The Ebola scare: Noguchi Memorial Institute for Medical Research up to the task

We are writing in response to an Opinion piece by one Josephus Akabontoak published in the Wednesday, August 20, 2014 issue of the Daily Graphic on the above heading. The article is not only a sad example of the kind of scaremongering which is stoking hysteria rather than helping build public knowledge about Ebola but also full of untruths and libelous statements about the Noguchi Memorial Institute for Medical Research (NMIMR).

The author poses a number of questions, mainly about NMIMR and proceeds  to answer them with  a  mixture  of  untruths  and  speculation,  thereby  impugning  the  institute’s scientific  and ethical  integrity.  

Contrary  to  the  most  elementary  standards  of  sound  journalism,  the  author made no attempt to get answers to his questions from the NMIMR before making his speculative and libelous assertions.

The writer, without any proof whatsoever, insinuates that we may be conniving “with the politicians to sing the tune of the government by falsifying test results when the disease is staring them in the face”. 

The Noguchi Memorial Institute for Medical Research was established in 1979 as a gift from the Japanese Government in memory of Dr Hideyo Noguchi, who succumbed to Yellow Fever in Ghana while researching the origins  of  the  disease in  1928.     From its  inception,  the  institute  has maintained the highest quality and ethical standards in the conduct of research.  

The institute is a semi-­autonomous  research  institute  of the University  of Ghana  and not under  the Ministry  of Health as the author claims.   

We have a clear mandate, part of which includes lending support to the Ministry of Health /Ghana Health Service in the control of diseases, especially in the area of laboratory support for outbreak investigations. This we have done over the years not only for the country but also for the sub-region as a whole.  

Institute ability

The writer questions the institute’s ability in terms of equipment and personnel to undertake the testing  for  the Ebola  virus.   

NMIMR  hosts  several centres involved  in  the  control  of  infectious diseases  both  for the country  and the sub-region  in the world-wide  scheme  of international reference centres.   

All these laboratories and the others are recognised internationally for what they do and have been leaders in the training of other laboratory personnel from the continent.  

Specifically on the issue of testing for the Ebola virus, this is being done with the latest equipment found in any high-end laboratory and with the strict containment that the handling of the Ebola virus requires.  

Indeed, research on highly infectious agents, as well as organisms of unknown pathogenicity like Ebola, requires stringent biosafety guidelines, including BSL3 laboratory (or P3), which is a  medium containment  facility that enables isolation and manipulation  of pathogens.    NMIMR boasts one of the best P3 facilities in the sub-­region.  Since the Ebola scare surfaced, we have had  visits  from  well-meaning  and  concerned   international   partners  such  as  the  Japanese International  Co-operation  Assistance  (JICA)  and  Japanese  Embassy  in  Accra  to  inform  their assistance to the institute on Ebola testing.   

The Canadian Institute of Public Health has also visited the institute to see our facilities, and was very pleased with what we have in place for carrying out tests on the Ebola  virus.  Indeed,   on   Monday,  August 18,   the   World   Health   Organisation   (WHO) approached the institute to help in hosting a training workshop for 16 African countries using the testing protocols that we employ in the institute. 

Human capacity

 In terms  of human  capacity,  NMIMR  has more  than  30 persons  with PhDs,  several  individuals with  Masters  and  Bachelors   degrees  in  the  Biological   Sciences,  Social  Sciences  and  other disciplines,   high-calibre   technicians   and   other   supporting   staff.  

Several   of   us   serve   on international advisory panels, including WHO, Foundation for National Institutes of Health (FNIH), international study panels etc. For example, a member of staff is the chair of the WHO committee on  Global  Polio  Eradication,  other  members  serve  on  the  WHO  Strategic  Advisory 

Group  of Experts (SAGE) Working Groups in their areas of expertise.  

Indeed, in the current Ebola outbreak, one staff member is serving as a scientist at the WHO Sub-Regional Ebola Outbreak Coordinating Centre  based  in  Conakry,  Guinea.  We  have  our  own  internal  quality  unit  which  ensures  that internal quality procedures are followed in all the departments. 

Besides the internal quality management, we subscribe to external quality assurance schemes which enable us to assess how our procedures and results compare to those of other institutions in the world.

The Ebola outbreak is scary, given the high case fatality rate in a relatively short period of time. However, it is especially in times such as these that we need cool heads instead of baseless scaremongering.  

Be it as it may, the Ebola virus disease (EVD) is a rare disease, especially in our part of the world, with all sorts of infections; it will not be the commonest cause of fevers.  

This, therefore, calls  for  careful  assessment  of all cases  that  come  to  our  health  facilities  for  the  usual  and common causes before we jump on the bandwagon of EVD diagnosis.   

Although rare, the infectious symptomatic phase is very clear and quite specific.  From what is known so far, the disease is not transmitted by the airborne route like the common cold. Therefore, strict adherence to infection control practices in our health facilities, to a large extent, will protect health workers before we get  a  full-blown  case  when  we  may  need  the  full  bodysuits  or  the  personal protective equipment (PPEs).   

Factual educational messages

 The  educational messages we need should be based on the facts of what is known and not on speculations which only feed the public with fear and panic.

What is known is clearly borne out  the situation in neighbouring Nigeria.  All the cases identified so far have been  persons  who  in  one  way  or  the  other,  came  into  direct  contact  with  the  patient  who collapsed on arrival and needed help.   

None of the passengers on the aircraft have so far come down with the disease.  Indeed, in an earlier outbreak in the 90s in Kitwik in, the Democratic Republic of Congo, secondary cases were seen among those who had direct contact with primary cases– caring for sick individuals or involved in funeral preparations, activities that exposed individuals to body fluids of infected  persons  but not among those who ate with individuals  who did not have symptoms.

The writer of the said article and the editor(s) by the publication have shown their clear lack of understanding of what testing is all about by the assertion that although a clinician in Kasoa had shown two individuals with symptoms suggestive of EVD, the test results reported by NMIMR were negative.  If the diagnosis could be easily made by observations or clinical assessments then there would be no need to test in the first place.  It is simply because the set of clinical symptoms could be indicative of another disease that samples are taken to the laboratory for testing.  

Besides what has to be done with the results is not a simple yes or no issue.  It depends on several factors, including the laboratory results, a discussion of which may go beyond the remit of this article.

To the specific  questions  raised  by the author; a) the Noguchi  Memorial  Institute  for Medical Research is not in a position to know what else the persons who tested negative were suffering from as we are not privy to their medical history and physical examination. 

This is clearly for the attending physician(s) to decide, given the results of our tests.  One thing to keep in mind is that patient’s  confidentiality  still needs to be respected  and it is not for anyone to broadcast  what afflicts  patients  seeking  care  in  our  facilities.    b)  similarly,  the  Ministry  of  Health  cannot  tell anybody what has happened to patients who sought help at the health facilities. 

By all means let us strengthen our screening for diseases at our entry points but this should be done with a clear purpose and not based on unfounded and baseless suppositions!  Emphatic.

So is NMIMR up to the task?   An emphatic  yes! The Noguchi Memorial Institute for Medical Research   is up to the task of testing for the Ebola  virus  in  suspected  samples.   

Our work is  recognised  by   international bodies such as the World Health Organisation (WHO) and other health-related institutions of international repute.  

Indeed, we are being called upon to support the testing of samples from other countries in the sub-region, as well as lead the efforts in laboratory training for other countries as we have done for such programmes as polio eradication and rota virus diarrhoea, etc.

The writer is the director of the NMIMR