Containing the Spread of Filoviruses

Policy
Analysis

Dillan
Brewer,
Cali
Foscue,
Jordan
Fuller,
Tucker
Plunkett,
Devyn
Reaid,
and

Savanna
Williams

Team
Topic
–
Newly
Emerging
Diseases

HADM3300
–
Health
Policy

November
19,
2014

I certify that I have read all guidelines for research papers for this course, both in the
course syllabus and in the Web page handout "Guidelines for Research Papers", and
that this paper fully complies with them, except for any waivers made by explicit prior
agreement with the instructor.

Containing the Spread of Filoviruses:
Ebola Virus Disease and Marburg Virus Disease
Outline
I. Defining the Problem – Page 1
a. Introduction
b. Setting the Scene
c. Classification and Transmission of Filoviruses
d. Symptoms and Treatments of Filoviruses
II. Background and History – Page 5
a. Ebola and Marburg Virus Diseases
i. Initial and past outbreaks
III. Current Situations and Implications – Page 7
a. Ebola Virus Disease
i. Ebola: The Spread and People at Risk
ii. International Policies and Government Impact on Ebola
iii. Domestic Policies and Government Impact on Ebola
b. Marburg Virus Disease
i. Marburg: The Spread and People at Risk
ii. Current Policies and Government Impact on Marburg
c. Problems with Policies
d. What was Done Right?
e. Implications: What Would Happen if Nothing were Done?
IV. Solution 1: Controlling Ebola Through Travel – Page 16
a. Current Policies
b. Proposed Solution
V. Solution 2: Rapid Testing – Page 20
a. Current Policies
b. Complications
c. Proposed Solution
VI. Solution 3: Vaccine – Page 24
a. Background to Vaccines as a Solution
b. Current State of Filovirus Vaccines
c. How to use Vaccines as a Solution
VII. Policy Recommendation – Page 31
VIII. Conclusion – Page 34

Defining the Problem
Introduction
Every few years, there seems to be an alarming outbreak of a new or lesser-known
disease that causes countless deaths, hysteria among the public, and increased health policy from
the world’s governments and health organizations. The current concern in the realm of healthcare
and epidemiology is the recent outbreak and spread of filoviruses – also known as viral
hemorrhagic fevers (VHF). Similar to the SARS epidemic of the early 2000s and the swine flu
pandemic of 2009, there has been heightened media attention and concern from the public over
what VHFs are, how they are transmitted, and what government organizations are doing to
control the spread of these diseases. Throughout the world, the public looks to government
organizations for guidance and leadership when outbreaks such as the current Ebola virus disease
and Marburg virus disease outbreaks occur. Health and public policies are what shapes the
course of an outbreak through regulating hospital protocols, travel restrictions, sending aid
groups to infected countries, and even providing accurate information. Without governing
organizations such as the Centers for Disease Control and Prevention (CDC) and World Health
Organization (WHO), there would be limited understanding of how to keep people safe and
contain the spread of contagious diseases. With that being said, are government and health
organizations doing enough to control the current epidemics? Judging by the ever-increasing
death toll and recent spread of Ebola to developed countries, there may be better solutions to
consider.
The following analysis focuses on how to control the spread of filoviruses, various
aspects of the diseases, and related health and public policies. However, before one can
understand and pass judgments on how various government organizations are dealing with the

spread of hemorrhagic fevers, it is imperative to understand how these diseases work. Therefore,
provided below is a thorough explanation of what filoviruses are, including their disease
classification, transmission, and signs and symptoms of the disease. Because the information
about past outbreaks can provide insight into how current policy should be written to better
contain such highly contagious diseases, an explanation of their history and various outbreaks in
the past is also included. Finally, a variety of solutions to be considered for controlling the spread
of filoviruses are detailed. These solutions will look at different methods for implementing
prevention tools in both developed and developing countries alike.
Setting the Scene
In July 2014, the media shed light on the most recent outbreak of Ebola virus disease
(EVD), rapidly spreading from one country to the next in West Africa and affecting the people of
Liberia, Senegal, Nigeria, Guinea, and Sierra Leone. In August 2014, two American
humanitarian workers, who were infected with EVD while in West Africa, were transported to
Emory University Hospital to be treated in a state of the art isolation unit. The EVD infected
workers were treated and discharged in conjunction with the nearby CDC. The initial reaction to
bringing these patients into the U.S. for treatment set the stage for the American public’s
perception on controlling the spread of the disease: cries of fear and questioning as to why U.S.
government would allow these EVD infected patients into our country littered the media and
internet conversations. That moment seemed to be the spark to the fire that is Ebola hysteria.
Since then, a Liberian man entered the U.S. without disclosing his prior EVD exposure. Within a
few days, he presented with flu-like symptoms, which were later confirmed to be symptoms of
Ebola. Two of the healthcare workers that cared for him later became infected with the disease,

which hospital administrators believe to be a breach of protocol (Fernandez, Manny). Most
recently in late October, a doctor in New York City that was caring for Ebola patients in Guinea
developed the disease and his family was placed under quarantine. In the months since the initial
outbreak, the death toll is nearing 5,000 and there are confirmed EVD cases – both travel related
and person-to-person transmission – in the United States, Mali, and Spain ("Ebola Virus
Disease").
Affecting far fewer people, while still highly contagious and important, is Marburg virus
disease (MVD). On October 5, 2014, the Ministry of Health in Uganda alerted WHO of a
confirmed case of MVD in a healthcare worker ("Marburg Virus Disease -Uganda"), causing
further alarm over the spread of these sometimes-fatal hemorrhagic fevers. Researchers
investigating this case of MVD are unsure of what initially caused the infection, as the man had
not been in contact with any animals thought to carry filoviruses ("Marburg Virus Disease -
Uganda"). Because this case was discovered and confirmed well after the start of the current
Ebola outbreak, WHO and CDC officials took action immediately to control any spread of
MVD, knowing how rapidly filoviruses can spread.
Classification and Transmission of Filoviruses
Filoviruses are part of the Filoviridae family of viruses, which cause severe viral
hemorrhagic fevers. The family consists of the five known strains of EVD and the single known
strain of MVD. The five known strains of EVD include Taï Forest, Sudan, Zaire, Reston and
Bundibugyo. Filoviruses are thought by researchers to be zoonotic, meaning their original hosts
are animals and the disease can be initially transmitted through animal-to-human contact.

Researchers have found it difficult to locate the original reservoir and host of the filoviruses
("Filoviridae").
Though there is a lack of understanding as to how the virus is initially transmitted from
an infected animal to a human – especially in the most recent outbreaks – there has been
significant research about the person-to-person spread of EVD and MVD. Understanding and
controlling the person-to-person spread of these diseases is especially important due to the lack
of a vaccine for VHFs. Because there is no definitive cure, being able to decrease the
transmission is the only way to eradicate the disease. VHFs are spread through contact with the
bodily fluids of an infected individual, including vomit, blood, semen, and other secretions
("Filoviridae"). This fact is especially important when considering the health and safety of health
care workers or family members caring for infected individuals, in addition to laboratory
workers. For this reason, organizations such as the CDC and WHO have focused heavily on
proper protocol and procedures for healthcare workers, specifying how to handle bodily fluids,
how to put on and remove protective gear, and how to dispose of human waste and remains.
Symptoms and Treatment of Filoviruses
The signs and symptoms of both EVD and MVD are highly similar. Both diseases have
an incubation period of anywhere from two to twenty-one days. The virus can live in your body
without causing you to present with any symptoms for up to twenty-one days, at which point the
infected human becomes contagious ("Ebola Virus Disease"). The CDC has found that in most
cases, patients present with symptoms eight to ten days after being exposed to a filovirus ("Ebola
Virus Disease"). The initial symptoms of EVD and MVD include the abrupt onset of high fever,
fatigue, muscle pain, headache, and sore throat. As seen in the case of the Liberian man who was

infected with EVD in Texas, these symptoms may present to health workers as flulike symptoms
(Fernandez, Manny). On about the third day of infection, patients usually develop severe
diarrhea, abdominal pain and cramping, nausea, and vomiting, lasting up to a week ("Marburg
Haemorrhagic Fever"). The final phase of filovirus symptoms is by far the worst: the
hemorrhagic characteristics of EVD and MVD set in, causing blood in the vomit and feces as
well bleeding from the nose, gums, vagina, and venipuncture sites where intravenous injections
occur. In the most severe and fatal cases, death usually occurs around days eight to nine of
infection ("Marburg Haemorrhagic Fever").
As there is no known vaccine to prevent infection or drug to cure filoviruses, the only
available treatment is supportive and palliative care. Healthcare workers must focus on
controlling the symptoms, such as the vomiting and diarrhea to prevent dehydration.
Additionally, because of the hemorrhagic nature of EVD and MVD, healthcare workers must be
able to provide safe blood transfusions, as most fatal cases are caused by severe blood loss.
Patients who receive immediate medical attention and have strong enough immune systems to
fight off the infection can survive the attack of a filovirus and will have antibodies to prevent
another infection for up to ten years ("Ebola Virus Disease").
Background and History
Ebola Virus Disease
The first recorded outbreak of EVD was in 1976 in Yambuku, Democratic Republic of
Congo, a town along the Ebola River, which is where the disease derives its name. This initial
outbreak infected over three hundred people and was fatal in 80% of the infected population.
There was a simultaneous outbreak in Nzara, Maridi, Sudan and a later recurrence in the same

location in 1979. From 1989-1992 there were issues in quarantine facilities in the United States
and Italy where monkeys were imported from a specific location in the Philippines. In both
locations, the Reston strain of EVD was introduced and caused an asymptomatic infection in the
workers handling the monkeys; however, no humans actually became ill. In 1995 there was a
third massive outbreak of EVD in Democratic Republic of Congo that was traced back to
patient-zero who likely had contact with monkeys where he worked in a forest.
("Outbreaks Chronology: Ebola Virus Disease")
The first appearance of the Sudan strain of EVD occurred in 2000-2001 in Uganda, in
which over four hundred people were infected. The outbreak was blamed on poor protection
amongst healthcare workers and family members and improper burial procedures. There
continued to be outbreaks of the initial EVD strain – later known as the Taï Forest strain –
throughout the early 2000s in Democratic Republic of Congo. The first emergence of the
Bundibugyo strain occurred in Bundibugyo, Uganda in 2007-2008 and caused a smaller outbreak
in comparison to previous outbreaks in Uganda. Until the most recent outbreak of EVD, all
outbreaks in West Africa were very small and contained. The 2014 outbreak in Guinea, Liberia,
Sierra Leone, and Democratic Republic of Congo is caused by the first appearance of the Zaire
strain and to date has infected over 13,000 humans, killing over 5,000 of the infected population.
("Outbreaks Chronology: Ebola Virus Disease")
Marburg Virus Disease
The initial two outbreaks of MVD - at the time referred to as Marburg Hemorrhagic
Fever - occurred in Marburg and Frankfurt, Germany and Belgrade, Serbia in 1967 ("Marburg
Haemorrhagic Fever"). The location of the primary outbreak is what contributed to the name of

this strain of filovirus. In both German cities and Serbia, the outbreaks were tied to African green
monkeys imported from Uganda for laboratory research ("Marburg Haemorrhagic Fever").
Though these initial outbreaks were much smaller - only affecting 31 people - than the initial
outbreak of EVD in 1976, it was the first outbreak of what would later be known as a filovirus.
Throughout the 1970s to the late 1990s, there were very small, isolated MVD outbreaks in
countries such as South Africa, Kenya, and Russia. The first large outbreak of MVD occurred in
1998-2000 in Democratic Republic of Congo and was fatal in over 80% of the 154 people
infected. The majority of the cases in this outbreak were in miners from the northeastern area of
the country, causing researchers to link the disease to bats living in the mining caves. In 2004-
2005, there was a second, even larger outbreak of MVD in Angola that affected over 250 people
and killed all but a few. Researchers still have very little understanding of what sparked the
2004-2005 deadly outbreak. Since the Angola outbreak, there have continued to be small,
isolated cases of MVD in Uganda and Kenya that have all been linked to either miners or
travelers exploring caves in these countries.
("Chronology of Marburg Hemorrhagic Fever Outbreaks")
Current Situations and Implications
Ebola: The Spread and People at Risk
Ebola virus disease (EVD) has quickly become one of the biggest epidemics of the
21st
Century. The most recent outbreak of EVD is currently taking place in West Africa,
originating in Guinea and spreading to Liberia, Sierra Leone, Nigeria, Mali, and even the United
States and Spain. There have been over 13,000 reported cases of EVD and it has proven fatal in
over 5,000 cases, with numbers showing no sign of stopping (Aylward et al.). EVD can cause

serious headaches, muscle pains, hemorrhagic fever, and vomiting that can become fatal if not
acted upon in a timely manner. All strains of this filovirus are believed to have been spread in
Africa by direct contact with a wild animal such as a monkey or fruit bat. Once a person has
EVD, the disease can be spread amongst humans by direct contact with blood and bodily fluids
of the person with the disease (Briand). The people most at risk are those who come in frequent
contact with infected and wild animals. The highest risk for person-to-person transmission is in
family members, medical workers, and the people involved in the burial process for the infected
deceased. EVD has rapidly become so deadly that domestic and international policies and
procedures need to be revamped in order to help prevent and combat further fatalities.
International Policies and Government Impact on Ebola
In West Africa, EVD has claimed the lives of thousands of people across various
countries. Researchers believe that a little boy in a village in Guinea was the first case of the
current outbreak because he ate an infected bat and bushmeat of animals infected with EVD
(Briand). From this village, EVD spread throughout the county and eventually the country. The
spread of EVD from Guinea to other countries such as Sierra Leone and Liberia, before making
its way to other parts of Africa and even the United States. The main cause for EVD’s spread
was direct contact with infected individuals and travel.
With the epidemic growing rapidly, organizations such as WHO, MSF, and the CDC
began working together with local governments in each of the affected African countries to treat
and contain EVD (Frieden). Many of these countries had problems in providing proper care and
cleanliness to its citizens due to the levels of poverty in their respective countries. In regards to
healthcare and prevention, these West African countries were severely understaffed and had

minimal supplies needed to prevent the spread of the outbreak. WHO worked with various
governments to provide supportive care for the people of West Africa. They sent fluids to
rehydrate patients from the illness. To eliminate the spread of the disease, they have also set up
prevention and control measures such as managing the cases, setting up surveillance of those
possibly infected, and tracking contacts of those infected (Farrar). Aid workers have helped
provide better lab services and monitoring of facilities both for the medical workers and patients.
WHO has also worked with government administrators to spread awareness throughout the
communities and to warn its citizens to be cautious in any contact with wildlife and other
affected humans. Supplies to protect citizens from EVD exposed is also being provided by
WHO.Other examples of WHO support is a monitoring system of twenty-one days for those who
have been in contact with someone who has had EVD and also have promoted safer burial
options for citizens killed by EVD (Farrar).
MSF and the CDC have provided important policies and implementations regarding
EVD. MSF has, like WHO, sent many health workers to West Africa to aid and support the
people living there and they are also training health care workers and the general public on how
to properly interact with those infected (Fauci). International aid workers are stressing the
importance of proper hygiene in the communities and the need to wear personal protective
equipment when working with EVD patients in regards to injections or in the burial process.
Many of the countries in Africa have now limited travel or created new travel restrictions to
other countries in order to help with borders and containing the diseases. In Africa, the CDC
similarly urges the use of protective equipment and proper patient handling techniques when
working with Ebola patients and no direct contact of skin to skin. Washing hands constantly with
soap and water is a small and easy step in order to help prevent contact with EVD. Direct contact

should be completely avoided by using proper techniques in handling patients and their items.
The CDC requests people monitor the health status themselves and others that may have been
around an area affected by EVD for approximately twenty-one days (Chan). Healthcare workers
must also provide and clean their medical areas and beds regularly to avoid contamination. The
CDC encouraged many of the African countries to quarantine those they deemed could be
infected by EVD, which helps prevent the spread of the disease to other countries (Feldmann).
These organizations have been able to make several impacts in order to help contain the spread
of Ebola and have saved hundreds of lives in the process of preventing the spread of such a nasty
disease.
Domestic Policies and Government Impact on Ebola
Halfway around the globe, the United States has also addressed EVD patients
domestically. There have, fortunately, only been nine total cases in the United States and thus
far, only one was not able to recover and became a fatality. Thomas Duncan was a Liberian
national coming to visit family in America and was the first patient of EVD in the United States
(Fernandez). After arriving in America, Duncan felt sick and went to the hospital and shortly
after passed away from the Ebola-like symptoms. The CDC confirmed through tests that Duncan
was EVD infected and domestic policy began evolving to contain EVD. Health care workers and
nurses, for example, who treated Duncan were being monitored and treated quickly if they began
showing EVD symptoms. While some EVD treatment nurses became sick, they were treated
efficiently and recovered. The United States government also began to implement other
safeguards throughout the country, including monitoring and surveillance of all possible contacts
to Duncan and those infected by EVD by the CDC. Infection control protocols were also revised

to mandate fully protective and covered clothing for all health workers working with EVD.
Healthcare workers in America also have become highly trained on EVD and how to combat it if
it becomes a larger problem domestically. Rapid response teams are in place now to travel to
labs and hospitals with potential cases of EVD. A big issue is international travel and the CDC
provides airport screening and surveillance to passengers and flight crews in airports of high
international travel while also requesting reports on those deemed as ill passengers on flights
(Breman). There were also encouraged twenty-one-day quarantines set up by many governors for
their particular states in order to prevent the spread of EVD. These quick response policies and
regulations set up and implemented in the United States have helped control the spread of EVD
throughout the country. Although many Americans are fearful about EVD and its death toll in
West Africa, the disease has, so far, been contained with few deaths domestically.
Marburg: The Spread and People at Risk
MVD can cause serious headaches and hemorrhagic fever in people who are affected.
MVD spreads like most filoviruses, in that it spreads from direct contact of people and animals
that are already infected. Bats and nonhuman primates seem to be the first animals that carry the
virus. People who go into caves inhabited by bats and people who come in contact with animals
infected have a higher risk of contracting MVD. MVD also spreads through contact with blood
and bodily fluids of infected people, as well as contaminated medical equipment. As a result, the
people most at risk are those who visit caves or work in mines in Africa and those who have
occupational exposure treating patients without the proper protective equipment. MVD is not a
very common filovirus outbreak, but when the disease infects someone it can be highly fatal.
This disease can become very fatal and can cause a major number of fatalities if not treated

correctly and promptly. The most recent outbreaks have occurred in Uganda in 2014.
Unfortunately, the one person proven to have been infected with MVD died due to complications
of hemorrhagic fever (Frieden). The United States, fortunately, has not diagnosed anyone having
MVD from this most recent outbreak. Governments, both domestically and internationally, need
to have policies in place that are ready to limit the spread of MVD in their respective countries.
The most recent outbreak of MVD occurred in late September 2014. In central Uganda
and the western district of Kasese, one man died and close to 100 others are being carefully
monitored. The man who died was thirty years old and was a hospital technician working at
Mengo Hospital in Uganda (Adalija). Over half of the people who were in contact with the man
are hospital workers and have been isolated for the duration of the twenty-one day incubation
period. Approximately eight of the exposed people have shown the symptoms of the disease and
since September, there have been an estimated eighteen cases of MVD throughout Africa,
resulting in nine fatalities (Adalija). Although these numbers are tragic, they had the potential to
be much higher and were not because of the impact of government and its policies that have been
able to limit the spread of MVD.
Current Policies and Government Impact on Marburg
Many acts taken in Africa and throughout the world have aided in preventing the spread
of MVD. In response to the September 2014 outbreak of MVD in Uganda, President Yoweri
Museveni deployed a national task force to attempt to prevent any further cases of MVD, as well
as to contain the current outbreak (Adalija). Museveni told his citizens to cooperate with the
national task force and health care workers, and to avoid shaking hands and having direct contact
with others as much as possible. The national task force helped provide additional health care

workers and physicians with the supplies and training necessary to treat infected individuals.
Additionally, local individuals are managing cases clinically and monitoring areas of infection
with the assistance of organizations such as World Health Organization, Medecins Sans
Frontieres, and the United States Centers for Disease Control (“Marburg Haemorrhagic Fever”).
These international groups are also aiding the Ugandan government in investigating and
surveying the cause of the outbreak and how it is being handled. They assist in setting up
isolation and treatment facilities and have taken a large role in training Ugandan healthcare
workers in prevention and control of MVD. WHO has further deployed staff to provide aid to the
national task force and advised against traveling to Uganda due to the current situation.
The Ugandan government is working on social mobilization to prepare its citizens in case
the outbreak cannot be prevented and contained. Uganda is receiving shipments of more personal
protective equipment (PPE) from the CDC, to help in preventing the spread of MVD (“Marburg
Haemorrhagic Fever”). Other policies are being implemented to facilitate rapid diagnosis, tracing
contacts of infected individuals, and identification of the disease. The CDC is lending support to
establish a better laboratory network to be able to respond to MVD cases faster. Uganda is also
improving communications with its neighboring countries to help strengthen the surveillance
around the borders to prevent the outbreak from spreading to other countries.
Although there are currently no vaccines available to eliminate MVD, many
pharmaceutical companies are working to find cures for infected MVD patients. Researchers in
Canada say they have developed a drug, which could prove successful in helping monkeys
survive MVD (Adalija). However, There have not yet been any human tests performed with this
curative drug. African governments have chosen a simpler approach to containing MVD, stating
to their people that there are many ways to help minimize the risk of being infected. The most

feasible solutions for underdeveloped countries include avoiding direct contact with infected
individuals and using proper nursing techniques. The embalming and burial process of deceased,
infected individuals should also be modified to avoid the spreading of MVD. While MVD may
not be the most popular of the two main filoviruses, it is a very dangerous disease and
government policies must be in place to contain the spread of such an highly contagious
infection.
Problems with Policies
Not surprisingly, controversy exists about how EVD and MVD patients have been treated
and the response of governments and private companies to these diseases. Many people believe
that if the medical workers in Africa and in the United States would have been trained better for
EVD, the disease death toll would not be as high as it was in the beginning (Chan). Others
speculate that if healthcare workers had more funding and proper equipment to eliminate
physical touching, EVD would not have spread so easily. Other problems with EVD relate to the
fact that there has not been any fast testing available and some question that if we have so much
money and research invested in drugs and pharmaceutical companies, how are there no vaccines
available to eliminate the spread of the disease (Feldmann). People believe that WHO and the
CDC had a slow response time in providing aid and establishing EVD handling policies. People
from any countries are furious over a lack of travel regulation. Many Americans fear that those
traveling to the United States from Liberia, Guinea, or Sierra Leone are bringing the disease here
with little monitoring or control by the departing or arriving governments on checking to make
sure passengers are free of disease. EVD has caused concerns for many around the globe, but the
nation of Nigeria may be able to help provide guidance on how to prevent the spread of Ebola.

What was Done Right?
The Nigerian Minister of Health Onyebuchi Chukwu along with WHO declared Nigeria
free of Ebola after a little over a month and only a few fatalities (Sifferlin). Chuckwu
summarized Nigeria’s actions, which included preparing early on how to train healthcare
workers about the disease due to the proximity of the outbreaks. They also declared Ebola a
national emergency early so that strategies and solutions could be met at a rapid rate. Nigeria
also trained local doctors already in Nigeria to avoid losing time while waiting on foreign
physicians to arrive (Sifferlin). They were also able to manage the fear of its citizens and used
contact tracing for anyone who might be involved with contact of Ebola. They were able to keep
borders open to not produce chaos and they urged international response to help rally everyone
together to help combat the disease. If these steps could have been implemented within every
country infected by Ebola, there may have been fewer fatalities and fewer EVD cases.
Implications: What Would Happen if Nothing were Done?
A major implication about EVD would be what would happen if no steps were taken to
prevent or contain the spread of EVD? Several thousands of cases of EVD have spread
throughout the world in less than a year with thousands of people dying. In addition, experts
believe there are thousands of EVD cases not even reported or registered that have caused
fatalities in underprivileged areas. If these numbers are accurate, the CDC projects that there may
be over 1.4 million people infected with EVD by January 2015 if actions are not taken to prevent
and diminish the spread of EVD (Michaud and Kates). If the spread of EVD is not contained,
many people may start to panic and cause chaos in Africa. While there is no cure for these
filoviruses yet, researchers and scientists are working extremely hard to find a cure. In the

meantime, as Nigeria recognized, there are many things that can be done in order to halt the
spread of EVD. There are also temporary measures and actions that can be undertaken to develop
further protections against filoviruses until the discovery of a cure.
Solution 1: Controlling Ebola Through Air Travel
Through the modern technology of air travel, a person can go anywhere in the world within
nearly twenty-four hours. All of these people take their diseases with them. Millions of people
travel by plane every day coming from and going to nearly every continent on the globe. All of
these different places are home to multiple and sometimes unique diseases. Air travel makes it
easier for diseases to move and infect new places. Unfortunately the people in these “new
places,” who previously were not at risk for disease exposure become at risk, if a passenger is
infected and deplanes in a “new place.”
Current air travel regulations are not enough to keep the fairly contained Ebola epidemic,
which only affects few African countries, from becoming a full blown global catastrophe.
Currently, the CDC advises airline crewmembers to follow normal infection control precautions
when handling a passenger that they believe might have Ebola. These precautions include
washing hands and wearing disposable gloves and facemasks (“Ebola Guidance for Airlines”).
While Ebola is not an airborne disease, there is still a need to take additional precautions to
control the spread through travel.
Current Policies
The CDC has, in the last few months, implemented a policy of exit screening for
passengers leaving the countries of Sierra Leone, Guinea, and Liberia. These countries are the

three hardest hit with the current EVD outbreak. This exit screening includes an initial primary
screening and a more thorough secondary screening if the passenger is flagged in the primary
screening. During the primary screening, performed by a general workforce that is not required
to have any public health training, workers take passengers’ temperatures and ask them to fill out
a public health questionnaire that will help the workers determine each passenger’s individual
risk. Passengers with temperatures above 101.5 degrees Fahrenheit or that report feeling feverish
are sent to the second screening. The questionnaire asks passengers to report if they have
experienced any of the other myriad of symptoms that are associated with EVD such as
headache, muscle pain, vomiting, diarrhea, stomach or abdominal pain, or unexplained bleeding
or bruising. In the secondary screening, the passengers that are flagged are asked to complete a
more thorough questionnaire and are given a more focused physical examination. If the
passenger does not pass the second screening they are referred for medical treatment. They are
also denied boarding and have to wait twenty-one days to fly (Pearson). These precautions are
thought to have stopped several passengers with EVD from leaving the original outbreak site.
Although, it is still unclear if these measures are enough.
This current outbreak of EVD is not the first time that exit or entry screening has been
used to assess the risk level of passengers. In 2008, a study was conducted in Australia to
measure the effectiveness of entry screening for influenza. Researchers used a number of the
same procedures that the CDC is currently implementing. They asked the passengers to self
report symptoms and fill out a health questionnaire. The study found that these measures were
ineffective in assessing the risk of the passengers, because a lot of the symptoms were also
symptoms of other diseases. They also found that by flagging anyone who exhibited one of the
symptoms, more people than necessary were being screened. This led to mass inefficiencies and

huge strains on the airport’s budget and personnel (Priest). Many of the findings of this study
would also hold true to the exit screenings that are currently being used for Filoviruses,
particularly EVD. Some of the main symptoms of EVD are also symptoms of other very
common diseases, like influenza. With flu season quickly approaching its peak many people will
be displaying these symptoms. Airports, especially those in Sierra Leone, Liberia, and Guinea,
will have trouble supporting such a large scale testing effort. These measures of exit screening
for EVD, while a step in the right direction, are lacking and highly inefficient.
Proposed Solution
A more comprehensive and specific test or screening procedure for all Filoviruses would
be the best solution for controlling the spread of EVD through travel precautions. The process
needs to be made more efficient and that will require the implementation of more resources than
these smaller African countries have. Due to the process of globalization, diseases that used to be
an issue for just one area now have implications for the entire globe (Rodriguez-Garcia). That is
why the global community, including the United States, has an obligation to step in and use their
combined resources to help solve this global health issue. The resources already being used in
exit screening in the countries of Sierra Leone, Guinea, and Liberia need to be heavily
supplemented with more efficient processes and more knowledgeable screening workers.
Currently, in the primary screening untrained workers are merely asking passengers to
self-report symptoms of illness. It is possible that some passengers are downplaying symptoms
out of fear or lack of education. People who are exhibiting a low grade fever, below 101.5, and
are not reporting other symptoms are cleared to fly and potentially travel all over the globe.
Verification of symptoms and an assessment performed by a worker with actual substantial

medical knowledge should be implemented. If the person is flagged in the primary screening,
they should be sent to the secondary screening and actually be evaluated by a medical doctor or
another equally trained individual. This would require more resources or a mass redistribution of
current resources, but it would make the process much more efficient and thorough.
The questionnaires that are being filled out by travelers, along with their travel history,
also need to be verified. The majority of people do not take surveys and questionnaires seriously;
they just check the box that they believe will get them through the fastest. With such a serious
public health risk time to verify the answers passengers are recording should be taken. Travel
histories also need to be required. The World Health Organization is currently advising health
care providers to ask patients about their travel history to rule out the possibility of a Filovirus
(“Travel and Transport Risk Assessment”). If WHO is calling on medical professionals to
require this information from patients, the same information should be asked of airline
passengers coming from countries in the middle of a severe EVD epidemic. This travel history
screening should not just be required from passengers leaving the airports in Sierra Leone,
Guinea, and Liberia, but all international travelers coming in to the United States, who have
travelled through these countries in the last thirty days. These histories need to be verified by
United States Customs officials before the passenger is allowed entry into the United States.
If a policy of more thorough screening processes, using medically trained professionals
for screening, and verification of travel histories was implemented there would be a large
decrease in the risk of transmission of EVD through air travel. As stated before, these policies
will take a united global effort, but that is the best option for fighting the risk of a global
catastrophe.

Solution 2: Rapid Testing
Current Policies
The current option to test for Ebola that is the PCR (polymerase chain reaction) many
other diseases. However, the PCR test is not fast enough and has some complications. The PCR
test which takes samples of a patient’s blood and detects the DNA to see if they are
infected. The CDC and WHO currently are working with others to improve a test for the
filoviruses, but Vogel, a author or sciencemagazine.org says, “In the short term, WHO and others
are focused on increasing the number of PCR-based labs” (Vogel).
With filoviruses emerging in the United States, and other countries, one of the solutions
needed to decrease these diseases is to find a rapid test to perform on people. With EVD
emerging currently, finding a solution for EVD would help greatly. Currently the CDC is
encouraging finding a rapid test for Ebola as a big priority, but does not believe enough research
has been done. “Even if we have the best treatments available, without a timely diagnosis people
are still going to die," says [Dan] Kelly” a infectious disease doctor being interviewed by Aryn
Baker (Baker). If there was a successful test created to quickly identify persons infected with
EVD outbreaks of filoviruses currently and in the future could be contained faster. As said
earlier, because filoviruses have an incubation period of twenty-one days sometimes fail to occur
before three weeks. This latent presentation of symptoms factor causes many problems
containing the spread of EVD; with the symptoms sometimes occurring up to three weeks after
the initial contact with infection. Latent symptoms also delay the infected person’s testing, which
allows more exposure to spread to other people, if it is not known that the individuals are
infected. Finding a rapid test that is cost efficient and able to test anyone at risk, quickly is a big
need for stopping the rapid outbreak with filoviruses emerging at any time. While medical

research takes a very long time, and large amount of money to fund it, even if the researchers
working now do not find a solution to rapid testing during this outbreak of Ebola, they would be
prepared for the next outbreak.
Complications
The existing PCR test is used effectively for many different diseases, but for EVD and
MVD there are many complications to it. One complication is the turn around rate of time once
the patient gets a blood test done. As Butterworth says in Race for a Cure, “the Centers for
Disease Control's Craig Manning points out, in previous outbreaks that blood samples had to be
shipped to the CDC's headquarters in Atlanta for analysis, a process that, agonizingly, took three
days” (Butterworth). The PCR test process is too long to determine if a patient is infected with
Ebola because an infected patient must be isolated right away, for them to avoid spreading the
virus. Butterworth also states that, “Now, thanks to the CDC's collaboration with the Ugandan
government, there is rapid 24-hour diagnostic testing available on the ground [in Uganda].”
(Butterworth). However, the PCR test available are currently not available generally to many
hospitals and healthcare facilities in the United States, which is a problem, that adds critical time
to the process of diagnosing an infected EVD patient.
Another challenge of the PCR test is the technique or process of the blood draw by the
physician and the reviewing doctor’s lack of location about where the patient is infected the
patient infected with the disease. Information about the place of infection could help to track the
DNA of a patient faster (Clothiaux). Pierre Clothiaux, an orthopedic surgeon and board of
director’s member at Cox North Hospital in Springfield, Missouri, stated that this is one of the
major problems of the PCR test. He also discussed that MRSA, Methicillin-resistant

Staphylococcus Aureus, a strain of staph that looks similar to Ebola, had the same problem of
being unfamiliar with where to get a blood sample to test the high risk patient (Clothiaux). As to
the technique of the blood drawn process, Jon Rappoport asks, “Is the [blood] sample taken from
the patient actually a virus or a piece of a virus? Or is it just an irrelevant piece of debris?” also
showing concern about where the blood is taken from the patient (Rappoport). Rappoport also
thinks that some doctors taking blood from the patients, who are at risk, are not taking blood that
would show if the patient has Ebola (Rappoport). Many PCR tests could come up negative due
to the location of where the doctor is drawing up blood on the patient. A failure to diagnose EVD
due to an improper blood drawn could cause the patient to keep going about life, spreading Ebola
to other people because of the patients’ unawareness they are infected with EVD. If doctors
could work with the patient to figure out when and where they were infected, this could help
identify the DNA easier in the PCR test.
Finally, the current PCR testing is costly. While costs are healthcare issue, usually high
costs are associated with curing a disease not diagnosing a disease. The CDC does not have the
monetary reserves to test anyone at risk of Ebola using the current PCR test. Loftus shows an
example of the high cost stating, “BioFire's FilmArray [system] uses PCR technology, but can
deliver results in about one hour on the premises of any treatment facility that has one of the
machines, which cost around $39,000” (Loftus). Finding a test that is inexpensive is key. Right
now because the test is expensive it can only be used for people who are very high at risk. In
separating patients to see who to test, the CDC categorizes possible EVD patients as: high risk,
some risk, low risk and no identifiable risk (Bray). Using the PCR test, the CDC limits testing
the patients to those at high risk only. Using a less expensive test, the CDC could test more
patients.

Proposed Solution
Given the limitations of the current PCR test for filoviruses, this test is not going to be a
successful tool for the United States and other countries to use in the future to treat EVD
patients. Therefore, the CDC is working with other organizations to find a rapid test, as well as
exploring other test options. These options are briefly summarized here.
After researching for the best solution for a rapid test, sciencemag.org talks about a test,
that the Corgenix research team is researching currently,that has the best potential for the CDC to
use. Vogel an author researching about rapid EVD states that, “Several teams are working on
prototype kits—small disposable devices resembling home pregnancy tests—that use just a few
drops of blood from a fingertip jab and can be carried easily to remote villages or on door-to-
door screening campaigns” (Vogel). Vogel further states that this test “allows a health worker to
collect a blood sample directly from a pricked finger onto a pad on one end of a diagnostic test
strip,” which if the patient is infected or not, the strip would show a response (Vogel). In another
article, Baker the author, points out the difference between the costs of these types of
experimental, portable tests that are being developed. He emphasizes that, “These tests, which
would cost anywhere from $2 to $10...could also be used in airports to confirm whether someone
with symptoms has Ebola” (Baker). Baker also further points out you could use this test
anywhere you would like to test high risk patients with the ability for anyone to work the test and
read the results (Baker).
Even though these tests are currently being researched, the scientists with this idea still
need to perfect these tests to make them as good as the PCR test without the complications. If
Corgenix successfully perfects the test, these tests would ideally be non-expensive, have a fast

turn around rate, and able to detect disease from just a finger prick, making it possible to test
more people accurately and faster. Vogel posits that, if a team ended up making this test
successful with these aspects “tests could also be helpful in screening patients entering non-
Ebola health centers or travelers at airports” (Vogel). Research confirms the needs to have
inexpensive, rapid testing, to be able to test people who are in any certain type of risk of Ebola or
other filoviruses, due to travel. With this type of test, healthcare workers would be able to test
anyone at risk, quickly and inexpensively; without having to know where the patient was
infected. Having a faster test would also drastically decrease the spreading of Ebola and other
filoviruses because of being able to identify and treat at risk patients faster.
Solution 3: Vaccine
Background to Vaccines as a Solution
One possible solution to control the spread of Filoviruses or viral hemorrhagic fevers
(VHF) is the creation and widespread distribution of a vaccine. There is currently no cure for the
most publicized Filovirus, EVD. Developing a vaccination is a key way to reduce disease
mortality and spread of this disease.
The current outbreak of EVD can be compared to the height of the Polio outbreaks in the
United States in the 1950’s. The population was under informed about the cause of the disease
and its spread and fear was catching. Much like Polio, people are afraid of catching EVD
because there is no cure and both diseases can be transmitted through bodily fluids, although
Polio is limited to transmission through fecal matter and saliva (“Polio”). Polio is currently very
nearly eradicated, mainly because of vaccines. There were two main Polio vaccine developers
focused on different methods of vaccination and vaccine administration. The first developer,

Salk, developed a vaccine with an inactive Poliovirus (IPV) that was mass-produced through
help from March of Dimes fundraising efforts. The vaccine was administered through a shot and
required boosters (Blume). Sabin, the other developer, developed an oral medication containing
active Polio virus, which went on to become more common due to easier administration, lasting
effectiveness, and its ability to improve community health. Through later testing, it was revealed
that the Sabin vaccine can cause Polio in a very low number of cases (“Polio”). The success of
vaccines in combating Polio is because of the large number of people that were vaccinated. This
high percent of the population receiving a vaccination is referred to as herd immunity, if a high
enough percent receive the vaccination then it protects the small number of people who have not
been vaccinated (Stern).
When considering a vaccine as a solution to containing the spread of VHF, there are
several factors to be mindful of when evaluating a vaccine that contribute to its efficacy. These
factors include the method of vaccine administration; nasally, orally, or injected into the muscle
are common ways to administer vaccines. Another factor that should be evaluated is the number
of doses of the vaccine and if later boosters required to be immune from VHF. The more
required participation of the public, the harder it will be to achieve herd immunity. A higher
number of doses or boosters will also add to the cost of the vaccine, which should be as low as
possible. A high cost would act as a barrier to the general public receiving the vaccine, especially
because the region where the current outbreak originated is extremely poor.
Rational vaccine design is another factor to consider, as a good design will, “Bind the
germline antibody precursor, select for the appropriate primary recombinational events, and
direct its somatic mutations toward the appropriate mature form,” (Nabel). Also as with the
Polio vaccine, the benefits and costs of using a live virus versus inactivated virus in the vaccine

must be carefully weighed. Although a live virus may be more effective, as was the case with
Polio, it could contribute to the public’s fears and prevent people from immunizing themselves
and their families (“Polio”).
Time to develop and manufacture the vaccine is critical, in preventing new cases and
VHF related deaths. Domestically a way to shorten development time is to focus energy and
funding on vaccines that are in clinical trial or have approval to begin clinical trials from the
FDA. Vaccines that are developed should be tested for efficacy on multiple strains of EVD, as a
way to prevent future outbreaks (Kanapathipillai et al.). In short these factors contribute to
achieving herd immunity, which may provide the best way to contain VHF.
Current State of Ebola Vaccines
There are no vaccines with FDA approval to treat EVD (“Ebola Virus Disease
Information for Clinicians in U.S. Healthcare Settings”). According to the CDC’s EVD fact page
there are several government agencies working with private companies to develop a vaccine for
EVD. There are also public health agencies in other countries, such as Canada, working on
promising vaccines, as well as privately operated pharmaceutical companies that are developing
vaccines. The following is a summary of the most well known and promising VHF vaccines.
National Health Institute’s National Institute of Allergy and Infectious Disease (NIAID) is
working with GlaxoSmithKline (GSK) to develop a vaccine called cAd3-EBOV that is not made
up of “Infectious Ebola virus material,” and is incorporated into a chimpanzee vector
(“Ebola/Marburg”; Kanapathipillai et al.). The vector causes the immune system to react to the
proteins in the vector. The viral vector will not replicate once the desired genes are inserted into
the system (“Ebola/Marburg”). The vaccine cAd3-EBOV has been tested in chimpanzees with

complete efficacy and has been approved by the FDA to start phase 1 clinical trials in humans
(Kanapathipillai et al.). This vaccine is being tested in two clinical trials for protection against
different strains of EVD. The first trial is testing its effectiveness against the Zaire strain and is
the monovalent, for a single disease, form of the vaccine. The other trial uses the bivalent,
directed at conferring immunity for two diseases, form of cAd3-EBOV to test effectiveness on
the Sudan strain (Kanapathipillai et al.). The studies for both forms of the vaccine are small, the
monovalent form will have 60 participants and the bivalent form will contain 20, non-
randomized, and open label subjects (Kanapathipillai et al.).
Another branch of NIAID, Division of Microbiology and Infectious Diseases, is
partnering with Crucell, a biopharmaceutical company, to develop a different kind of vaccine
than cAd3-EBOV. Crucell’s vaccine would be for EVD, as well as MVD, and is based on
recombining adenovirus vectors. There is a planned clinical trial set to begin in the next year or
so (“Ebola/Marburg”).
NIAID is also funding a project at Profectus Biosciences, which is attempting to create
“A recombinant vesicular stomatitis virus vectored vaccine against Ebolavirus”
(“Ebola/Marburg”). Researchers are working on developing the best methods for designing this
vector before applying for any clinical trials (“Ebola/Marburg”).
Bavarian Nordic is receiving support from NIAID in its early stages of researching a
Marburg vaccine incorporating the Modified Vaccina Ankara vector (“Ebola/Marburg”). NIAID
is not only working with private companies, but also Universities researching EVD vaccines.
One promising approach is from Thomas Jefferson University, where researchers are using the
rabies virus as a vaccine platform for EVD (“Ebola/Marburg”). This platform has shown promise
in protecting animals against infection. The current testing uses a live virus, but researchers at

Thomas Jefferson are working on creating a version of this vaccine with an inactive virus for use
in humans. The animal version will continue testing to hopefully be used on wild animals in
Africa to prevent animals spreading the virus to people (“Ebola/Marburg).
The Department of Defense is another U.S. government agency that is working on
developing a vaccine for Ebola. Department of Defense Secretary Hagel explained at press
conference in September 2014 that the department has approval for a clinical trial to test for a
vaccine, which will be tested at the Walter Reed Army Institute of Research (Phellerin).
In addition to U.S. government agencies, other countries’ health agencies are partnering with
private companies that are researching potential vaccines for Filoviruses. For example, NewLink
Genetics Corporation did a small study on monkeys with a new vaccine they are developing
(Fox). The idea to use rVSV as a vector for a vaccine against Ebola or Marburg has existed since
2005, but it was not until the most recent outbreak of EVD that private companies began to
pursue an rVSV based vaccine (Bausch). The vaccine uses the common cold virus as a vehicle to
transport Ebola genetic material. What makes NewLink’s vaccine unique is the method, in which
it is administered. While many vaccines are given as shots, this one is a Nasal spray (Fox). They
are now partnering with the Public Health Agency of Canada to begin testing the vaccine, named
rVSVΔG-EBOV-GP, in the United States in a clinical trial. Canada’s public health agency has
donated 800 doses of rVSVΔG-EBOV-GP to the WHO, which is examining ways to test the
vaccine in Europe and sub-Saharan Africa (Kanapathipillai et al.). Other trials of rVSV based
vaccines for EVD have been successful through oral doses and given full protection in as little as
thirty minutes, in tests in non-human primates (Bausch).

How to use Vaccines as a Solution
In order to use vaccines as a way to control the spread of Filoviruses, government
agencies must communicate and facilitate funding for vaccine development. Vaccines for
Filoviruses should also receive breakthrough therapy status from the FDA to expedite safe
vaccine testing and once a safe and effective vaccine is developed, the general public should be
vaccinated, the same way Polio and MMR vaccines have been given.
Today many government agencies are currently at different testing stages on vaccines for
different Filoviruses. Unfortunately, these agencies are not under the same pressure as other
researchers to publish, so the discoveries they make often stay within agency walls. Recently,
WHO had a meeting in Geneva, in late September 2014, to discuss prominent potential vaccines
and ways to maximize efficacy. They encouraged clinical trials for the vaccines to be accelerated
and promoted the position that all results should be shared to help other researchers
(Kanapathipillai et al.) This encouragement by WHO to share findings could be further
developed to advance vaccine development as a solution. By creating a global health policy that
during life threatening outbreaks of a disease, government agencies and private companies agree
to share relevant research to find a vaccine or cure faster, unnecessary loss of life could be
minimized and vaccines could be available for VHF. While developing and testing a vaccine can
be quite expensive, and challenging for smaller companies or universities to continue testing a
promising vaccine, there are other options. Governments and nonprofits as well as larger
companies can and should consider new partnerships as a way to ensure ideas from small
entities are tested. As a way to encourage these partnerships and potentially recoup costs, if a
vaccine created through these partnerships is marketed, then all developing participant entities
could retain a percentage of sales or patent.

Once a vaccine is developed and approved for clinical use to prevent VHF, getting the
general public vaccinated may be challenging. There is a court case, Jacobson v Massachusetts,
that lays the groundwork for compulsory vaccinations (Joseph). The interpretation of this law
does allow citizens to choose not to vaccinate themselves or their children for religious reasons
(Joseph). Due to the importance of herd immunity in vaccine efficacy, even a small percentage
of the general public refusing a VHF inoculation religious grounds could cause VHF flare ups
and lengthen the time it takes to eradicate these diseases, as seen in recent measles outbreaks
(“Polio”).
While vaccines have the potential to control the spread of filoviruses, the vaccine solution
has several potential problems. One of the problems is the way these vaccines are tested; clinical
trials contain small numbers of participants who are healthy and fail to accurately account for the
health of at risk populations (Nabel). The sample sizes are incredibly small for cAd3-EBOV and
rVSVΔG-EBOV-GP, the most promising vaccine candidates, so the clinical trials “Will only
provide data on adverse events,” (Kanapathipillai et al.). The small number of participants in
clinical trials could lead to a vaccine being approved without enough testing and when the larger
population is exposed unforeseen adverse effects similar to the Polio vaccine (Nabel). Another
problem associated with vaccines is high cost of development for a vaccine; one way to combat
this problem is to test the vaccine on more than one disease as is the case with GSK’s cAd3-
EBOV vaccine (Nabel; Kanapathipillai et al.). Another problem associated with cost is
distributing a vaccine in underdeveloped countries, including those in West Africa that are
currently experiencing the worst of the Ebola outbreak. EVD has torn apart the medical
infrastructure of Western Africa, many health workers have been killed or are too weak to return
to work and international aid workers are afraid to visit the region. Additionally people are afraid

to visit hospitals or clinics because of the infected people they might encounter (Farrar and Piot).
The lack of trained healthcare workers and fear of healthcare settings combines to create a
perfect storm of a population that will not respond well to vaccination efforts (Nabel). There is
already a resistance to vaccination in the affected countries, including Nigeria, which will make
changing public opinion to be in favor of vaccination against VHF extremely difficult (Nabel).
These countries also have limited resources and are spread out with the average citizen having
limited ability to travel, which will make getting the vaccine to the majority of the population
very resource intensive (Nabel).
Policy Recommendation
There is an ever-growing problem with viral hemorrhagic fevers. While the world is
actively pursuing a solution to this current EVD epidemic, what solution should they be focusing
on? The focus should be on a solution that makes sense economically, can be implemented
quickly and easily, and is very effective at combating the spread of EVD.
To recap, one common solution that readily comes to mind is to develop a vaccine. It is
typically the duty of the country’s or world’s health organization (s) to attempt to combat the
disease by seeking a cure for the disease. However, while a vaccine may potentially be the
long-term solution for combatting the spread of VHF it will take years for a vaccine to be created
and go through all of the clinical trials needed for approval by the FDA. Until a vaccine is FDA
approved, it is not widely accepted for the combatting of a rapidly spreading disease. Although
there is currently progress being made to develop a vaccine and some vaccines have already been
sent to be tested in clinical trials, the road to a cure is still a figment of the fairly distant
future. The production of a vaccine is very costly, which makes it nearly impossible for smaller

companies or universities to get involved in the research and production of a vaccine. There is
also a lack of government funding supporting the discovery and testing of a vaccine for
VHF. Even if a vaccine were created by a company the cost of the vaccine could be
astronomically expensive because the company would be trying to recoup the cost of developing
and testing the vaccine while also trying to make profit from it. The cost associated with the
development and testing of a vaccine along with the amount of time it takes to develop it, make a
vaccine not a feasible solution to stop the spread of VHF currently.
Given the above, the best current solution to limit the spread of VHF is to employ a
multifaceted approach by developing and combining the use of rapid testing and implementing
policies and procedures with regard to mass travel. By combining these two solutions to the
problem, the spread of VHFs can be limited by testing travelers that are leaving infected
countries through the use of rapid testing. Those with the disease would be kept from traveling
to other countries and thus spreading the disease. This strategy would limit the spread of these
diseases to other countries until a cure or vaccine can be developed.
As detailed above, the PCR test is being used to test individuals to see if they have MVD
or EVD. This PCR test has a long wait period to receive results and is also very expensive
(about $100 per test) (Baker). However, the test being developed by Corgenix, which is similar
to a pregnancy test, shows promise. It costs about $2 per test and gives fast results by showing a
response based on whether the individual is infected or not (Baker). The Corgenix test can be
administered by pricking the finger of an individual and then placing the drop of blood on the
paper test to get the results (Baker). Efforts to develop this test further to be as accurate as the
PCR test should be undertaken (Baker). To help speed the process of finalizing the development
of this rapid test, governments should provide funding and give incentives to the developer.

The Corgenix rapid test, once finalized, should be used as part of the procedure of exiting a
country that is infected with Ebola or Marburg. The procedures that Sierra Leone, Guinea, and
Liberia are using would be more efficient with the use of this rapid test. All individuals that are
at any possible risk of being infected with a VHF should have to take this test if they want to
leave the country. If individuals refuse to take the test they should not be allowed to fly or travel
to another country until they are tested. Individuals should be tested by a professional with
medical knowledge such as a nurse or physician. Those who test positive would then be required
to have a physician conduct further tests to verify the results and begin treatment. The
individuals who test positive should not be allowed to fly or leave the country for twenty-one
days unless the physician determines through extensive testing that the individual does not, in
fact, have VHF. Travelers should also be required to reveal their travel history to airport
officials so if the person is infected they can determine who they came into contact with and
what areas are at risk. Airport officials should check every person’s travel history and make sure
it is accurate by checking passports and running background checks of the person. If travelers do
not provide accurate travel history they could face prosecution for lying to a government official.
The use of the Corgenix test coupled with these mass travel policy changes would vastly
diminish the amount of individuals who ‘slip through the cracks.’
To implement the PCR test development and use recommendation, WHO and world
leaders, such as the U.S., must coordinate their efforts. Without such coordination, any policy
recommendation will fail. Accordingly, to begin the process, the U.S. could request WHO and
other world leaders, including the countries with VHF infection issues, to partner with each other
to undertake the development of the Corgenix rapid test as well as the implementation of the
travel precautions and restrictions. Such a partnership would benefit the infected countries and

the non-infected countries alike. More importantly, such a coordinated effort would provide an
ongoing global health response network to continue to promote rapid response options to future
VHF outbreaks or other similar outbreaks.
Conclusion
After surveying all of the possible solutions to stop the spread of filoviruses, we assert
that Corgenix rapid testing coupled with changes to mass transportation checkpoints is the most
effective way to contain the spread of VHF. When making a decision on what solution to
choose, we considered many different factors including the cost, the length of time it would take,
and ease of implementation. Through research of past outbreaks and how they were handled, we
have learned that limiting the spread of the filoviruses is key before any other actions can be
taken. If actions are not taken to stop the spread of VHF, they could lead to thousands of
otherwise preventable deaths. As suggested by the aforementioned data, if nothing is done to
prevent the spread of these debilitating diseases the Center for Disease Control and Prevention
has projected that there may be more than 1.4 million people infected by January 2015 (Michaud
and Kates). This could result in wide spread panic throughout the world, outside of developing
countries. Thus, measures should be taken to limit the spread of these viruses. Therefore, our
solution should be implemented as soon as possible so that it can begin to limit the spread of
these filoviruses and save lives around the world.

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