Dr. Donald P. Francis
Talks to Teachers About the Ebola Outbreak
Dr. Donald Francis is currently doing research to develop a vaccine for HIV at Genentech, Inc. In February of 1992 he retired after 20 years in the U.S. Public Health Service. At the time of his retirement he was the Centers for Disease AIDS Advisor to the State of California and Special Consultant to Mayor Art Agnos in San Francisco. In the latter capacity he served as the Chair of the Mayor's HIV Task Force.
Dr. Francis is a Californian having done his undergraduate studies at the University of California at Berkeley. He received his M.D. from Northwestern University and his Doctor of Science from Harvard. Before beginning his work on AIDS, Dr. Francis was involved in epidemic control around the world. He was instrumental in eradicating smallpox from Sudan, India and Bangladesh. He was also on the front line of the cholera epidemic in Nigeria in the early 1970's and the Ebola epidemic in Sudan in 1976. Dr. Francis also did some of the early developmental work on the hepatitis B vaccine, both in the United States and in the People's Republic of China.
He began his work on AIDS in 1981. He was one of the first scientists to suggest that AIDS was caused by an infectious agent. As director of CDC's AIDS Laboratory Activities, he worked closely with the Institut Pasteur to prove that HIV was the cause of AIDS. He was also one of the earliest scientists to realize the impact HIV would have on the United States and has been an indefatigable advocate for a logical public response.
This transcript was taken from an online discussion sponsored by Access Excellence that occurred on America Online on May 15, 1995.
Q: Current reports of an outbreak of Ebola virus infection in Zaire highlight many of the scientific and political issues of emerging diseases. What does this situation tell us about how good our responses are and how might we improve them?
A: One, it teaches us to be ever-alert for outbreaks of exotic diseases. In all Ebola outbreaks, literally, months pass since the discovery of the first case before the outbreak is actually reported making the outbreak more difficult to control.
Q: Is this disease airborn or do you have to have human contact with someone?
A: You have to have very close human contact. It is essentially a disease of people who nurse sick patients.
Q: The World Health Organization (WHO) evidently does not support the imposition of quarantine in Kikwit. Was the quarantine an overreaction?
A: Yes. But typical of all of these outbreaks, quarantines have been imposed at great cost to the people and to the government. More effective use of resources would be to intensely follow all contacts of ill patients and ignore those more removed.
Q: This gets to the question of how to contain the panic that accompanies reports like this?
A: I think you have to differentiate between panic and appropriate concern. Both can be dealt with, with well-founded information to the people.
Q: What are the chances of the Ebola virus coming to the US?
A: Given the short incubation period, it is unlikely that an individual would come to the U.S. However, given the relative smallness of the world, every health care worker and hospital should treat any traveler from Zaire with fever with suspicion. If caution in hospitals (isolation) is instituted, transmission even if a case were introduced should be minimal.
Q: A recent US study outlines strategies for preventing and controlling emerging diseases in the US. The report made recommendations, but the CDC etc have received no added funding. Does this leave us in a vulnerable situation?
A: Yes. Clearly, importations like HIV and the potential of importation of Ebola should tell us something. That something is to be alert and have the people, laboratories, and resources capable of responding. Like police and the military historically public health has been considered a front-line responsibility of government. But with recent anti-government sentiment, that logic has been discarded at great social cost to our country and the world.
Q: Do scientists have any additional information as to why the Ebola Reston strain was not able to jump species - and do they know what made this particular strain genetically different from the Zaire and Marburg strain?
A: It is capable of jumping species (to humans) but does not apparently cause disease. The reasons for this are unknown. But such species variations are quite common with viruses. For example, HIV kills the vast majority of humans, yet when injected into chimpanzees seems to produce minimal disease.
Q: My students are terrified that this virus will enter the US. How confident are we that we have it contained?
A: From our previous experience with the other two outbreaks, rather simple isolation procedures stop the spread in hospitals and communities. So the same procedures should contain it this time. We will know from the case count as intensive surveillance for new cases has been instituted.
Q: Hospitals appear to be the link. Is this an example of a new niche?
Q: Absolutely. If the primary mode of transmission of this virus is from patient to caregiver, then the establishment of new, large hospitals in rural Africa add a new niche which previously was not there. Thus in years past, transmission of Ebola would be limited to household members instead of large numbers of healthcare workers. In that setting, these outbreaks probably would not be recognized and would spontaneously die out.
Q: Ebola has headlines now, but there are other emerging diseases of great concern, from AIDS and Machupo to Hantavirus and Dengue. What is the common element. Why does there seem to be an accleration in the emergence of previously dormant pathogens?
A: There are several reasons. One is the incursion of humans into new environments such as African jungles in large numbers. Two, is the establishment of new ecological niches such as hospitals, urbanization, or gay bath houses. Third, is our increasing power of laboratory science to diagnose and detect new infectious agents.
Q: Nothing quite compares to AIDS in terms of the scale of the epidemic and social disruption it causes.You have been a vocal commentator on the response of governments to the AIDS epidemic. What is lacking in the government response, what should be happening that is not And what does this tell us about potential reaction to future outbreaks of new diseases?
A: First of all, I must say, I hope I have been more than just a commentator. What has been lacking is science-based logic. We have been dulled by the fact that the incubation period of HIV is ten years instead of ten days as with Ebola. In a public health sense, that long, infectious incubation period is a greater danger than the short incubation period of something like Ebola.
The course of our country and the world was set by the inappropriate behavior of the Reagan administration, which lost total sight of what the government's response to such a dangerous importation should have been. Now with the continuing anti-government sentiment and inability to corral both logic and resources togethe the chaos continues. Ultimately, we are going to have to treat every infection of HIV with the same concern that we do for Ebola. Once that happens, we should be able to control the epidemic.
Q: What is the current status of AIDS vax trials, and what are the present obstacles, scientific and political?
A: The U.S. government has decided to postpone efficacy trials of the current two candidate vaccines That decision has all but stopped worldwide HIV vaccine development. Until we know whether the current vaccines do indeed protect humans from HIV infections, future design improvements will have little basis in fact.
Q: Don.. imagine you're in a biology classroom right now... what one point would you want to get across to the students?
A: I would stress the big picture of the biological body and put less emphasis on all the minutia. In all my schooling, it seems as though the stress was always placed on memorizing the little cycles, pathways, and enzymes. And the integrated picture was seldom painted. Without that picture, the excitement is lost and the spirit drowns.
Q: A couple of questions about an Ebola vaccine.
Can an immune system treatment-such as an antibody by effective on an virus that acts so quickly - even if one could be found?
Q: Have there been any attempts to do this?
A: I don't know. If there were, they must be extremely small efforts.
Q: Can a scientist look at the genome of a virus and pinpoint a possible mutation that would convert the virus to an airborne spread virus that was previously spread only by direct contact with body fluids?
A: No. Only if we had evidence of airborne spread and then look back at the genomic differences between the airborne and non-airborne subspecies.
Q: Originally with AIDS there was confusion and fear about routes of transmission. Now there is some confusion about the routes of transmission of Ebola, could you clarify?
A: I think the routes of transmission of HIV were quite clear by 1982. Similarly, even with a few outbreaks of Ebola, we have a good idea of its transmission, except for a few unusual situations, the transmission routes of these bugs are not a mystery. Unfortunately, much of the press hype and discussion centers around the few exceptions instead of the rule.
Q: From what I understand, the Marburg was a different type of Ebola virus, not as lethal, in that effect because they found a vaccine that worked against it. What is the difference between the Ebola Zaire and the Marburg. Why won't the vaccine work?
A: I know of no vaccine for Marburg. The mortality was slightly less of this sister virus. But in the big picture, they are almost identical.
Q: Finally, for future virus hunters, what kind of studies and training would you advise?
A: First of all, is epidemiology. Understanding the basic tools of epidemiology will be useful for any study of any new disease occurrence in humans. Second, for virologic diseases specifically, a strong background in clinical and laboratory virology is useful. As a foundation for all of this, a solid background in biology is essential.
More information about the Ebola virus can be found
Science Update: Ebola Infection
Dr. Frederick A. Murphy Talks about the Ebola Virus
Science Seminars Archive