Speaking Zika with the man who co-discovered Ebola
By:London School of Hygiene & Tropical Medicine https://lshtm.ac.uk/themes/custom/lshtm/images/lshtm-logo-black.png
Friday 1 April 2016
ResearchGate: What were your experiences publishing research during the Ebola outbreak in 1976?
Peter Piot: There was only one major publication on the 1976 Ebola epidemic. That’s because we agreed to publish it as a team. We didn’t want individual papers and we didn’t fuss over who would be the first author. Right up until the 2014/2015 outbreak, we were only a very small group of researchers and we all knew each other. We could all fit into one room. That’s changed now and I think that’s a good thing.
RG: What lessons were learned from the most recent Ebola outbreak?
Piot: The 2014-2015 Ebola outbreak was a game-changing event – much like the AIDS epidemic was. No other recent health crisis gave rise to such a combination of humanitarian, political, and scientific activity. It created a momentum to put some order in the house, especially in terms of the World Health Organization (WHO), and international mechanisms for response, solidarity, and intervention. This is very positive news. But a glass can both be half full and half empty: we were very late in responding to the outbreak and many problems arose.
The ethics and practicalities of doing research in such an environment was very challenging. The first issue was none of these countries had ever done a clinical trial. Ever. We were also not ready with the protocols. A lot of time was wasted, for example, discussing whether trials should be placebo-controlled or not. Regulations were also extremely dogmatic, which resulted in reluctant R&D companies and a divided scientific community. Fortunately, ironically, we had candidate vaccines. This is not because of public health rationale, however, but because of the threat of bioterrorism.
RG: What about data-sharing and collaboration?
Piot: That’s something I thought was really bad. It’s clear that data and sample sharing was not great during the Ebola outbreak. There was radio silence after the initial publication of the virus’s genome sequence. It was quite a long time before there were any publications, and then there was clearly no sharing of data. That was a big issue.
Social science was also missing in the early stages of the Ebola outbreak. Marketing research, perceptions, and anthropology, for example, could have been done immediately because it doesn’t require the same lengthy protocols. It’s the practical side needed to reduce miscommunication and misunderstanding.
RG: Are these lessons applicable to the Zika virus?
Piot: The response to the Zika virus has been different. First of all, that’s in Latin America where the development of health services is much better, and the infection itself is very different. But I do think WHO learned a lesson and reacted better. They promptly declared it a public health emergency of international importance. There also appears to be more collaboration. The Pan American Health Organization convened in Washington this week (March 3, 2016) to develop a research agenda for information exchange. The Wellcome Trust has also called for information sharing and rapid publication. It’s open science on three sides: the funders, the scientists, and the publishers. Will this happen? I hope so. It really supposes a level of trust and recognition of everyone’s contributions. At the moment, our whole science enterprise is very competitive; a lot hinges on academic careers, grants, patents, and sometimes even the publishers want money. This all goes against what we need in the case of epidemics.
RG: What else drove this immediate scientific response to the Zika virus?
Piot: I think it’s because Zika raises many questions we don’t know the answer to. In the case of Ebola, we knew when it started, what the basic transmission modes were, and more-or-less what we needed to do for immediate action – we knew that since 1976. But it’s different with Zika. We know we’re dealing with mosquitoes and the infection is a mild dengue, or like a bad flu with a bit of a rash. But vector controlled science is not very well developed – even if malaria has been around for a long time – and it’s Zika’s probable complications, like microcephaly in babies, that make it so bad. We need to prove this neurological link. While it looks like that’s the case, it’s important to know without a doubt. Also, nearly every day there’s new information about the virus. Now you find it in breast milk, now there’s sexual transmission, and now it can lead to temporary paralysis and blood transfusion, for example.
RG: What do you suggest is the best way to maintain the quality of scientific output during a health crisis?
Piot: I’m all in favour of publishing quite early on, but the data has to be as raw as possible so the readers and reviewers can judge. Articles are built over time more and more often in physics, mathematics, and even economics. It’s out on some network, people comment, the next version is there, and so on. That’s not as prominent in the medical sciences, partly because of the financial interests and careers involved, and I think it should be. It’s needed – especially in the case of epidemics.
RG: What’s your advice to the scientific community going forward with Zika research?
Piot: Being an optimist, I thought our response to the recent Ebola epidemic was an improvement on previous outbreaks, but we could have done much, much better. This may sound a little bit idealistic but the way I see it, we owe it to the over 11,000 people who died from Ebola that we are better prepared for our next epidemic, and that we’re better equipped for research and development. I think in the case of Zika it’s particularly important that we have this very rapid exchange of information and that we remain optimistic.
Read the original ResearchGate article.
Images: Aedes aegypti mosquito; Credit: James Gathany/CDC