Higher education and West Africa’s Ebola outbreak
The global nature of health challenges such as Ebola, and the internationalisation of higher education, means that the sector plays a role in most major global developments.
Last week saw the announcement of experimental therapies and vaccines developed by world-leading universities and major pharmaceutical companies, supported by research councils and funding from foundations and governments.
The Ebola situation
The outbreak of Ebola viral disease in West Africa was first reported in March this year in Guinea. It spread in four countries – Guinea, Liberia, Sierra Leone and Nigeria – with a first case reported in Senegal last week and a different virus appearing in the Democratic Republic of Congo, laboratory-confirmed on 26 August.
Senegal reported its first case late last week, involving a 21-year-old student from Guinea.
Last Friday the number of Ebola cases had reportedly risen to 3,069 with 1,552 deaths, and the outbreak continued to accelerate with more than 40% of cases having occurred within the past three weeks – although most were concentrated in a few localities. World Health Organization – WHO – reporting on Ebola virus disease can be accessed here.
The death rate from the disease is 52% but ranges from 42% in Sierra Leone to 66% in Guinea. People infected with the Ebola virus are thought to be contagious only when they are sick, and after death, and the virus is transmitted only through contact with bodily fluids.
WHO analysis has shown that 62% of reported cases are still concentrated in the epicentre of the outbreak in Guinea, Liberia and Sierra Leone and cases continue to rise. Major cities are a problem because of population density and repercussions for travel and trade.
The epidemic is anticipated to claim more lives than all previous Ebola outbreaks combined. WHO declared it a global health emergency and predicted that it could eventually infect 20,000 people.
West African students abroad
In the case of Nigeria, all cases of Ebola have been linked to one imported case and there has not been wider transmission – a factor of some relief to universities in destination countries since there are tens of thousands of Nigerian students abroad.
The UNESCO Institute for Statistics’ “Global Flow of Tertiary-Level Students” map reports nearly 50,000 Nigerians studying abroad, with 17,550 in the United Kingdom, 6,113 in neighbouring Ghana, 4,795 in Malaysia, 2,575 in South Africa and 2,031 in Canada, and approaching 1,000 Nigerian students each in Finland, Saudi Arabia, the UAE and Russia.
Newer figures show that in 2013 there were more than 7,300 Nigerian students in the United States, according to the Open Doors report of the Institute of International Education, as well as 79 from Guinea, 172 from Liberia and 123 from Sierra Leone.
UNESCO puts the total number of international students from Guinea at just over 6,000, with the majority – nearly 4,000 – in France and just over 500 in Morocco followed by Saudi Arabia, Canada, Spain and Malaysia.
There are more than 800 students from Sierra Leone abroad – mostly in Saudi Arabia, the United Kingdom and America – and just under 700 Liberian students overseas, primarily in Ghana and the United States, according to UNESCO.
With several international airlines cancelling flights in and out of affected West African countries, it is possible that international students will find it increasingly difficult to reach their destination countries for study – or return home.
In response to local concerns about international students from West Africa spreading Ebola on campuses, universities in popular West African student destination countries have been disseminating information about how the disease is spread and what health authorities and universities are doing in response to Ebola.
Most universities receiving West African students appear to be monitoring their health in a quite hands-off way – asking students to take their temperature regularly – as well as following health guidelines and keeping abreast of outbreak developments.
The spread of Ebola on campuses is being considered a low threat.
Newspapers in the US, Canada and the UK were reporting students – armed with information universities and the media were giving them – to be generally relaxed about West African students on campus.
But many universities have suspended study abroad programmes in West Africa, are discouraging students from travelling in countries where the outbreak has occurred and are also monitoring students who may have travelled in West Africa recently.
In Britain, the government produced an Ebola advice and risk assessment for tertiary institutions last Friday.
It describes the risk of Ebola arriving in the United Kingdom as “very low”. Affected countries have introduced exit screening at airports to ensure that people who are ill do not board flights, in line with WHO guidance and as part of efforts to reduce the risk of international spread of disease.
“However, as the time between contact with an infected person and symptoms first appearing can range from two to 21 days, it is possible that students returning from affected countries could develop symptoms up to three weeks after arrival,” said the UK guidance.
Public Health England produced an algorithm – a short series of questions leading to actions – to inform the assessment of unwell students.
In the United States, there were reports that West African students might need to undergo health checks on arriving in the country.
The US Centers for Disease Control and Prevention did not issue recommendations for colleges and universities, but some states provided information on symptoms and many universities instituted health screening and developed plans to deal with Ebola cases if they occurred.
In Ghana, with its thousands of international students from across West Africa, universities are submitting Ebola-preparedness plans to the Ministry of Education, as are university hospitals.
Affected medics and scientists
The WHO and partners are in West Africa establishing Ebola treatment centres and building capacity for laboratory testing, contact tracing, social mobilisation and safe burials. They are being assisted by numerous West African and international doctors and researchers.
WHO said that as of 25 August, at least 240 health workers had been infected in the outbreak and more than 120 had died.
One was a Senegalese epidemiologist who worked with WHO in Sierra Leone, and arrived last Wednesday in Germany for treatment. The epidemiologist was a surveillance officer, not involved in the direct treatment of patients, WHO spokeswoman in West Africa Christy Feig told the Canadian Broadcasting Corporation, CBC News.
Feig said WHO was checking to make sure there was not an infection risk in the living and working environment that had not been uncovered.
“The international surge of health workers is extremely important and if something happens, if health workers get infected and it scares off other international health workers from coming, we will be in dire straits,” she told CBC News.
Last week the US Centers for Disease Control and Prevention said two staff members had been removed from Kailahun in Sierra Leone after one had low-risk contact with a person infected by the Ebola virus.
Also last week it was announced that a third medic, Dr Sahr Rogers, had died in Sierra Leone. He had been working in a hospital in Kenema in the east, in a country that has only two doctors per 100,000 people. By comparison, reported CBC, Canada had 2.5 doctors per 1,000 people.
Canada said it was to bring home three scientists from Sierra Leone, who had been working to identify people infected with Ebola, as a precautionary measure.
Several Westerners infected with Ebola who were sent home for treatment – including two Americans and a British nurse – have survived, with research assisting in the development of effective treatments which are now being disseminated to health workers in West Africa.
As the Ebola outbreak unfolded, universities and drug companies raced ahead with studying the disease, and developing experimental therapies and vaccines.
Last Friday Bloomberg reported that France’s state health institute Inserm was talking to the Guinea authorities about first clinical trials of experimental Ebola therapies.
Jean-Francois Delfraissy, director of Inserm’s Institute of Microbiology and Infectious Diseases, said there were two trials being considered, each involving some 15 patients to test compounds from Fujifilm Holdings Corp and Tekmira Pharmaceuticals Corp.
The Boston Business Journal reported that researchers from the Broad Institute and Harvard University had published research on 99 Ebola virus genomes, identifying mutations relevant for diagnostics and treatment, online in the journal Science.
The research “details the sequencing of 99 Ebola virus strains collected from 78 patients diagnosed with the disease in Sierra Leone during the first 24 days of the initial outbreak”, said the publication.
The Broad Institute team’s testing of samples of the disease shipped from Africa, found more than 300 genetic changes, which they said made the 2014 virus distinct from previous Ebola outbreaks.
The Boston Business Journal reported co-author of the research Pardis Sabeti, a senior associate member at the Broad Institute and an associate professor at Harvard University, as saying there were significant implications for diagnosis and vaccines.
“Based on what the virus is that we’re looking at, based on the analysis we’ve done, the virus has a number of mutations that have happened over a short period of time.” Understanding the virus was critical for the efficacy of diagnostics.
There are vaccine trials under way in the United States for another strain of Ebola.
Last Thursday The Telegraph revealed that an experimental Ebola vaccine was to be tested on British volunteers “in fast-tracked emergency clinical trials to begin in September”.
“The vaccine will use a single Ebola protein and will not infect the subjects with live Ebola virus.” Meanwhile, 10,000 doses would be produced so that the vaccine could be widely used if the trials were successful.
“The vaccine being developed by GlaxoSmithKline and the US National Institutes of Health is being fast-tracked with a £2.8 million [US$4.6 million] grant from the Wellcome Trust, the Medical Research Council and the UK Department for International Development.”
Initially, according to The Telegraph, 60 volunteers would be injected with the vaccine at the Jenner Institute at Oxford University “and if they show a good immune response with few side effects then a further 40 volunteers will be given the vaccine in Gambia”, followed by a similar test in Mali, both under Medical Research Council – MRC – units there.
Professor Umberto D'Alessandro, director of the MRC Unit in Gambia, said the proposed trial would not “benefit immediately those currently at risk but we hope that in a not too distant future we may be able to protect people against Ebola”.