Sr. Scientist, EID & BSS, Metabiota Inc.
Jean-Paul Joseph Gonzalez MD, PhD graduated from the Medical School of Bordeaux Univeristy, France, in 1974. After completing his internship in Amazonian French Guiana, he spent his career as medical researcher, working for the French government through its major research institutions, including the Pasteur Institute, the Institute of Research for the Development, and others. He received his Ph.D. in viral ecology in 1984 from the University of Clermont-Ferrand, France. He has dedicated his career to research, training and expertise for developing countries across the Americas, Africa and Asia. His main fields of research are viral disease epidemiology and virus ecology including arbovirology, viral hemorrhagic fevers, the fundamentals and domains of disease emergence. He has led field and laboratory teams of researchers, from the Pasteur Institute International Network and, universities and institutes of country partners, including Brazil, Central African Republic, Gabon, Senegal, Thailand, Laos, among others. He has also worked at the Centers for Disease Control and Prevention in Atlanta, and as a visiting professor at the Yale University Arbovirus Research Unit, has been involved in high security laboratory practices and research, and with the early development of geographical information systems applied to health. He and his teams have identified new pathogens for humans and animals, vectors and hosts of diseases, and have developed tools and strategies for the control and prevention of highly infectious transmitted disease. He has revisited the spread and dynamics of several viral hemorrhagic fevers, giving spatial and temporal dimensions towards a more dynamic epidemiological understanding. He has developed several scientific concepts and research strategies for health (e.g.: long lasting co-evolution of germs and hosts on the scale of geological times). In 2008, he joined Metabiota, Inc. as a consultant, and was retained as Senior Staff Consultant, perpetuating his expertise on emerging viral disease, biosafety, biosecurity and biosurveillance, mentoring and training young scientists from developing countries. He has published more than 300 scientific papers, chapters and books.
14:30-16:00 6 NOVEMBER
thematic SESSION Ii.A: FIT FOR PURPOSE GLOBAL HEALTH POLICIES
“Be prepare for the bad weather, be ready for the storm, stay alert and move on.”
From the Ebola River to the Ebola Virus Disease Pandemic: What Have We Learned?
In March 2014, when the first case of Ebola fever surfaced, of what would become an enormous, unprecedented epidemic of Ebola Virus Disease (EVD) in West Africa, twenty-three outbreak and emerging events of Ebola fever had taken place previously in Sub-Saharan Africa. All these occurrences had been recorded by the international medical community, and most of them had been well documented and described, including details about epidemic pattern, emergence and spread, evolution and disappearance.
Moreover, for the last 38 years, a tremendous effort has been made by the scientific community, including medical sciences, molecular biology, and social sciences in order to understand the emergence and spread of the virus, the pathogenesis in human and animals, the natural cycle of the pathogen. Several attempts at developing a vaccine have taken place and some were ready to use a few years ago, though only for non-human primates.
Altogether, it took more than twenty years to unveil a portion of the natural history of the Ebola virus and identify potential species as the natural reservoir; however, there are still some questions about the role of the reservoir and other natural hosts with respect to the fundamentals and geography of virus emergence.
Nevertheless, the major and most important characteristics of the disease have been well understood for some time, including the human-to-human transmission as the first factor for scaling up a limited epidemic to a large outbreak. The second major factor identified was understanding the mobility that connects any index case to a naïve neighboring or distant population, which ultimately leads to the importance of finding multiple contacts of potentially infected persons at a critical subclinical stage of EVD incubation period.
So, what has happened in West Africa in the past year? At first, the experts did not foresee a rapid and wide dissemination of the disease in West Africa, as all previous EVD outbreaks have occurred in Central Africa. As is the habitual nature, limited and late first international responses on the ground (typically arriving a few months after a supposed index case) began timidly. Also, as usual, strategies involving multiple actors becoming engaged in an international response were discouraged. Local health authorities, at the onset, believed that they could handle a response, supported by their historical partners. Ultimately, WHO and other international responders had to circumvent heavy administrative workloads before any critical engagement. And the epidemic continued to evolve ….
Most of the previous Ebola fever epidemics occurred in rural areas with very low population densities, extremely limited transportation means, distant public health facilities, and ultimately, remote and isolated populations. However, for the West African EVD outbreak, the situation was slightly but importantly different: even though the supposed emergence (i.e., index case) occurred in a rural area, people were accustomed to moving locally and between neighboring regions; transportation (i.e., motorbikes and cars) was much more abundant/available than ever; local homogenous ethnic groups had been interacting and communicating for centuries despite spanning three country borders; and cell phones were available to contact the local traditional healer, overcoming limited or nonexistent health system access. Ultimately, when large metropolitan areas were affected for the first time in EVD outbreak history, inventing new strategies became necessary to counter the spread of the disease, hindering the de facto response.
From these elementary observations, it is clear that community counseling, education, and social mobilization are the main activities that need to be intensively developed, including in-depth knowledge of local population history and traditional culture. To be sustainable, any potential actions in future outbreaks will requires emergency funding immediately accessible.
Epidemics demonstrate patterns similar to any natural catastrophes, definitely large epidemics can be insured despite the diversity and uniqueness of the events by creating financial mechanisms to facilitate the movement of critical resources within affected countries. Early responder teams need to be identified in-country at the national and district levels.
International response needs to be organized in total synergy and transparence with local health authorities. As an interim action, constant capacity-building needs to be developed among all public health sectors, from laboratory development, to clinics and epidemiology. Perhaps, after this 24th Ebola outbreak, we will be prepared for future epidemic challenges in a shrinking global community.