Priorities for Ebola virus disease response in west Africa

In their Viewpoint, Annette Rid and Ezekiel Emanuel urge to “focus on strengthening of health systems and basic infra structure, rather than experimental treatments and vaccines”. Although we agree that dysfunctional health systems have contributed to the continuing amplifi cation of Ebola virus disease in west Africa, we disagree that resources to address these gaps should be prioritised in the midst of an outbreak. Instead, efforts to improve patient outcomes should be the highest priority, and should target both optimisation of supportive care of patients and assess ment of the added benefi t of promising investigational therapeutics. As clinicians working in Ebola virus disease outbreaks in Guinea, Sierra Leone, and the Democratic Republic of Congo, we saw how the absence of health personnel to provide supportive treatment resulted in suboptimum clinical care and the devastating loss of human lives. If the tools, expertise, and human power to improve supportive clinical care were made available by governmental and non-governmental relief agencies, however, these poor outcomes would undoubtedly change. Moreover, although the minimum experience we have with therapeutics like Z-Mapp provides reason for optimism, small-scale, methodologically sound studies in west Africa are crucial for determination of the incremental benefit of such therapeutics above optimised supportive care. We think that currently implementable solutions, such as convalescent plasma transfusions from survivors, should be reinvestigated. Provision of optimised Ebola virus disease treatment is essential to obtain the confidence and collab oration of the affected communities, which are necessary to control this epidemic. We think that the focus now should be on interventions that show positive eff ects, after which, the health system can be salvaged.