The Hail Mary

When I was an undergraduate my alma mater’s football team’s biggest yard-gaining play was the quick kick. You read that right. It’s a play of desperation, one that’s rarely seen in modern football. Another play of desperation is the “Hail Mary pass”, a long forward pass with little likelihood of successful execution.

That’s pretty much analogous to what Scott Gottlieb and Tevi Troy propose as our response to the Ebola epidemic in West Africa:

Mr. Obama has stated repeatedly that the U.S. has helped to snuff out every other outbreak of Ebola and that the country will do the same with this one. However, past outbreaks occurred almost exclusively in remote villages, and entire locales would be cordoned off while the virus burned itself out. Liberia, a country of 4.4 million people, can’t be encircled. Nor can Dallas be quarantined.

Instead, medical countermeasures are critical. Despite early swagger by public-health officials at the National Institutes of Health and CDC that this crisis will be solved with public-health tools alone, and that a vaccine or treatment won’t be available in time, smart medical experts are recognizing the need for a therapeutic drug or vaccine.

One leading plan is for a 30,000-person clinical trial to begin as early as December with two experimental vaccines. Two groups of 10,000 West Africans will each receive one of the two novel vaccines. A third group of 10,000 West Africans will serve as a control group and receive a hepatitis B vaccine. The plan is dependent on completing early-stage trials under way now and having vaccine supply on schedule.

While a vaccine is needed to help stop the epidemic in West Africa, it is equally important to develop a drug to treat the disease in those who have been infected. This is especially so for the U.S., where a drug or drugs can combat containable outbreaks.

The problem with this strategy is that it ignores downside risk. It could take two years or twenty years to develop an effective vaccine. Or it may prove impossible to develop one. We just don’t know. Meanwhile, the number of cases in West Africa will continue to grow, people will continue to die, and, in all likelihood, the probability that Ebola will become endemic in West Africa or even in sub-Saharan Africa more generally will grow.

The only way we can avoid the worst case scenarios of the Ebola epidemic is by serious attention now, not merely from the United States but from the entire developed world. There’s a lot riding on it.

13 comments… add one
  • CStanley Link

    I don’t really understand your criticism. Advocating for acceleration of testing for vaccines and treatments isn’t desperation, it’s just part of the process of confronting this problem.

  • Perhaps I’m misinterpreting what they’re saying but I read it as suggesting that they think we should throw in the towel on fighting a frontline battle against Ebola in West Africa in favor of developing a vaccine.

    I have no opposition to developing a vaccine but I think the downside risk is sufficient that the epidemic in West Africa needs to be confronted.

  • CStanley Link

    Well it really isn’t an either/or, and I didn’t get the impression they were suggesting that it was. My take on it is that doing just one without the other would be doomed- we can’t wait until a vaccine is ready, but we also can’t delay on getting the vaccine ready. The frontline approach alone will not be sufficient and will quickly burn through the available resources, so we have to also hope that we can get a vaccine ready and work doggedly toward it.

  • Teams with athletic WBs should quick kick more often. It’s not like it’s the drop kick. Do it every now and then on third & long at midfield to keep the defenses guessing.

  • I see nothing in the op-ed that suggests that they view it as an “and/both” situation. Here’s what they write:

    Mr. Obama has stated repeatedly that the U.S. has helped to snuff out every other outbreak of Ebola and that the country will do the same with this one. However, past outbreaks occurred almost exclusively in remote villages, and entire locales would be cordoned off while the virus burned itself out. Liberia, a country of 4.4 million people, can’t be encircled. Nor can Dallas be quarantined.

    In other words, the epidemic in West Africa can’t be addressed so the only hope is a vaccine. Otherwise, what does that “however” mean?

  • steve Link

    Behind a paywall that I can’t get behind at work. I don’t see why it needs to either/or. We know how to stop the disease, but cultural practices there make it difficult. We are certainly having trouble finding enough resources. Doesnt mean we don’t work towards it. A vaccine would be a lot easier, but we don’t know if that is possible yet.

    Steve

  • CStanley Link

    I took that to mean that this time the epidemic won’t be amenable to control with quarantine. We need the additional factor of an effective vaccine.

    In essence, instead of these authors arguing for an “either”approach, I think they’re actually arguing against that and saying this is a situation that will require a two pronged approach. I admit they didn’t explicitly endorse continued efforts to beef up the response, but i assumed they were arguing against those who are ONLY looking to do that. It just seems nonsensical to argue that we should ditch the current efforts and wait for a vaccine, so perhaps I’m just assuming that they aren’t being idiotic.

  • I don’t interpret it that way. I think they’re writing West Africa off and focusing their attentions on the U. S.

    Let me put it another way. What we’re doing now is tentative moves in West Africa combined with looking for vaccines and/or treatments. That’s the status quo. It’s the Administration’s present position. I find it hard to interpret that op-ed as that they’re supporting the Administration’s position.

  • CStanley Link

    You can criticize policy I different ways- either arguing that it is the wrong approach, or that the things being done are necessary but insufficient on their own. I read this piece as the latter,and while I could be wrong, I googled one of the authors and came up with this clip (if link works):
    http://www.aei.org/media/health/global-health/did-the-government-drop-the-ball-on-ebola-gottlieb-on-fox-business-networks-willis-report/#.VEVVuEBog-Y.mailto

    His answers to questions there seem supportive of my interpretation because he is specifically discussing the policy to deal with the epidemic in Africa.

    The point, as I see it, is that quarantine can only be done effectively when there are smaller numbers of cases and geographic locations but drugs and vaccines are necessary additions in epidemics of this scale. In effect, vaccination induced “herd health” acts as more effective quarantine.

  • CStanley Link

    Actually this is even better in confirming my interpretation- here, Gottleib endorsed the current military project and public health efforts in Africa but said they won’t be able reverse the course of the epidemic without also adding pharmaceuticals.

    http://www.c-span.org/video/?321227-4/washington-journal-dr-scott-gottlieb-ebola-outbreak-west-africa

  • Vaccine research, indeed, medical research generally are what’re referred to as “valence issues”. Baseball, apple pie, etc. Nobody’s against it. The parties compete only in who supports it more.

    If they’re arguing that we need to do research on a vaccine, the WSJ has wasted valuable column space. Nobody disagrees. If they’re arguing that providing support in West Africa is a waste of time, that’s the way I interpreted it. If they’re arguing that providing support in West Africa is necessary to buy time, they could have articulated it better, espeically if you need to research their complete oeuvres to come to that conclusion.

  • CStanley Link

    I see it as part of the competition to see who supports it more. He’s positioning himself as more in favor of it than the administration is, since they haven’t been ahead of the curve and haven’t talked about it much at all.

  • Guarneri Link

    I’m late to this party but was saying to myself as I went through comments what Dave said at 2:37………who could argue with a two pronged approach. Tell me something I don’t know.

    I still find myself flummoxed by the line that we know how to manage this and if we do the right things…… Well yeah, I’m sure we do. You know what else? If Phil Michelson shoots 65-65-65-65 in next years Masters he’ll win. Suppose we should tell him? Suppose he can do it?

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