WASHINGTON (AP) — A top U.S. official outlined plans Wednesday for clinical trials of a possible Ebola vaccine in West Africa, as the global response to the outbreak took on added urgency with the disclosure of a new cluster of cases in Mali and reports that the death toll had surpassed 5,000.
Two studies of a U.S.-developed vaccine will begin in Liberia and Sierra Leone by January and if they go well, "we could know by the middle of 2015 whether or not we have an effective vaccine," Dr. Anthony Fauci, infectious disease chief at the National Institutes of Health, told the Senate Appropriations Committee.
The confirmation of long-anticipated vaccine studies came as the Senate panel began evaluating the Obama administration's request for $6.2 billion in emergency aid to fight Ebola.
"These resources are essential to stop the outbreak in Africa, and protect us," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.
While the number of infections is slowing in some parts of West Africa, the World Health Organization said cases still are surging in Sierra Leone. Worse, nearby Mali on Wednesday reported three deaths linked to Ebola and moved to track dozens of people who may have been exposed.
"That cluster has to be controlled or we're going to have another front," Frieden warned.
The spending request includes $4.64 billion in immediate spending to fight the epidemic and shore up U.S. preparedness. The domestic work includes such things as continuing training so far given to 250,000 nurses and other U.S. health workers on how to safely handle any cases, designating hospitals in every state capable of handling Ebola or other serious infectious diseases, and creating a national stockpile of protective equipment for health workers.
Some of the money also would go to setting up health systems in other vulnerable countries so they could spot similar outbreaks early enough to stop them before they became a crisis.
More than $1.5 billion of the aid package would be for a contingency fund to deal with any unexpected developments.
Shortly before the hearing started, Army Maj. Gen. Gary Voleski said the U.S. military's Ebola response in Liberia will top out at 3,000 troops, 1,000 fewer than had been planned. "There is a lot of capacity here that we didn't know about before," he said by phone from Monrovia, Liberia.
Sen. Barbara Mikulski, D-Md., who chairs the committee, said lawmakers would move rapidly on the request. "We need to contain the disease and we need to eradicate it," she said.
But some lawmakers questioned whether the money really will be enough to improve U.S. hospitals' preparedness for Ebola and other infectious diseases.
Others asked whether the Obama administration was taking enough security measures against Ebola.
"Why not take the extra conservative step" of quarantining returning health care workers like the Defense Department is quarantining soldiers, Sen. Dan Coats, R-Ind., said.
Health and Human Services Secretary Sylvia Burwell said the military made an operational decision to cover a very large number of people at once, while the restrictions on returning health workers are customized depending on whether they're at high or low risk of infection. Everyone must monitor for symptoms, but only some are advised to restrict their movements.
Fauci noted that he is deemed at low risk because he cared for a Dallas nurse who became infected while treating the first U.S. Ebola case, a Liberian man who came here unknowingly infected.
"If I were to be quarantined, I wouldn't have been able to be here with you testifying," he said.
Stigma surrounding health care workers, both internationally and in the affected countries, is a growing problem, said Benoit Carpentier, a spokesman with the International Federation of the Red Cross, whose teams are carrying out safe burials and running a treatment center in West Africa.
Stigma "is a threat to the global response," he said.
And despite the U.S. funding debate, money doesn't solve every problem, Carpentier said. Time might be the scarcest resource now, he said — time to reach remote villages and explain how the virus is transmitted, time to persuade people to change their behaviors so they don't spread the disease, time to track down people who have come in contact with the sick. It's difficult for health workers and others to keep up.
Also included in the U.S. funding request is $238 million for the NIH for clinical trials of experimental vaccines and treatments. Fauci said Wednesday that he had just seen results of U.S. safety testing of the first experimental Ebola vaccine, and the results were good enough to go ahead with those hoped-for studies in West Africa to see if the shots really do work.
Rigorously studying experimental treatments is key too, he said, citing an NIH meeting with all the doctors who had cared for the nine Ebola patients treated in the U.S. Most received at least one experimental treatment, and looking at their records, "it was clear we had no idea what works or what doesn't work," Fauci said.
DiLorenzo reported from Dakar, Senegal.