First Volunteers for the Forgotten Ebola

Se llama ChAdOx.

It's called ChAdOx.

Es una plataforma de adenovirus, que básicamente usa un virus modificado para enseñar al sistema inmunológico cómo combatir el ébola.

It's an adenovirus platform, which basically uses a modified virus to teach the immune system how to fight Ebola.

Which is a meaningful detail, because Oxford proved with COVID that the ChAdOx platform can be scaled up fast and manufactured cheaply.

That's specifically why it matters for diseases in lower-income countries.

If this works, it might actually reach the people who need it.

Exacto.

Exactly.

Pero hay que ser honestos sobre lo que significa este ensayo.

But we have to be honest about what this trial means.

Es un ensayo de fase uno.

It's a phase one trial.

Eso quiere decir que el objetivo principal es comprobar que la vacuna es segura en humanos y que no causa problemas graves.

That means the main objective is to verify that the vaccine is safe in humans and doesn't cause serious problems.

No es el paso final.

It's not the final step.

Es el primero.

It's the first one.

Walk me through the stages, because I think most people, myself included before I looked this up, conflate a trial with an approval.

They're very different things.

Claro.

Of course.

Después de los estudios en laboratorio y en animales, hay tres fases en humanos.

After laboratory and animal studies, there are three phases in humans.

La fase uno prueba la seguridad con un grupo pequeño, quizás veinte o cuarenta personas.

Phase one tests safety with a small group, perhaps twenty or forty people.

La fase dos prueba si funciona y cuál es la dosis correcta, con más voluntarios.

Phase two tests whether it works and what the correct dose is, with more volunteers.

La fase tres compara la vacuna con miles de personas en condiciones reales.

Phase three compares the vaccine with thousands of people in real conditions.

Todo el proceso puede durar cinco o diez años.

The whole process can take five or ten years.

Five to ten years.

And we're in the middle of an active Ebola outbreak right now in the DRC.

Those timelines don't line up.

No, no coinciden.

No, they don't.

Y eso nos lleva a la otra noticia de hoy.

And that brings us to the other news today.

Los Estados Unidos anunciaron que van a prohibir la entrada de ciudadanos del Congo en vuelos comerciales.

The United States announced it will ban entry of Congolese citizens on commercial flights.

La razón oficial es el brote de ébola.

The official reason is the Ebola outbreak.

Pero esta decisión es muy polémica.

But this decision is very controversial.

Very controversial is an understatement.

I covered the 2014 West Africa crisis fairly closely from the States, and we had this exact argument then.

There were calls to ban flights from Sierra Leone, Guinea, Liberia.

The public health community was almost unanimous: travel bans don't work the way people think they do.

La Organización Mundial de la Salud tiene una posición clara sobre esto.

The World Health Organization has a clear position on this.

Las prohibiciones de viaje durante epidemias generalmente no detienen el virus, pero sí crean muchos problemas.

Travel bans during epidemics generally don't stop the virus, but they do create many problems.

La gente busca otras rutas para viajar.

People look for other routes to travel.

Los trabajadores de salud no pueden llegar a las zonas afectadas.

Health workers can't reach affected areas.

Y los países afectados pierden dinero y apoyo internacional.

And affected countries lose money and international support.

There's also the stigma question, which is harder to quantify but very real.

When you ban entry from a specific country, you attach a label to everyone from that place.

I've spoken to Congolese doctors, researchers, people who've dedicated their lives to fighting these outbreaks, and the message a travel ban sends them is: we see you as a vector, not a person.

Y hay otro problema muy práctico.

And there's another very practical problem.

El Congo es un país enorme, con más de cien millones de habitantes.

Congo is a huge country, with more than a hundred million inhabitants.

La mayor parte del país no tiene ébola.

Most of the country doesn't have Ebola.

Prohibir la entrada de todos los ciudadanos congoleños porque hay un brote en una región es como prohibir la entrada de todos los americanos porque hay una epidemia de gripe en Texas.

Banning entry to all Congolese citizens because there's an outbreak in one region is like banning entry to all Americans because there's a flu epidemic in Texas.

That comparison is going to land differently for some listeners in Texas.

But the point is absolutely valid.

And yet, I understand the political impulse.

When something scary is happening somewhere else, the instinct is to close the door.

Sí, el impulso es humano.

Yes, the impulse is human.

Pero en 2014 vimos lo que pasó.

But in 2014 we saw what happened.

Países como Nigeria y Senegal controlaron el ébola muy bien, porque cooperaron con la comunidad internacional, dejaron entrar a los expertos y fueron transparentes con la información.

Countries like Nigeria and Senegal controlled Ebola very well, because they cooperated with the international community, let experts in, and were transparent with information.

Los países que tuvieron más problemas fueron los que tenían menos recursos y menos confianza institucional.

The countries that had the most problems were those with fewer resources and less institutional trust.

Nigeria containing Ebola in 2014 was one of the great public health achievements of the decade and it got almost no press.

Lagos, twenty million people, a densely packed megacity.

They tracked every contact, quarantined effectively, and stopped it in eight weeks.

Eight weeks.

The lesson was right there.

La diferencia clave en Nigeria fue la confianza.

The key difference in Nigeria was trust.

La gente confió en el sistema de salud.

People trusted the health system.

En el Congo oriental, eso es mucho más difícil.

In eastern Congo, that's much harder.

Hay un conflicto armado activo en la región.

There's an active armed conflict in the region.

Los grupos armados controlan algunas áreas.

Armed groups control some areas.

La gente tiene miedo, no solo del virus, sino también de las instituciones.

People are afraid, not just of the virus, but also of institutions.

Eastern Congo is one of the most complex and overlooked humanitarian crises on earth.

I spent time there in the early 2000s.

There are militias, there are UN peacekeepers with a mixed record, there are mineral extraction interests tangled up with everything.

Trying to run a vaccination campaign in that environment is not a logistics problem.

It's a political and security problem first.

Exactamente.

Exactly.

En el brote de ébola de 2018 y 2019 en el Congo, hubo ataques directos contra los centros de vacunación.

In the 2018 and 2019 Ebola outbreak in Congo, there were direct attacks on vaccination centers.

Los trabajadores de salud tuvieron que escapar.

Health workers had to flee.

Y eso fue con la cepa Zaire, para la cual ya existía la vacuna Ervebo.

And that was with the Zaire strain, for which the Ervebo vaccine already existed.

Imagina la dificultad con una cepa para la que todavía no hay vacuna aprobada.

Imagine the difficulty with a strain for which there's still no approved vaccine.

Which brings us back to why the Oxford trial matters so much.

Ervebo works for Zaire.

It doesn't cross-protect against Bundibugyo.

So right now, if Bundibugyo is circulating in an active conflict zone, the main tool is contact tracing, isolation, and supportive care.

All of which are brutally difficult in that context.

Hay una estrategia que funcionó bien en el pasado con la cepa Zaire.

There's a strategy that worked well in the past with the Zaire strain.

Se llama vacunación en anillo.

It's called ring vaccination.

En lugar de vacunar a toda la población, los equipos médicos identifican a todas las personas que tuvieron contacto con un caso confirmado de ébola, y las vacunan a ellas primero.

Instead of vaccinating the whole population, medical teams identify all the people who had contact with a confirmed Ebola case, and vaccinate them first.

Es más eficiente y más rápido.

It's more efficient and faster.

Ring vaccination was also how smallpox was eradicated, ultimately.

You don't need a hundred percent coverage if you can build a firewall around every case.

Brilliant strategy in theory, but it requires functioning contact tracing, which requires people to tell you who they've been near, which requires trust.

Again, we come back to trust.

Y el acceso.

And access.

Médicos Sin Fronteras trabajó en el Congo durante años y tuvo que salir de algunas zonas porque era demasiado peligroso.

Doctors Without Borders worked in Congo for years and had to leave some areas because it was too dangerous.

Cuando los trabajadores humanitarios no pueden entrar, el virus puede circular sin control durante semanas antes de que alguien lo sepa.

When humanitarian workers can't get in, the virus can circulate undetected for weeks before anyone knows.

I keep thinking about the asymmetry here.

Oxford's trial, the scientific achievement, the volunteer who this week let a needle go into their arm for a disease most people in wealthy countries have never heard of.

That's a remarkable act.

And simultaneously, the US is pulling up a drawbridge.

Es una contradicción muy clara.

It's a very clear contradiction.

Por un lado, los científicos trabajan para proteger a la gente del Congo.

On one hand, scientists work to protect people in Congo.

Por otro lado, los políticos dicen que esa misma gente no puede entrar al país.

On the other hand, politicians say those same people can't enter the country.

Y si el Congo no puede recibir ayuda, si sus médicos e investigadores no pueden viajar, el brote va a ser peor para todos.

And if Congo can't receive help, if its doctors and researchers can't travel, the outbreak is going to be worse for everyone.

There's a line I read once, I can't remember whose it was, about how epidemics don't respect borders but our responses pretend they do.

Every time.

We relearn this every outbreak and then forget it before the next one.

Y hay algo más que quiero mencionar sobre el contexto económico.

And there's something else I want to mention about the economic context.

La República Democrática del Congo tiene minerales que el mundo necesita, especialmente el cobalto para las baterías de coches eléctricos.

The Democratic Republic of Congo has minerals the world needs, especially cobalt for electric car batteries.

El mundo quiere los minerales del Congo, pero no quiere ayudar al Congo con sus problemas de salud.

The world wants Congo's minerals, but doesn't want to help Congo with its health problems.

Eso es una hipocresía enorme.

That's enormous hypocrisy.

That's a point I wasn't expecting and I think it's the most important thing you've said in this episode.

The phones in our pockets run partly on Congolese cobalt.

The electric cars we're buying to feel virtuous about climate change run on it too.

The global economy is deeply entangled with the DRC.

And the response when they have a health emergency is to close the door.

Sí.

Yes.

Y para terminar con algo positivo, el ensayo de Oxford es una señal de que, al menos en el mundo científico, hay personas que quieren cambiar esta situación.

And to end on something positive, the Oxford trial is a sign that, at least in the scientific world, there are people who want to change this situation.

Si la vacuna funciona y es segura, Oxford dijo que quería fabricarla a un precio accesible para los países pobres.

If the vaccine works and is safe, Oxford said it wanted to manufacture it at an accessible price for poor countries.

Eso es diferente de lo que pasó con otras vacunas en el pasado.

That's different from what happened with other vaccines in the past.

That matters.

Oxford had that same commitment with AstraZeneca on COVID, to manufacture at cost for low-income countries, and it wasn't perfectly executed but it was meaningfully different from the approach of some other manufacturers.

If they carry that model forward to Bundibugyo, there's real reason for hope.

Oye, Fletcher, una cosa.

Hey, Fletcher, one thing.

Yo usé varias veces la palabra «ensayo» hoy.

I used the word 'ensayo' several times today.

Un ensayo clínico.

A clinical trial.

¿Sabes que en español «ensayo» tiene varios significados completamente diferentes?

Do you know that in Spanish 'ensayo' has several completely different meanings?

Hm.

Now that you mention it, I've seen «ensayo» on the cover of books, like literary essays.

And I think I've seen it for theater rehearsals too?

Is that the same word doing three different jobs?

Exactamente.

Exactly.

«Ensayo» puede ser un ensayo literario, como los de Montaigne.

'Ensayo' can be a literary essay, like Montaigne's.

También puede ser un ensayo de teatro o de música, cuando el grupo practica antes del espectáculo.

It can also be a theater or music rehearsal, when the group practices before the show.

Y también es un ensayo científico o clínico.

And it's also a scientific or clinical trial.

Las tres cosas vienen de la misma idea: probar algo, intentar algo antes de que sea definitivo.

All three come from the same idea: trying something, attempting something before it's definitive.

That's actually elegant.

In English we've split those three things into completely separate words: essay, rehearsal, trial.

And they feel like they belong to different worlds.

In Spanish they're the same word, which makes the underlying logic visible.

A clinical trial is a rehearsal.

A literary essay is an attempt.

I like that.

Y si alguna vez ves el cartel de «ensayo general» en un teatro, eso significa el ensayo final antes del estreno.

And if you ever see the sign 'ensayo general' in a theater, that means the final rehearsal before opening night.

Es el ensayo más importante.

It's the most important rehearsal.

Un poco como una fase tres clínica, ¿no?

A bit like a clinical phase three, right?

El ensayo más serio antes de que sea real.

The most serious trial before it becomes real.

I'm going to think about that the next time I read about a drug entering phase three trials.

It's opening night, and we're still in rehearsal.

That's the right frame for what Oxford is doing right now with Bundibugyo.