor.  

Containing the Spread of Filoviruses: Ebola Virus Disease and Marburg Virus Disease

Outline

I. Defining the Problem – Page 1

a. Introduction b. Setting the Scene c. Classification and Transmission of Filoviruses d. Symptoms and Treatments of Filoviruses

II. Background and History – Page 5 a. Ebola and Marburg Virus Diseases

i. Initial and past outbreaks III. Current Situations and Implications – Page 7

a. Ebola Virus Disease i. Ebola: The Spread and People at Risk

ii. International Policies and Government Impact on Ebola iii. Domestic Policies and Government Impact on Ebola

b. Marburg Virus Disease i. Marburg: The Spread and People at Risk

ii. Current Policies and Government Impact on Marburg c. Problems with Policies d. What was Done Right? e. Implications: What Would Happen if Nothing were Done?

IV. Solution 1: Controlling Ebola Through Travel – Page 16 a. Current Policies b. Proposed Solution

V. Solution 2: Rapid Testing – Page 20 a. Current Policies b. Complications c. Proposed Solution

VI. Solution 3: Vaccine – Page 24 a. Background to Vaccines as a Solution b. Current State of Filovirus Vaccines c. How to use Vaccines as a Solution

VII. Policy Recommendation – Page 31 VIII. Conclusion – Page 34

Defining the Problem

Introduction

Every few years, there seems to be an alarming outbreak of a new or lesser-known

disease that causes countless deaths, hysteria among the public, and increased health policy from

the world’s governments and health organizations. The current concern in the realm of healthcare

and epidemiology is the recent outbreak and spread of filoviruses – also known as viral

hemorrhagic fevers (VHF). Similar to the SARS epidemic of the early 2000s and the swine flu

pandemic of 2009, there has been heightened media attention and concern from the public over

what VHFs are, how they are transmitted, and what government organizations are doing to

control the spread of these diseases. Throughout the world, the public looks to government

organizations for guidance and leadership when outbreaks such as the current Ebola virus disease

and Marburg virus disease outbreaks occur. Health and public policies are what shapes the

course of an outbreak through regulating hospital protocols, travel restrictions, sending aid

groups to infected countries, and even providing accurate information. Without governing

organizations such as the Centers for Disease Control and Prevention (CDC) and World Health

Organization (WHO), there would be limited understanding of how to keep people safe and

contain the spread of contagious diseases. With that being said, are government and health

organizations doing enough to control the current epidemics? Judging by the ever-increasing

death toll and recent spread of Ebola to developed countries, there may be better solutions to

consider.

The following analysis focuses on how to control the spread of filoviruses, various

aspects of the diseases, and related health and public policies. However, before one can

understand and pass judgments on how various government organizations are dealing with the

spread of hemorrhagic fevers, it is imperative to understand how these diseases work. Therefore,

provided below is a thorough explanation of what filoviruses are, including their disease

classification, transmission, and signs and symptoms of the disease. Because the information

about past outbreaks can provide insight into how current policy should be written to better

contain such highly contagious diseases, an explanation of their history and various outbreaks in

the past is also included. Finally, a variety of solutions to be considered for controlling the spread

of filoviruses are detailed. These solutions will look at different methods for implementing

prevention tools in both developed and developing countries alike.

Setting the Scene

In July 2014, the media shed light on the most recent outbreak of Ebola virus disease

(EVD), rapidly spreading from one country to the next in West Africa and affecting the people of

Liberia, Senegal, Nigeria, Guinea, and Sierra Leone. In August 2014, two American

humanitarian workers, who were infected with EVD while in West Africa, were transported to

Emory University Hospital to be treated in a state of the art isolation unit. The EVD infected

workers were treated and discharged in conjunction with the nearby CDC. The initial reaction to

bringing these patients into the U.S. for treatment set the stage for the American public’s

perception on controlling the spread of the disease: cries of fear and questioning as to why U.S.

government would allow these EVD infected patients into our country littered the media and

internet conversations. That moment seemed to be the spark to the fire that is Ebola hysteria.

Since then, a Liberian man entered the U.S. without disclosing his prior EVD exposure. Within a

few days, he presented with flu-like symptoms, which were later confirmed to be symptoms of

Ebola. Two of the healthcare workers that cared for him later became infected with the disease,

which hospital administrators believe to be a breach of protocol (Fernandez, Manny). Most

recently in late October, a doctor in New York City that was caring for Ebola patients in Guinea

developed the disease and his family was placed under quarantine. In the months since the initial

outbreak, the death toll is nearing 5,000 and there are confirmed EVD cases – both travel related

and person-to-person transmission – in the United States, Mali, and Spain ("Ebola Virus

Disease").

Affecting far fewer people, while still highly contagious and important, is Marburg virus

disease (MVD). On October 5, 2014, the Ministry of Health in Uganda alerted WHO of a

confirmed case of MVD in a healthcare worker ("Marburg Virus Disease -Uganda"), causing

further alarm over the spread of these sometimes-fatal hemorrhagic fevers. Researchers

investigating this case of MVD are unsure of what initially caused the infection, as the man had

not been in contact with any animals thought to carry filoviruses ("Marburg Virus Disease -

Uganda"). Because this case was discovered and confirmed well after the start of the current

Ebola outbreak, WHO and CDC officials took action immediately to control any spread of

MVD, knowing how rapidly filoviruses can spread.

Classification and Transmission of Filoviruses

Filoviruses are part of the Filoviridae family of viruses, which cause severe viral

hemorrhagic fevers. The family consists of the five known strains of EVD and the single known

strain of MVD. The five known strains of EVD include Taï Forest, Sudan, Zaire, Reston and

Bundibugyo. Filoviruses are thought by researchers to be zoonotic, meaning their original hosts

are animals and the disease can be initially transmitted through animal-to-human contact.

Researchers have found it difficult to locate the original reservoir and host of the filoviruses

("Filoviridae").

Though there is a lack of understanding as to how the virus is initially transmitted from

an infected animal to a human – especially in the most recent outbreaks – there has been

significant research about the person-to-person spread of EVD and MVD. Understanding and

controlling the person-to-person spread of these diseases is especially important due to the lack

of a vaccine for VHFs. Because there is no definitive cure, being able to decrease the

transmission is the only way to eradicate the disease. VHFs are spread through contact with the

bodily fluids of an infected individual, including vomit, blood, semen, and other secretions

("Filoviridae"). This fact is especially important when considering the health and safety of health

care workers or family members caring for infected individuals, in addition to laboratory

workers. For this reason, organizations such as the CDC and WHO have focused heavily on

proper protocol and procedures for healthcare workers, specifying how to handle bodily fluids,

how to put on and remove protective gear, and how to dispose of human waste and remains.

Symptoms and Treatment of Filoviruses

The signs and symptoms of both EVD and MVD are highly similar. Both diseases have

an incubation period of anywhere from two to twenty-one days. The virus can live in your body

without causing you to present with any symptoms for up to twenty-one days, at which point the

infected human becomes contagious ("Ebola Virus Disease"). The CDC has found that in most

cases, patients present with symptoms eight to ten days after being exposed to a filovirus ("Ebola

Virus Disease"). The initial symptoms of EVD and MVD include the abrupt onset of high fever,

fatigue, muscle pain, headache, and sore throat. As seen in the case of the Liberian man who was

infected with EVD in Texas, these symptoms may present to health workers as flulike symptoms

(Fernandez, Manny). On about the third day of infection, patients usually develop severe

diarrhea, abdominal pain and cramping, nausea, and vomiting, lasting up to a week ("Marburg

Haemorrhagic Fever"). The final phase of filovirus symptoms is by far the worst: the

hemorrhagic characteristics of EVD and MVD set in, causing blood in the vomit and feces as

well bleeding from the nose, gums, vagina, and venipuncture sites where intravenous injections

occur. In the most severe and fatal cases, death usually occurs around days eight to nine of

infection ("Marburg Haemorrhagic Fever").

As there is no known vaccine to prevent infection or drug to cure filoviruses, the only

available treatment is supportive and palliative care. Healthcare workers must focus on

controlling the symptoms, such as the vomiting and diarrhea to prevent dehydration.

Additionally, because of the hemorrhagic nature of EVD and MVD, healthcare workers must be

able to provide safe blood transfusions, as most fatal cases are caused by severe blood loss.

Patients who receive immediate medical attention and have strong enough immune systems to

fight off the infection can survive the attack of a filovirus and will have antibodies to prevent

another infection for up to ten years ("Ebola Virus Disease").

Background and History

Ebola Virus Disease

The first recorded outbreak of EVD was in 1976 in Yambuku, Democratic Republic of

Congo, a town along the Ebola River, which is where the disease derives its name. This initial

outbreak infected over three hundred people and was fatal in 80% of the infected population.

There was a simultaneous outbreak in Nzara, Maridi, Sudan and a later recurrence in the same

location in 1979. From 1989-1992 there were issues in quarantine facilities in the United States

and Italy where monkeys were imported from a specific location in the Philippines. In both

locations, the Reston strain of EVD was introduced and caused an asymptomatic infection in the

workers handling the monkeys; however, no humans actually became ill. In 1995 there was a

third massive outbreak of EVD in Democratic Republic of Congo that was traced back to

patient-zero who likely had contact with monkeys where he worked in a forest.

("Outbreaks Chronology: Ebola Virus Disease")

The first appearance of the Sudan strain of EVD occurred in 2000-2001 in Uganda, in

which over four hundred people were infected. The outbreak was blamed on poor protection

amongst healthcare workers and family members and improper burial procedures. There

continued to be outbreaks of the initial EVD strain – later known as the Taï Forest strain –

throughout the early 2000s in Democratic Republic of Congo. The first emergence of the

Bundibugyo strain occurred in Bundibugyo, Uganda in 2007-2008 and caused a smaller outbreak

in comparison to previous outbreaks in Uganda. Until the most recent outbreak of EVD, all

outbreaks in West Africa were very small and contained. The 2014 outbreak in Guinea, Liberia,

Sierra Leone, and Democratic Republic of Congo is caused by the first appearance of the Zaire

strain and to date has infected over 13,000 humans, killing over 5,000 of the infected population.

("Outbreaks Chronology: Ebola Virus Disease")

Marburg Virus Disease

The initial two outbreaks of MVD - at the time referred to as Marburg Hemorrhagic

Fever - occurred in Marburg and Frankfurt, Germany and Belgrade, Serbia in 1967 ("Marburg

Haemorrhagic Fever"). The location of the primary outbreak is what contributed to the name of

this strain of filovirus. In both German cities and Serbia, the outbreaks were tied to African green

monkeys imported from Uganda for laboratory research ("Marburg Haemorrhagic Fever").

Though these initial outbreaks were much smaller - only affecting 31 people - than the initial

outbreak of EVD in 1976, it was the first outbreak of what would later be known as a filovirus.

Throughout the 1970s to the late 1990s, there were very small, isolated MVD outbreaks in

countries such as South Africa, Kenya, and Russia. The first large outbreak of MVD occurred in

1998-2000 in Democratic Republic of Congo and was fatal in over 80% of the 154 people

infected. The majority of the cases in this outbreak were in miners from the northeastern area of

the country, causing researchers to link the disease to bats living in the mining caves. In 2004-

2005, there was a second, even larger outbreak of MVD in Angola that affected over 250 people

and killed all but a few. Researchers still have very little understanding of what sparked the

2004-2005 deadly outbreak. Since the Angola outbreak, there have continued to be small,

isolated cases of MVD in Uganda and Kenya that have all been linked to either miners or

travelers exploring caves in these countries.

("Chronology of Marburg Hemorrhagic Fever Outbreaks")

Current Situations and Implications

Ebola: The Spread and People at Risk

Ebola virus disease (EVD) has quickly become one of the biggest epidemics of the

21st Century. The most recent outbreak of EVD is currently taking place in West Africa,

originating in Guinea and spreading to Liberia, Sierra Leone, Nigeria, Mali, and even the United

States and Spain. There have been over 13,000 reported cases of EVD and it has proven fatal in

over 5,000 cases, with numbers showing no sign of stopping (Aylward et al.). EVD can cause

serious headaches, muscle pains, hemorrhagic fever, and vomiting that can become fatal if not

acted upon in a timely manner. All strains of this filovirus are believed to have been spread in

Africa by direct contact with a wild animal such as a monkey or fruit bat. Once a person has

EVD, the disease can be spread amongst humans by direct contact with blood and bodily fluids

of the person with the disease (Briand). The people most at risk are those who come in frequent

contact with infected and wild animals. The highest risk for person-to-person transmission is in

family members, medical workers, and the people involved in the burial process for the infected

deceased. EVD has rapidly become so deadly that domestic and international policies and

procedures need to be revamped in order to help prevent and combat further fatalities.

International Policies and Government Impact on Ebola

In West Africa, EVD has claimed the lives of thousands of people across various

countries. Researchers believe that a little boy in a village in Guinea was the first case of the

current outbreak because he ate an infected bat and bushmeat of animals infected with EVD

(Briand). From this village, EVD spread throughout the county and eventually the country. The

spread of EVD from Guinea to other countries such as Sierra Leone and Liberia, before making

its way to other parts of Africa and even the United States. The main cause for EVD’s spread

was direct contact with infected individuals and travel.

With the epidemic growing rapidly, organizations such as WHO, MSF, and the CDC

began working together with local governments in each of the affected African countries to treat

and contain EVD (Frieden). Many of these countries had problems in providing proper care and

cleanliness to its citizens due to the levels of poverty in their respective countries. In regards to

healthcare and prevention, these West African countries were severely understaffed and had

minimal supplies needed to prevent the spread of the outbreak. WHO worked with various

governments to provide supportive care for the people of West Africa. They sent fluids to

rehydrate patients from the illness. To eliminate the spread of the disease, they have also set up

prevention and control measures such as managing the cases, setting up surveillance of those

possibly infected, and tracking contacts of those infected (Farrar). Aid workers have helped

provide better lab services and monitoring of facilities both for the medical workers and patients.

WHO has also worked with government administrators to spread awareness throughout the

communities and to warn its citizens to be cautious in any contact with wildlife and other

affected humans. Supplies to protect citizens from EVD exposed is also being provided by

WHO.Other examples of WHO support is a monitoring system of twenty-one days for those who

have been in contact with someone who has had EVD and also have promoted safer burial

options for citizens killed by EVD (Farrar).

MSF and the CDC have provided important policies and implementations regarding

EVD. MSF has, like WHO, sent many health workers to West Africa to aid and support the

people living there and they are also training health care workers and the general public on how

to properly interact with those infected (Fauci). International aid workers are stressing the

importance of proper hygiene in the communities and the need to wear personal protective

equipment when working with EVD patients in regards to injections or in the burial process.

Many of the countries in Africa have now limited travel or created new travel restrictions to

other countries in order to help with borders and containing the diseases. In Africa, the CDC

similarly urges the use of protective equipment and proper patient handling techniques when

working with Ebola patients and no direct contact of skin to skin. Washing hands constantly with

soap and water is a small and easy step in order to help prevent contact with EVD. Direct contact

should be completely avoided by using proper techniques in handling patients and their items.

The CDC requests people monitor the health status themselves and others that may have been

around an area affected by EVD for approximately twenty-one days (Chan). Healthcare workers

must also provide and clean their medical areas and beds regularly to avoid contamination. The

CDC encouraged many of the African countries to quarantine those they deemed could be

infected by EVD, which helps prevent the spread of the disease to other countries (Feldmann).

These organizations have been able to make several impacts in order to help contain the spread

of Ebola and have saved hundreds of lives in the process of preventing the spread of such a nasty

disease.

Domestic Policies and Government Impact on Ebola

Halfway around the globe, the United States has also addressed EVD patients

domestically. There have, fortunately, only been nine total cases in the United States and thus

far, only one was not able to recover and became a fatality. Thomas Duncan was a Liberian

national coming to visit family in America and was the first patient of EVD in the United States

(Fernandez). After arriving in America, Duncan felt sick and went to the hospital and shortly

after passed away from the Ebola-like symptoms. The CDC confirmed through tests that Duncan

was EVD infected and domestic policy began evolving to contain EVD. Health care workers and

nurses, for example, who treated Duncan were being monitored and treated quickly if they began

showing EVD symptoms. While some EVD treatment nurses became sick, they were treated

efficiently and recovered. The United States government also began to implement other

safeguards throughout the country, including monitoring and surveillance of all possible contacts

to Duncan and those infected by EVD by the CDC. Infection control protocols were also revised

to mandate fully protective and covered clothing for all health workers working with EVD.

Healthcare workers in America also have become highly trained on EVD and how to combat it if

it becomes a larger problem domestically. Rapid response teams are in place now to travel to

labs and hospitals with potential cases of EVD. A big issue is international travel and the CDC

provides airport screening and surveillance to passengers and flight crews in airports of high

international travel while also requesting reports on those deemed as ill passengers on flights

(Breman). There were also encouraged twenty-one-day quarantines set up by many governors for

their particular states in order to prevent the spread of EVD. These quick response policies and

regulations set up and implemented in the United States have helped control the spread of EVD

throughout the country. Although many Americans are fearful about EVD and its death toll in

West Africa, the disease has, so far, been contained with few deaths domestically.

Marburg: The Spread and People at Risk

MVD can cause serious headaches and hemorrhagic fever in people who are affected.

MVD spreads like most filoviruses, in that it spreads from direct contact of people and animals

that are already infected. Bats and nonhuman primates seem to be the first animals that carry the

virus. People who go into caves inhabited by bats and people who come in contact with animals

infected have a higher risk of contracting MVD. MVD also spreads through contact with blood

and bodily fluids of infected people, as well as contaminated medical equipment. As a result, the

people most at risk are those who visit caves or work in mines in Africa and those who have

occupational exposure treating patients without the proper protective equipment. MVD is not a

very common filovirus outbreak, but when the disease infects someone it can be highly fatal.

This disease can become very fatal and can cause a major number of fatalities if not treated

correctly and promptly. The most recent outbreaks have occurred in Uganda in 2014.

Unfortunately, the one person proven to have been infected with MVD died due to complications

of hemorrhagic fever (Frieden). The United States, fortunately, has not diagnosed anyone having

MVD from this most recent outbreak. Governments, both domestically and internationally, need

to have policies in place that are ready to limit the spread of MVD in their respective countries.

The most recent outbreak of MVD occurred in late September 2014. In central Uganda

and the western district of Kasese, one man died and close to 100 others are being carefully

monitored. The man who died was thirty years old and was a hospital technician working at

Mengo Hospital in Uganda (Adalija). Over half of the people who were in contact with the man

are hospital workers and have been isolated for the duration of the twenty-one day incubation

period. Approximately eight of the exposed people have shown the symptoms of the disease and

since September, there have been an estimated eighteen cases of MVD throughout Africa,

resulting in nine fatalities (Adalija). Although these numbers are tragic, they had the potential to

be much higher and were not because of the impact of government and its policies that have been

able to limit the spread of MVD.

Current Policies and Government Impact on Marburg

Many acts taken in Africa and throughout the world have aided in preventing the spread

of MVD. In response to the September 2014 outbreak of MVD in Uganda, President Yoweri

Museveni deployed a national task force to attempt to prevent any further cases of MVD, as well

as to contain the current outbreak (Adalija). Museveni told his citizens to cooperate with the

national task force and health care workers, and to avoid shaking hands and having direct contact

with others as much as possible. The national task force helped provide additional health care

workers and physicians with the supplies and training necessary to treat infected individuals.

Additionally, local individuals are managing cases clinically and monitoring areas of infection

with the assistance of organizations such as World Health Organization, Medecins Sans

Frontieres, and the United States Centers for Disease Control (“Marburg Haemorrhagic Fever”).

These international groups are also aiding the Ugandan government in investigating and

surveying the cause of the outbreak and how it is being handled. They assist in setting up

isolation and treatment facilities and have taken a large role in training Ugandan healthcare

workers in prevention and control of MVD. WHO has further deployed staff to provide aid to the

national task force and advised against traveling to Uganda due to the current situation.

The Ugandan government is working on social mobilization to prepare its citizens in case

the outbreak cannot be prevented and contained. Uganda is receiving shipments of more personal

protective equipment (PPE) from the CDC, to help in preventing the spread of MVD (“Marburg

Haemorrhagic Fever”). Other policies are being implemented to facilitate rapid diagnosis, tracing

contacts of infected individuals, and identification of the disease. The CDC is lending support to

establish a better laboratory network to be able to respond to MVD cases faster. Uganda is also

improving communications with its neighboring countries to help strengthen the surveillance

around the borders to prevent the outbreak from spreading to other countries.

Although there are currently no vaccines available to eliminate MVD, many

pharmaceutical companies are working to find cures for infected MVD patients. Researchers in

Canada say they have developed a drug, which could prove successful in helping monkeys

survive MVD (Adalija). However, There have not yet been any human tests performed with this

curative drug. African governments have chosen a simpler approach to containing MVD, stating

to their people that there are many ways to help minimize the risk of being infected. The most

feasible solutions for underdeveloped countries include avoiding direct contact with infected

individuals and using proper nursing techniques. The embalming and burial process of deceased,

infected individuals should also be modified to avoid the spreading of MVD. While MVD may

not be the most popular of the two main filoviruses, it is a very dangerous disease and

government policies must be in place to contain the spread of such an highly contagious

infection.

Problems with Policies

Not surprisingly, controversy exists about how EVD and MVD patients have been treated

and the response of governments and private companies to these diseases. Many people believe

that if the medical workers in Africa and in the United States would have been trained better for

EVD, the disease death toll would not be as high as it was in the beginning (Chan). Others

speculate that if healthcare workers had more funding and proper equipment to eliminate

physical touching, EVD would not have spread so easily. Other problems with EVD relate to the

fact that there has not been any fast testing available and some question that if we have so much

money and research invested in drugs and pharmaceutical companies, how are there no vaccines

available to eliminate the spread of the disease (Feldmann). People believe that WHO and the

CDC had a slow response time in providing aid and establishing EVD handling policies. People

from any countries are furious over a lack of travel regulation. Many Americans fear that those

traveling to the United States from Liberia, Guinea, or Sierra Leone are bringing the disease here

with little monitoring or control by the departing or arriving governments on checking to make

sure passengers are free of disease. EVD has caused concerns for many around the globe, but the

nation of Nigeria may be able to help provide guidance on how to prevent the spread of Ebola.

What was Done Right?

The Nigerian Minister of Health Onyebuchi Chukwu along with WHO declared Nigeria

free of Ebola after a little over a month and only a few fatalities (Sifferlin). Chuckwu

summarized Nigeria’s actions, which included preparing early on how to train healthcare

workers about the disease due to the proximity of the outbreaks. They also declared Ebola a

national emergency early so that strategies and solutions could be met at a rapid rate. Nigeria

also trained local doctors already in Nigeria to avoid losing time while waiting on foreign

physicians to arrive (Sifferlin). They were also able to manage the fear of its citizens and used

contact tracing for anyone who might be involved with contact of Ebola. They were able to keep

borders open to not produce chaos and they urged international response to help rally everyone

together to help combat the disease. If these steps could have been implemented within every

country infected by Ebola, there may have been fewer fatalities and fewer EVD cases.

Implications: What Would Happen if Nothing were Done?

A major implication about EVD would be what would happen if no steps were taken to

prevent or contain the spread of EVD? Several thousands of cases of EVD have spread

throughout the world in less than a year with thousands of people dying. In addition, experts

believe there are thousands of EVD cases not even reported or registered that have caused

fatalities in underprivileged areas. If these numbers are accurate, the CDC projects that there may

be over 1.4 million people infected with EVD by January 2015 if actions are not taken to prevent

and diminish the spread of EVD (Michaud and Kates). If the spread of EVD is not contained,

many people may start to panic and cause chaos in Africa. While there is no cure for these

filoviruses yet, researchers and scientists are working extremely hard to find a cure. In the

meantime, as Nigeria recognized, there are many things that can be done in order to halt the

spread of EVD. There are also temporary measures and actions that can be undertaken to develop

further protections against filoviruses until the discovery of a cure.

Solution 1: Controlling Ebola Through Air Travel

Through the modern technology of air travel, a person can go anywhere in the world within

nearly twenty-four hours. All of these people take their diseases with them. Millions of people

travel by plane every day coming from and going to nearly every continent on the globe. All of

these different places are home to multiple and sometimes unique diseases. Air travel makes it

easier for diseases to move and infect new places. Unfortunately the people in these “new

places,” who previously were not at risk for disease exposure become at risk, if a passenger is

infected and deplanes in a “new place.”

Current air travel regulations are not enough to keep the fairly contained Ebola epidemic,

which only affects few African countries, from becoming a full blown global catastrophe.

Currently, the CDC advises airline crewmembers to follow normal infection control precautions

when handling a passenger that they believe might have Ebola. These precautions include

washing hands and wearing disposable gloves and facemasks (“Ebola Guidance for Airlines”).

While Ebola is not an airborne disease, there is still a need to take additional precautions to

control the spread through travel.

Current Policies

The CDC has, in the last few months, implemented a policy of exit screening for

passengers leaving the countries of Sierra Leone, Guinea, and Liberia. These countries are the

three hardest hit with the current EVD outbreak. This exit screening includes an initial primary

screening and a more thorough secondary screening if the passenger is flagged in the primary

screening. During the primary screening, performed by a general workforce that is not required

to have any public health training, workers take passengers’ temperatures and ask them to fill out

a public health questionnaire that will help the workers determine each passenger’s individual

risk. Passengers with temperatures above 101.5 degrees Fahrenheit or that report feeling feverish

are sent to the second screening. The questionnaire asks passengers to report if they have

experienced any of the other myriad of symptoms that are associated with EVD such as

headache, muscle pain, vomiting, diarrhea, stomach or abdominal pain, or unexplained bleeding

or bruising. In the secondary screening, the passengers that are flagged are asked to complete a

more thorough questionnaire and are given a more focused physical examination. If the

passenger does not pass the second screening they are referred for medical treatment. They are

also denied boarding and have to wait twenty-one days to fly (Pearson). These precautions are

thought to have stopped several passengers with EVD from leaving the original outbreak site.

Although, it is still unclear if these measures are enough.

This current outbreak of EVD is not the first time that exit or entry screening has been

used to assess the risk level of passengers. In 2008, a study was conducted in Australia to

measure the effectiveness of entry screening for influenza. Researchers used a number of the

same procedures that the CDC is currently implementing. They asked the passengers to self

report symptoms and fill out a health questionnaire. The study found that these measures were

ineffective in assessing the risk of the passengers, because a lot of the symptoms were also

symptoms of other diseases. They also found that by flagging anyone who exhibited one of the

symptoms, more people than necessary were being screened. This led to mass inefficiencies and

huge strains on the airport’s budget and personnel (Priest). Many of the findings of this study

would also hold true to the exit screenings that are currently being used for Filoviruses,

particularly EVD. Some of the main symptoms of EVD are also symptoms of other very

common diseases, like influenza. With flu season quickly approaching its peak many people will

be displaying these symptoms. Airports, especially those in Sierra Leone, Liberia, and Guinea,

will have trouble supporting such a large scale testing effort. These measures of exit screening

for EVD, while a step in the right direction, are lacking and highly inefficient.

Proposed Solution

A more comprehensive and specific test or screening procedure for all Filoviruses would

be the best solution for controlling the spread of EVD through travel precautions. The process

needs to be made more efficient and that will require the implementation of more resources than

these smaller African countries have. Due to the process of globalization, diseases that used to be

an issue for just one area now have implications for the entire globe (Rodriguez-Garcia). That is

why the global community, including the United States, has an obligation to step in and use their

combined resources to help solve this global health issue. The resources already being used in

exit screening in the countries of Sierra Leone, Guinea, and Liberia need to be heavily

supplemented with more efficient processes and more knowledgeable screening workers.

Currently, in the primary screening untrained workers are merely asking passengers to

self-report symptoms of illness. It is possible that some passengers are downplaying symptoms

out of fear or lack of education. People who are exhibiting a low grade fever, below 101.5, and

are not reporting other symptoms are cleared to fly and potentially travel all over the globe.

Verification of symptoms and an assessment performed by a worker with actual substantial

medical knowledge should be implemented. If the person is flagged in the primary screening,

they should be sent to the secondary screening and actually be evaluated by a medical doctor or

another equally trained individual. This would require more resources or a mass redistribution of

current resources, but it would make the process much more efficient and thorough.

The questionnaires that are being filled out by travelers, along with their travel history,

also need to be verified. The majority of people do not take surveys and questionnaires seriously;

they just check the box that they believe will get them through the fastest. With such a serious

public health risk time to verify the answers passengers are recording should be taken. Travel

histories also need to be required. The World Health Organization is currently advising health

care providers to ask patients about their travel history to rule out the possibility of a Filovirus

(“Travel and Transport Risk Assessment”). If WHO is calling on medical professionals to

require this information from patients, the same information should be asked of airline

passengers coming from countries in the middle of a severe EVD epidemic. This travel history

screening should not just be required from passengers leaving the airports in Sierra Leone,

Guinea, and Liberia, but all international travelers coming in to the United States, who have

travelled through these countries in the last thirty days. These histories need to be verified by

United States Customs officials before the passenger is allowed entry into the United States.

If a policy of more thorough screening processes, using medically trained professionals

for screening, and verification of travel histories was implemented there would be a large

decrease in the risk of transmission of EVD through air travel. As stated before, these policies

will take a united global effort, but that is the best option for fighting the risk of a global

catastrophe.

Solution 2: Rapid Testing

Current Policies

The current option to test for Ebola that is the PCR (polymerase chain reaction) many

other diseases. However, the PCR test is not fast enough and has some complications. The PCR

test which takes samples of a patient’s blood and detects the DNA to see if they are

infected. The CDC and WHO currently are working with others to improve a test for the

filoviruses, but Vogel, a author or sciencemagazine.org says, “In the short term, WHO and others

are focused on increasing the number of PCR-based labs” (Vogel).

With filoviruses emerging in the United States, and other countries, one of the solutions

needed to decrease these diseases is to find a rapid test to perform on people. With EVD

emerging currently, finding a solution for EVD would help greatly. Currently the CDC is

encouraging finding a rapid test for Ebola as a big priority, but does not believe enough research

has been done. “Even if we have the best treatments available, without a timely diagnosis people

are still going to die," says [Dan] Kelly” a infectious disease doctor being interviewed by Aryn

Baker (Baker). If there was a successful test created to quickly identify persons infected with

EVD outbreaks of filoviruses currently and in the future could be contained faster. As said

earlier, because filoviruses have an incubation period of twenty-one days sometimes fail to occur

before three weeks. This latent presentation of symptoms factor causes many problems

containing the spread of EVD; with the symptoms sometimes occurring up to three weeks after

the initial contact with infection. Latent symptoms also delay the infected person’s testing, which

allows more exposure to spread to other people, if it is not known that the individuals are

infected. Finding a rapid test that is cost efficient and able to test anyone at risk, quickly is a big

need for stopping the rapid outbreak with filoviruses emerging at any time. While medical

research takes a very long time, and large amount of money to fund it, even if the researchers

working now do not find a solution to rapid testing during this outbreak of Ebola, they would be

prepared for the next outbreak.

Complications

The existing PCR test is used effectively for many different diseases, but for EVD and

MVD there are many complications to it. One complication is the turn around rate of time once

the patient gets a blood test done. As Butterworth says in Race for a Cure, “the Centers for

Disease Control's Craig Manning points out, in previous outbreaks that blood samples had to be

shipped to the CDC's headquarters in Atlanta for analysis, a process that, agonizingly, took three

days” (Butterworth). The PCR test process is too long to determine if a patient is infected with

Ebola because an infected patient must be isolated right away, for them to avoid spreading the

virus. Butterworth also states that, “Now, thanks to the CDC's collaboration with the Ugandan

government, there is rapid 24-hour diagnostic testing available on the ground [in Uganda].”

(Butterworth). However, the PCR test available are currently not available generally to many

hospitals and healthcare facilities in the United States, which is a problem, that adds critical time

to the process of diagnosing an infected EVD patient.

Another challenge of the PCR test is the technique or process of the blood draw by the

physician and the reviewing doctor’s lack of location about where the patient is infected the

patient infected with the disease. Information about the place of infection could help to track the

DNA of a patient faster (Clothiaux). Pierre Clothiaux, an orthopedic surgeon and board of

director’s member at Cox North Hospital in Springfield, Missouri, stated that this is one of the

major problems of the PCR test. He also discussed that MRSA, Methicillin-resistant

Staphylococcus Aureus, a strain of staph that looks similar to Ebola, had the same problem of

being unfamiliar with where to get a blood sample to test the high risk patient (Clothiaux). As to

the technique of the blood drawn process, Jon Rappoport asks, “Is the [blood] sample taken from

the patient actually a virus or a piece of a virus? Or is it just an irrelevant piece of debris?” also

showing concern about where the blood is taken from the patient (Rappoport). Rappoport also

thinks that some doctors taking blood from the patients, who are at risk, are not taking blood that

would show if the patient has Ebola (Rappoport). Many PCR tests could come up negative due

to the location of where the doctor is drawing up blood on the patient. A failure to diagnose EVD

due to an improper blood drawn could cause the patient to keep going about life, spreading Ebola

to other people because of the patients’ unawareness they are infected with EVD. If doctors

could work with the patient to figure out when and where they were infected, this could help

identify the DNA easier in the PCR test.

Finally, the current PCR testing is costly. While costs are healthcare issue, usually high

costs are associated with curing a disease not diagnosing a disease. The CDC does not have the

monetary reserves to test anyone at risk of Ebola using the current PCR test. Loftus shows an

example of the high cost stating, “BioFire's FilmArray [system] uses PCR technology, but can

deliver results in about one hour on the premises of any treatment facility that has one of the

machines, which cost around $39,000” (Loftus). Finding a test that is inexpensive is key. Right

now because the test is expensive it can only be used for people who are very high at risk. In

separating patients to see who to test, the CDC categorizes possible EVD patients as: high risk,

some risk, low risk and no identifiable risk (Bray). Using the PCR test, the CDC limits testing

the patients to those at high risk only. Using a less expensive test, the CDC could test more

patients.

Proposed Solution

Given the limitations of the current PCR test for filoviruses, this test is not going to be a

successful tool for the United States and other countries to use in the future to treat EVD

patients. Therefore, the CDC is working with other organizations to find a rapid test, as well as

exploring other test options. These options are briefly summarized here.

After researching for the best solution for a rapid test, sciencemag.org talks about a test,

that the Corgenix research team is researching currently,that has the best potential for the CDC to

use. Vogel an author researching about rapid EVD states that, “Several teams are working on

prototype kits—small disposable devices resembling home pregnancy tests—that use just a few

drops of blood from a fingertip jab and can be carried easily to remote villages or on door-to-

door screening campaigns” (Vogel). Vogel further states that this test “allows a health worker to

collect a blood sample directly from a pricked finger onto a pad on one end of a diagnostic test

strip,” which if the patient is infected or not, the strip would show a response (Vogel). In another

article, Baker the author, points out the difference between the costs of these types of

experimental, portable tests that are being developed. He emphasizes that, “These tests, which

would cost anywhere from $2 to $10...could also be used in airports to confirm whether someone

with symptoms has Ebola” (Baker). Baker also further points out you could use this test

anywhere you would like to test high risk patients with the ability for anyone to work the test and

read the results (Baker).

Even though these tests are currently being researched, the scientists with this idea still

need to perfect these tests to make them as good as the PCR test without the complications. If

Corgenix successfully perfects the test, these tests would ideally be non-expensive, have a fast

turn around rate, and able to detect disease from just a finger prick, making it possible to test

more people accurately and faster. Vogel posits that, if a team ended up making this test

successful with these aspects “tests could also be helpful in screening patients entering non-

Ebola health centers or travelers at airports” (Vogel). Research confirms the needs to have

inexpensive, rapid testing, to be able to test people who are in any certain type of risk of Ebola or

other filoviruses, due to travel. With this type of test, healthcare workers would be able to test

anyone at risk, quickly and inexpensively; without having to know where the patient was

infected. Having a faster test would also drastically decrease the spreading of Ebola and other

filoviruses because of being able to identify and treat at risk patients faster.

Solution 3: Vaccine

Background to Vaccines as a Solution

One possible solution to control the spread of Filoviruses or viral hemorrhagic fevers

(VHF) is the creation and widespread distribution of a vaccine. There is currently no cure for the

most publicized Filovirus, EVD. Developing a vaccination is a key way to reduce disease

mortality and spread of this disease.

The current outbreak of EVD can be compared to the height of the Polio outbreaks in the

United States in the 1950’s. The population was under informed about the cause of the disease

and its spread and fear was catching. Much like Polio, people are afraid of catching EVD

because there is no cure and both diseases can be transmitted through bodily fluids, although

Polio is limited to transmission through fecal matter and saliva (“Polio”). Polio is currently very

nearly eradicated, mainly because of vaccines. There were two main Polio vaccine developers

focused on different methods of vaccination and vaccine administration. The first developer,

Salk, developed a vaccine with an inactive Poliovirus (IPV) that was mass-produced through

help from March of Dimes fundraising efforts. The vaccine was administered through a shot and

required boosters (Blume). Sabin, the other developer, developed an oral medication containing

active Polio virus, which went on to become more common due to easier administration, lasting

effectiveness, and its ability to improve community health. Through later testing, it was revealed

that the Sabin vaccine can cause Polio in a very low number of cases (“Polio”). The success of

vaccines in combating Polio is because of the large number of people that were vaccinated. This

high percent of the population receiving a vaccination is referred to as herd immunity, if a high

enough percent receive the vaccination then it protects the small number of people who have not

been vaccinated (Stern).

When considering a vaccine as a solution to containing the spread of VHF, there are

several factors to be mindful of when evaluating a vaccine that contribute to its efficacy. These

factors include the method of vaccine administration; nasally, orally, or injected into the muscle

are common ways to administer vaccines. Another factor that should be evaluated is the number

of doses of the vaccine and if later boosters required to be immune from VHF. The more

required participation of the public, the harder it will be to achieve herd immunity. A higher

number of doses or boosters will also add to the cost of the vaccine, which should be as low as

possible. A high cost would act as a barrier to the general public receiving the vaccine, especially

because the region where the current outbreak originated is extremely poor.

Rational vaccine design is another factor to consider, as a good design will, “Bind the

germline antibody precursor, select for the appropriate primary recombinational events, and

direct its somatic mutations toward the appropriate mature form,” (Nabel). Also as with the

Polio vaccine, the benefits and costs of using a live virus versus inactivated virus in the vaccine

must be carefully weighed. Although a live virus may be more effective, as was the case with

Polio, it could contribute to the public’s fears and prevent people from immunizing themselves

and their families (“Polio”).

Time to develop and manufacture the vaccine is critical, in preventing new cases and

VHF related deaths. Domestically a way to shorten development time is to focus energy and

funding on vaccines that are in clinical trial or have approval to begin clinical trials from the

FDA. Vaccines that are developed should be tested for efficacy on multiple strains of EVD, as a

way to prevent future outbreaks (Kanapathipillai et al.). In short these factors contribute to

achieving herd immunity, which may provide the best way to contain VHF.

Current State of Ebola Vaccines

There are no vaccines with FDA approval to treat EVD (“Ebola Virus Disease

Information for Clinicians in U.S. Healthcare Settings”). According to the CDC’s EVD fact page

there are several government agencies working with private companies to develop a vaccine for

EVD. There are also public health agencies in other countries, such as Canada, working on

promising vaccines, as well as privately operated pharmaceutical companies that are developing

vaccines. The following is a summary of the most well known and promising VHF vaccines.

National Health Institute’s National Institute of Allergy and Infectious Disease (NIAID) is

working with GlaxoSmithKline (GSK) to develop a vaccine called cAd3-EBOV that is not made

up of “Infectious Ebola virus material,” and is incorporated into a chimpanzee vector

(“Ebola/Marburg”; Kanapathipillai et al.). The vector causes the immune system to react to the

proteins in the vector. The viral vector will not replicate once the desired genes are inserted into

the system (“Ebola/Marburg”). The vaccine cAd3-EBOV has been tested in chimpanzees with

complete efficacy and has been approved by the FDA to start phase 1 clinical trials in humans

(Kanapathipillai et al.). This vaccine is being tested in two clinical trials for protection against

different strains of EVD. The first trial is testing its effectiveness against the Zaire strain and is

the monovalent, for a single disease, form of the vaccine. The other trial uses the bivalent,

directed at conferring immunity for two diseases, form of cAd3-EBOV to test effectiveness on

the Sudan strain (Kanapathipillai et al.). The studies for both forms of the vaccine are small, the

monovalent form will have 60 participants and the bivalent form will contain 20, non-

randomized, and open label subjects (Kanapathipillai et al.).

Another branch of NIAID, Division of Microbiology and Infectious Diseases, is

partnering with Crucell, a biopharmaceutical company, to develop a different kind of vaccine

than cAd3-EBOV. Crucell’s vaccine would be for EVD, as well as MVD, and is based on

recombining adenovirus vectors. There is a planned clinical trial set to begin in the next year or

so (“Ebola/Marburg”).

NIAID is also funding a project at Profectus Biosciences, which is attempting to create

“A recombinant vesicular stomatitis virus vectored vaccine against Ebolavirus”

(“Ebola/Marburg”). Researchers are working on developing the best methods for designing this

vector before applying for any clinical trials (“Ebola/Marburg”).

Bavarian Nordic is receiving support from NIAID in its early stages of researching a

Marburg vaccine incorporating the Modified Vaccina Ankara vector (“Ebola/Marburg”). NIAID

is not only working with private companies, but also Universities researching EVD vaccines.

One promising approach is from Thomas Jefferson University, where researchers are using the

rabies virus as a vaccine platform for EVD (“Ebola/Marburg”). This platform has shown promise

in protecting animals against infection. The current testing uses a live virus, but researchers at

Thomas Jefferson are working on creating a version of this vaccine with an inactive virus for use

in humans. The animal version will continue testing to hopefully be used on wild animals in

Africa to prevent animals spreading the virus to people (“Ebola/Marburg).

The Department of Defense is another U.S. government agency that is working on

developing a vaccine for Ebola. Department of Defense Secretary Hagel explained at press

conference in September 2014 that the department has approval for a clinical trial to test for a

vaccine, which will be tested at the Walter Reed Army Institute of Research (Phellerin).

In addition to U.S. government agencies, other countries’ health agencies are partnering with

private companies that are researching potential vaccines for Filoviruses. For example, NewLink

Genetics Corporation did a small study on monkeys with a new vaccine they are developing

(Fox). The idea to use rVSV as a vector for a vaccine against Ebola or Marburg has existed since

2005, but it was not until the most recent outbreak of EVD that private companies began to

pursue an rVSV based vaccine (Bausch). The vaccine uses the common cold virus as a vehicle to

transport Ebola genetic material. What makes NewLink’s vaccine unique is the method, in which

it is administered. While many vaccines are given as shots, this one is a Nasal spray (Fox). They

are now partnering with the Public Health Agency of Canada to begin testing the vaccine, named

rVSVΔG-EBOV-GP, in the United States in a clinical trial. Canada’s public health agency has

donated 800 doses of rVSVΔG-EBOV-GP to the WHO, which is examining ways to test the

vaccine in Europe and sub-Saharan Africa (Kanapathipillai et al.). Other trials of rVSV based

vaccines for EVD have been successful through oral doses and given full protection in as little as

thirty minutes, in tests in non-human primates (Bausch).

How to use Vaccines as a Solution

In order to use vaccines as a way to control the spread of Filoviruses, government

agencies must communicate and facilitate funding for vaccine development. Vaccines for

Filoviruses should also receive breakthrough therapy status from the FDA to expedite safe

vaccine testing and once a safe and effective vaccine is developed, the general public should be

vaccinated, the same way Polio and MMR vaccines have been given.

Today many government agencies are currently at different testing stages on vaccines for

different Filoviruses. Unfortunately, these agencies are not under the same pressure as other

researchers to publish, so the discoveries they make often stay within agency walls. Recently,

WHO had a meeting in Geneva, in late September 2014, to discuss prominent potential vaccines

and ways to maximize efficacy. They encouraged clinical trials for the vaccines to be accelerated

and promoted the position that all results should be shared to help other researchers

(Kanapathipillai et al.) This encouragement by WHO to share findings could be further

developed to advance vaccine development as a solution. By creating a global health policy that

during life threatening outbreaks of a disease, government agencies and private companies agree

to share relevant research to find a vaccine or cure faster, unnecessary loss of life could be

minimized and vaccines could be available for VHF. While developing and testing a vaccine can

be quite expensive, and challenging for smaller companies or universities to continue testing a

promising vaccine, there are other options. Governments and nonprofits as well as larger

companies can and should consider new partnerships as a way to ensure ideas from small

entities are tested. As a way to encourage these partnerships and potentially recoup costs, if a

vaccine created through these partnerships is marketed, then all developing participant entities

could retain a percentage of sales or patent.

Once a vaccine is developed and approved for clinical use to prevent VHF, getting the

general public vaccinated may be challenging. There is a court case, Jacobson v Massachusetts,

that lays the groundwork for compulsory vaccinations (Joseph). The interpretation of this law

does allow citizens to choose not to vaccinate themselves or their children for religious reasons

(Joseph). Due to the importance of herd immunity in vaccine efficacy, even a small percentage

of the general public refusing a VHF inoculation religious grounds could cause VHF flare ups

and lengthen the time it takes to eradicate these diseases, as seen in recent measles outbreaks

(“Polio”).

While vaccines have the potential to control the spread of filoviruses, the vaccine solution

has several potential problems. One of the problems is the way these vaccines are tested; clinical

trials contain small numbers of participants who are healthy and fail to accurately account for the

health of at risk populations (Nabel). The sample sizes are incredibly small for cAd3-EBOV and

rVSVΔG-EBOV-GP, the most promising vaccine candidates, so the clinical trials “Will only

provide data on adverse events,” (Kanapathipillai et al.). The small number of participants in

clinical trials could lead to a vaccine being approved without enough testing and when the larger

population is exposed unforeseen adverse effects similar to the Polio vaccine (Nabel). Another

problem associated with vaccines is high cost of development for a vaccine; one way to combat

this problem is to test the vaccine on more than one disease as is the case with GSK’s cAd3-

EBOV vaccine (Nabel; Kanapathipillai et al.). Another problem associated with cost is

distributing a vaccine in underdeveloped countries, including those in West Africa that are

currently experiencing the worst of the Ebola outbreak. EVD has torn apart the medical

infrastructure of Western Africa, many health workers have been killed or are too weak to return

to work and international aid workers are afraid to visit the region. Additionally people are afraid

to visit hospitals or clinics because of the infected people they might encounter (Farrar and Piot).

The lack of trained healthcare workers and fear of healthcare settings combines to create a

perfect storm of a population that will not respond well to vaccination efforts (Nabel). There is

already a resistance to vaccination in the affected countries, including Nigeria, which will make

changing public opinion to be in favor of vaccination against VHF extremely difficult (Nabel).

These countries also have limited resources and are spread out with the average citizen having

limited ability to travel, which will make getting the vaccine to the majority of the population

very resource intensive (Nabel).

Policy Recommendation

There is an ever-growing problem with viral hemorrhagic fevers. While the world is

actively pursuing a solution to this current EVD epidemic, what solution should they be focusing

on? The focus should be on a solution that makes sense economically, can be implemented

quickly and easily, and is very effective at combating the spread of EVD.

To recap, one common solution that readily comes to mind is to develop a vaccine. It is

typically the duty of the country’s or world’s health organization (s) to attempt to combat the

disease by seeking a cure for the disease. However, while a vaccine may potentially be the

long-term solution for combatting the spread of VHF it will take years for a vaccine to be created

and go through all of the clinical trials needed for approval by the FDA. Until a vaccine is FDA

approved, it is not widely accepted for the combatting of a rapidly spreading disease. Although

there is currently progress being made to develop a vaccine and some vaccines have already been

sent to be tested in clinical trials, the road to a cure is still a figment of the fairly distant

future. The production of a vaccine is very costly, which makes it nearly impossible for smaller

companies or universities to get involved in the research and production of a vaccine. There is

also a lack of government funding supporting the discovery and testing of a vaccine for

VHF. Even if a vaccine were created by a company the cost of the vaccine could be

astronomically expensive because the company would be trying to recoup the cost of developing

and testing the vaccine while also trying to make profit from it. The cost associated with the

development and testing of a vaccine along with the amount of time it takes to develop it, make a

vaccine not a feasible solution to stop the spread of VHF currently.

Given the above, the best current solution to limit the spread of VHF is to employ a

multifaceted approach by developing and combining the use of rapid testing and implementing

policies and procedures with regard to mass travel. By combining these two solutions to the

problem, the spread of VHFs can be limited by testing travelers that are leaving infected

countries through the use of rapid testing. Those with the disease would be kept from traveling

to other countries and thus spreading the disease. This strategy would limit the spread of these

diseases to other countries until a cure or vaccine can be developed.

As detailed above, the PCR test is being used to test individuals to see if they have MVD

or EVD. This PCR test has a long wait period to receive results and is also very expensive

(about $100 per test) (Baker). However, the test being developed by Corgenix, which is similar

to a pregnancy test, shows promise. It costs about $2 per test and gives fast results by showing a

response based on whether the individual is infected or not (Baker). The Corgenix test can be

administered by pricking the finger of an individual and then placing the drop of blood on the

paper test to get the results (Baker). Efforts to develop this test further to be as accurate as the

PCR test should be undertaken (Baker). To help speed the process of finalizing the development

of this rapid test, governments should provide funding and give incentives to the developer.

The Corgenix rapid test, once finalized, should be used as part of the procedure of exiting a

country that is infected with Ebola or Marburg. The procedures that Sierra Leone, Guinea, and

Liberia are using would be more efficient with the use of this rapid test. All individuals that are

at any possible risk of being infected with a VHF should have to take this test if they want to

leave the country. If individuals refuse to take the test they should not be allowed to fly or travel

to another country until they are tested. Individuals should be tested by a professional with

medical knowledge such as a nurse or physician. Those who test positive would then be required

to have a physician conduct further tests to verify the results and begin treatment. The

individuals who test positive should not be allowed to fly or leave the country for twenty-one

days unless the physician determines through extensive testing that the individual does not, in

fact, have VHF. Travelers should also be required to reveal their travel history to airport

officials so if the person is infected they can determine who they came into contact with and

what areas are at risk. Airport officials should check every person’s travel history and make sure

it is accurate by checking passports and running background checks of the person. If travelers do

not provide accurate travel history they could face prosecution for lying to a government official.

The use of the Corgenix test coupled with these mass travel policy changes would vastly

diminish the amount of individuals who ‘slip through the cracks.’

To implement the PCR test development and use recommendation, WHO and world

leaders, such as the U.S., must coordinate their efforts. Without such coordination, any policy

recommendation will fail. Accordingly, to begin the process, the U.S. could request WHO and

other world leaders, including the countries with VHF infection issues, to partner with each other

to undertake the development of the Corgenix rapid test as well as the implementation of the

travel precautions and restrictions. Such a partnership would benefit the infected countries and

the non-infected countries alike. More importantly, such a coordinated effort would provide an

ongoing global health response network to continue to promote rapid response options to future

VHF outbreaks or other similar outbreaks.

Conclusion

After surveying all of the possible solutions to stop the spread of filoviruses, we assert

that Corgenix rapid testing coupled with changes to mass transportation checkpoints is the most

effective way to contain the spread of VHF. When making a decision on what solution to

choose, we considered many different factors including the cost, the length of time it would take,

and ease of implementation. Through research of past outbreaks and how they were handled, we

have learned that limiting the spread of the filoviruses is key before any other actions can be

taken. If actions are not taken to stop the spread of VHF, they could lead to thousands of

otherwise preventable deaths. As suggested by the aforementioned data, if nothing is done to

prevent the spread of these debilitating diseases the Center for Disease Control and Prevention

has projected that there may be more than 1.4 million people infected by January 2015 (Michaud

and Kates). This could result in wide spread panic throughout the world, outside of developing

countries. Thus, measures should be taken to limit the spread of these viruses. Therefore, our

solution should be implemented as soon as possible so that it can begin to limit the spread of

these filoviruses and save lives around the world.

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