National Institutes of Health officials assured lawmakers on Thursday that U.S. health experts are following concerns of an Ebola outbreak in Africa closely and said a number of medical countermeasures have already been deployed in response.
"Obviously given our prior experience, we are on very high alert," said Anthony Fauci, M.D., head of the National Institute of Allergy and Infectious Diseases, in response to a question about how worried the U.S. should be about reports that Ebola had been found in an urban area of the Democratic Republic of Congo.
"There are factors that mitigate against their having the same situation as we saw in West Africa, but there are also some factors that might favor that," Fauci said while testifying in front of a Senate Appropriations subcommittee. The first cases of Ebola were reported in early May in a remote area of the DRC.
On the other hand, at least one case is now in a more populated area, he said: "Even though there is only one case there, there's a total now of 44 cases, even though only two have been confirmed. There are 20 that are probable and 20 that are suspicious. So there are probably many more cases."
He said U.S. health officials are working with the World Health Organization to ship countermeasures the agency worked on during the last Ebola outbreak a few years ago. He pointed to shipments of Merck's vaccine which the DRC requested to support efforts to curb new cases.
He also pointed to ZMapp, an experimental Ebola treatment with a triple combination of antibodies that was found safe and well-tolerated but never definitively shown to be a better treatment for Ebola. The NIH also has some experimental drugs, including monoclonal antibodies created by the vaccine research center and being developed in partnership with Gilead, Fauci said.
"We are on high alert. We are always concerned when there is Ebola. But we right now have a number of countermeasures that we were able to develop to go in and hopefully block that," he said. "Our expectations are always cautious. Our hopes are always that we will not have the kind of outbreak that we saw in West Africa."
Other infectious diseases
During the hearing, lawmakers also asked about the NIH’s broader efforts in addressing other infectious disease concerns, including the Zika virus and the seasonal flu.
Vaccines are in development for both diseases but still have plenty of steps before they become reality, officials said.
Fauci said a Zika vaccine is in the midst of a phase 2b clinical efficacy trial in several countries in South America, as well as in Mexico, the Caribbean, Texas and Florida. It is scheduled to have between 2,400 and 5,000 people enrolled in the trial by the end of the year. "Then, if in fact there is an outbreak, we could get an efficacy signal and if there is not, then we are working very closely with the FDA. If we can get enough immunogenicity data that mainly shows it does induce the response that you want and bridge that to the animal data that is very convincing that this vaccine can do what you want, we're working with FDA to figure out if, in fact, we can get an accelerated approval.”
Fauci indicated reaching the goal for a universal flu vaccine is further off and will come in iterations.
NIH and infectious disease experts from around the world developed a strategic plan and research agenda which was published in the Journal of Infectious Diseases in February. The agency is working to implement that plan, identifying and sponsoring candidates in the commercial sector such as Israel-based BiondVax Pharmaceuticals.
"The perfect, and that's going to be difficult to do, universal flu vaccine would be one that would cover all version of seasonal and any potential pandemic flu," Fauci said. "The end game is that you and I, but most likely our children, will be able to get a vaccine early on in life, a booster maybe every 10 years or so, and not have to worry about it each year. It's the guess that's the problem."