In August, European scientists were working round the clock at the prestigious Spallanzani National Institute for Infectious Diseases in Rome to set up a mobile laboratory soon to be deployed in Ebola-affected villages in West Africa.
This would be the second such lab emerging from the EuropeAid-funded Emlab project, which seeks to establish “three deployable mobile laboratory units for the detection and diagnosis of infectious pathogens up to the highest risk group 4.” The first lab was already set up in Guinea in March, and the third will be made available for training.
However, a number of details were still being worked out in Rome, the most important of which is whether the second mobile lab will be dispatched to Sierra Leone or Liberia, the other two countries affected by the Ebola outbreak that has been crippling West Africa and had caused over 1,000 deaths since March, as of late August.
“It has not been decided yet. It will depend on the evolution of the epidemic,” Giuseppe Ippolito, scientific director at the Spallanzani Institute, told Devex.
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Ippolito noted that “we are facing the widest epidemic of Ebola ever faced” as donors, aid agencies and public health workers are scrambling to contain the spread of the disease in increasingly harsh conditions.
“It has already been five months. We thought it could have lasted about one or one-and-a-half months, as in the past. We didn't imagine an epidemic of such a dimension,” he said.
The institute had already sent six epidemiologists and a virologist to Nigeria, while the Emlab consortium was recruiting more experts to manage the second laboratory and conduct field tests. The first challenge they would face in battling Ebola, Ippolito explained, was selecting “adequately experienced staff members” that are able to work in class-4 labs, which manage the highest-risk pathogens.
No economic incentives
And as well as HR needs, there is also an urgent call for more financial resources. As of August, Emlab was scheduled to end within 12 months and, despite achieving good results, would soon be looking for a new backer to invest additional funds into the program. This, the scientist admitted, was proving to be a big stumbling block.
“We have never been able to understand how to get additional funds … We need additional resources [so that] we can put people in better working conditions, with the right materials [and] multiply our efforts. If we had four labs, we could have used them in this situation. That's a criticism that I address to myself and to the other members of the coordination team: We haven't been able to capitalize on our [efforts],” Ippolito said.
However, he pointed out that the model of the mobile labs is not endlessly scalable.
“It is necessary to invest so that Western institutions that have experience with new pathogens are supported in research and interventions. Not just for activities in laboratory, but also [on the ground], for instance to measure the cases of infections that don’t seem very interesting now, but can [later] become very relevant,” he said.
For some viruses there is no data available in many countries, and Ippolito called for better systems to monitor the infections: “Until now, no one has thought Ebola could have spread in West Africa, but analyzing old samples we saw that there were already [cases].”
Overcoming the recruitment challenge
The Emlab project, which provides technologies and experts on testing and diagnostics in Africa, includes partners from Germany, Italy, France, the United Kingdom, Hungary, Switzerland and Slovenia and by late August had already conducted about 1,100 tests — of which more than 400 were positive.
The laboratories seek to identify and register infections so affected villages can be isolated, and thus limit the spread of the virus. Each lab is manned by six experts, who can remain on the ground for a maximum of 28 days at a time. They cannot work for a longer period “because dealing with such dangerous agents, believe me, it's not easy,” Ippolito said.
Moreover, specialists in this sector typically already work for European institutions, hospitals and research centers, and Emlab cannot offer them economic incentives. The Italian scientist explained that since EuropeAid funding covers only the labs, including materials and logistics, providing more benefits for personnel is a constraint. He stressed the need for the provision of per-diem expenses at a level similar to those given to World Health Organization staff.
“Our staff members receive $0.67 per month … that's the amount required by the WHO to get the insurance … That's nothing, it's less than one euro,” Ippolito said. Program personnel currently receive 50 euros ($66) per per day in daily expenses, giving approximately 30 euros to the NGOs that arrange food and lodging.
So is it possible to attract qualified experts without offering a larger pay packet? “Fortunately, personal commitment still exists … There are no resources for the staff and any expert goes there voluntarily, if they believe in it,” Ippolito said. “We select motivated people that are going to do a job and put their lives at risk for free.”
Before deployment, Emlab provides a month-long specialized training course, not only including technical training but also tough survival sessions in the German Black Forest, sleeping under plastic sheets, keeping warm while outdoors and learning to work as part of an international team.
Ippolito is well aware that the conditions encountered in the field are not suitable for everyone. “Not all the experts are necessarily able to pass the tests,” he said, describing a set of drills to test the capacity of teams to work under extreme pressure and control anxiety in specific situations that have so far proven to be “quite effective.”
28 days later — living with Ebola
In the labs, scientists carry out difficult, time-consuming work and every day brings a different challenge.
“The first [problem] is power. The second is the cold chain. In developing countries it is difficult to get power always at the same voltage,” Ippolito said. “[Our staff] had some days with nothing to eat and no water to wash themselves. Logistics is a problem, for sure.”
Governments routinely provide security to avoid damage being done to the labs — as well as to protect against the risk of contamination in case their contents are stolen. But significant safety concerns remain, as up to 30 health professionals had died as of late August, the majority of whom were locals.
“Local health professionals are more exposed and sometimes they do not access individual protective equipment, like masks, gloves, overalls, etc.,” said Ippolito. According to a note Ippolito received from Sierra Leone, China is providing a significant amount of protective gear, but the problem is ensuring a continuous supply. “Only if there is continuity will people use the equipment. If they have it for just 10 days in a month, they will never be used to it,” he said.
The deaths of local staff and their future protection is an aspect that “hasn't been stressed enough,” and Ippolito stressed the importance of training local staff members, with a third EU-funded laboratory devoted to this goal.
Despite progress in the area of staff safety, Ippolito remains very concerned about the future of training programs due to recent EU foreign aid budget cuts. There’s also the “brain drain” problem: Many African specialists that have been trained in international institutes will choose to not return to their country of origin.
Identification is just the first phase
After having identified and isolated the infected villages, the interventions are then essentially of an anthropological and social nature. For instance, it is necessary to convince people to stop conducting funerals involving the bodies of infected Ebola victims — a difficult task.
“People contaminate themselves cleaning the body. The second problem is to convince them not to visit infected people in the isolation wards. In African hospitals, everyone goes everywhere without any precautions,” Ippolito said.
As of late August the EU had disbursed 11.9 million euros ($15.79 million) to WHO, Médecins Sans Frontières and the Red Cross to fight the latest outbreak of the epidemic in West Africa. There are concerns, however, that the joint response — which also includes the United States, Canada and a number of international NGOs — could be weakened by a lack of coordination among the many organizations on the ground.
"[A first problem] is that is not very easy to coordinate staff with different backgrounds, coming from different countries. The second is that in those situations there is not a real chain of command and control. There is not always detailed [coordination],” Ippolito said.
Moreover, he added, even if actors do a great job, sometimes they do not have a sufficient quantity of adequately experienced personnel to face these kinds of epidemics. A swift exit is thus not an option.
Leaving Ebola-affected countries in the lurch would “mean losing everything done up to now. We need to give the help that is necessary to identify and isolate the villages where there are infected people … If we cannot do that, we won't be able to halt this epidemic,” he said.
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