Celebrating Congolese doctor Jean-Jacques Muyembe, the man behind breakthrough of Ebola cure
London, August 17, 2019 (AltAfrica)- In a development that transforms the fight against Ebola, two experimental treatments are working so well that they will now be offered to all patients in the Democratic Republic of Congo, scientists announced on Monday.
One African hero, is credited with the success. Dr Jean-Jacques Muyembe Tamfum, a Congolese who himself was almost a victim. He has devoted the last four decades to researching Ebola virus disease. But to God be the glory that he is alive to celebrate his achievement and save the mankind from another catastrophe
Jean-Jacques Muyembe-Tamfum has investigated ten outbreaks of Ebola and Marburg, which must be some kind of record, but were it not for a simple precaution he took during the first outbreak of Ebola, in 1976, then he may not have lived to see the breakthrough
His breakthrough, the antibody-based treatments are quite powerful — “Now we can say that 90 percent can come out of treatment cured,” one scientist said — and they raise hopes that the disastrous epidemic in eastern Congo can soon be stopped and future outbreaks more easily contained.
Two people with Ebola who were treated with the new drugs in the city of Goma in the Democratic Republic of the Congo (DRC) have been declared “cured,”
The drugs were being tested as part of a randomized clinical trial in four towns in the DRC. This week, researchers halted the trial early when preliminary results showed that two of the four drugs being tested — known as REGN-EB3 and mAb114 — were found to be more effective.
Until now, the medical community had no reliable way to treat people infected with Ebola.
In the current DRC Ebola outbreak, 67 percent of those infected with the virus have died. But with one of the new drugs, up to 94 percent of people recovered.
These early results bring scientists closer to curing the disease, which has resulted in at least 1,900 deathsTrusted Source in the DRC since the outbreak began last summer.
But while the world celebrates a rare achievement of great magnitude, the world should also raise glasses to a man described as Ebola hero Dr Jean-Jacques Muyembe
-“I spent four decades of my life thinking how to treat patients with the Ebola virus. So this is the achievement of my life,” Dr Jean-Jacques Muyembe, who with his team of researchers, discovered a new Ebola treatment that can cure symptoms in just an hour told the BBC.
Jean-Jacques Muyembe Tamfum was part of the research team that investigated the first known outbreak of Ebola virus disease in 1976.
“From now on, we will no longer say that Ebola is incurable,” said Dr Muyembe, who is the director general of Congo’s National Institute for Biomedical Research, which has overseen the trial. “These advances will help save thousands of lives.”
Muyembe, who joined scientists recently to announce the trial results, said, news of a cure could change the course of this outbreak.
“Now we can say that 90 percent can come out of treatment cured, they will start believing it and developing trust,” said the 77-year-old, who was part of the team that discovered Ebola 43 years ago. “The first ones to transmit this information will be the patients themselves.”
Dr. Muyembe, who has been referred to as a “true hero,” has been fighting Ebola since it first appeared in the DRC (then Zaire) in 1976.
At age 34, Muyembe was the first virologist ever to see an Ebola patient, and he has helped fight all of the outbreaks to hit his country since.
He pioneered the use of survivors’ blood serum — which contains antibodies — in order to save patients. The two experiment treatments that proved successful recently descend in part from his original research, according to The New York Times.
Jean-Jacques Muyembe Tamfum worked on the World Health Organization (WHO) team that implemented detection and control measures in the first documented urban outbreak of Ebola in Kikwit in 1995 in the Democratic Republic of the Congo.
Muyembe is Director-General of the National Institute for Biomedical Research and Professor of Microbiology at Kinshasa University Medical School in the Democratic Republic of the Congo.
He worked at the Institut Pasteur de Dakar in Senegal in 1981 and the US Centers for Disease Control and Prevention in 1981 in the Special Pathogens Branch for the study of Ebola and Marburg viruses and has chaired several international committees for the control of Ebola outbreaks
He was appointed dean of the Faculty of Kinshasa University Medical school in 1978, having received his PhD in virology from the University of Leuven in Belgium (1973) and graduated in medicine from the University of Lovanium in Kinshasa (1969).
When asked about how he felt about this, he said: “I’m a little sentimental. I had this idea a long time ago, and I’ve waited patiently for it. I’m very happy, and I can’t believe it.”
According to the BBC, the new drugs, named REGN-EB3 and mAb114, work by attacking the Ebola virus with antibodies, neutralising its impact on human cells.
His first encounter with Ebola came at a Belgian mission hospital in Yambuku in Equateur Province of the Democratic Republic of the Congo (DRC). “We heard that a lot of people were dying, even the Catholic sisters”, recalls Muyembe, who was then a young Professor of Microbiology at Kinshasa University Medical School.
“The Minister of Health ordered me to go there and assess the situation.”When he arrived at the hospital, Muyembe was astonished to find that the staff had fled and the wards were deserted save for a child. “The mother said it was malaria but I think it was probably Ebola because the child died in the night.”
The next day, he awoke to find the hospital full of anxious villagers, many of whom were also feverish: “Word had got out that we had come from Kinshasa with medicine. I thought it was typhoid fever so I lined them up and collected blood. I was immediately struck by the fact that when I removed the syringe from people’s arms the site of the puncture wounds bled profusely. My fingers and hands were soiled with blood. I just used water and soap to wash it off.”
Next, Muyembe went to the homes of three nuns who had died in the night and took liver biopsies using a long steel rod, which involved even more blood and, once again, he had to wash with soap and water. In all, 30 people would be infected with Ebola at the mission and 22 would die.
The liver biopsies proved inconclusive and it was only when Muyembe, with the help of a Belgian medical colleague, persuaded a fourth nurse to accompany him to Kinshasa and sent her blood to the Institute of Tropical Medicine in Antwerp for analysis, from where it was forwarded to the US Centers for Disease Control and Prevention, that they learnt they had discovered a new filovirus.
“We had no protective equipment, we didn’t even have chlorine”, says Muyembe. “I was lucky, yes, very lucky.”Since then, Muyembe, now Director of the National Institute for Biomedical Research (INRB) in Kinshasa and a scientific adviser to WHO, has become one of the foremost medical researchers in Africa.
“Jean-Jacques Muyembe is a unique and courageous African health leader”, says Peter Piot, Professor of Global Health and Director of the London School of Hygiene & Tropical Medicine, who first met Muyembe at Yambuku.
“He stayed in Congo during decades of very turbulent history and succeeded in maintaining scientific excellence and integrity throughout. He has trained several generations of much needed physicians, microbiologists, and public health workers in DRC. He is a role model for many of us.”
At the INRB, Muyembe, who is 73, heads a team of 15 researchers studying everything from sleeping sickness to the Bas-Congo virus. His laboratory is also responsible for the surveillance of measles, yellow fever, and polio.
In recognition of his many contributions to medical research and public health, earlier this month the Mérieux Foundation awarded him the €500 000 2015 Christophe Mérieux Prize to fund further research into infectious diseases in the Congo Basin.
It’s all a far cry from the village in Bandundu where he grew up a poor farmer’s son. Educated by Jesuits, his interest in microbiology emerged when he went to Lovanium University in Kinshasa, in 1962, to study medicine and in his first year was given the task of investigating childhood immunity to diphtheria.
After graduating MD, he obtained a PhD in virology at the University of Leuven in Belgium, before returning to DRC in 1973. There he quickly found himself thrust into outbreak control as he was dispatched to investigate an epidemic of cholera near the border with Angola, followed by a fatal outbreak of meningitis in army recruits.
“That’s when I realised I couldn’t just study microbes in the laboratory, I had to go into the field”, he says. His work in outbreak control has saved many lives, but perhaps his greatest contribution has been to recognise the sociocultural dimension of Ebola and that outbreaks can be stopped in their tracks if hospitals practise strict infection control and health authorities prioritise community engagement.
According to David Heymann, Head and Senior Fellow at Chatham House Centre on Global Health Security, who worked alongside Muyembe at Yambuku and a subsequent Ebola outbreak in Kikwit in the DRC in 1995, Muyembe’s first action when he arrives at an outbreak is to call a meeting of local community leaders and chiefs.
“He speaks about those who are infected as being full of evil spirits that cause illness as they attempt to escape”, says Heymann. “Jean-Jacques Muyembe also discusses with them the reason that there are foreigners with him—because these spirits are stronger than most, and that he needs foreign help. Outbreaks then stop rapidly.”
Muyembe’s approach applies particularly to traditional burial practices. Outside interventions can be seen as an attack on community traditions, he explains. “By seizing their cadavers we hurt their spirit.”
Instead, Jean-Jacques Muyembe and his community relay teams facilitate dignified but safe burials by distributing gloves and protective equipment to family members participating in funerary rites. Indeed, Heymann points out that while the world was focused on the Ebola outbreak in west Africa last summer, in August, 2014, Muyembe and his team stopped yet another Ebola outbreak in the DRC in less than 3 months.
One can only wonder what would have transpired in west Africa had Muyembe’s methods been adopted there with similar urgency.
In this special interview, Jean-Jacques Muyembe Tamfum talks to Fiona Fleck of W.H.O about those experiences and how he and his colleagues are using the knowledge they have built up in recent Ebola outbreaks
Q: How did you become interested in epidemiology?
A: After graduating in medicine, I decided to do a PhD in virology at the University of Leuven in Belgium where I started to do some research in the treatment of viral infections, working with mice, but when I went back to Congo, at that time called Zaïre, I was unable to pursue my work, because there were no labs there and no laboratory animals. That year, 1974, there was a cholera outbreak in the Port of Matadi, and I was dispatched to investigate. The following year I was sent to investigate an outbreak of bacterial meningitis that was killing a lot of soldiers in the military camp of Kitona in the Kongo central province. I went to the location, and isolated the bacteria. The government launched a vaccination campaign, and that was the end of the epidemic.
Q: So was that how you started to work on outbreak investigations?
A: Yes, those two experiences made me realise that I couldn’t just study microbes in the laboratory, but needed to get into the field. Then, in 1976, there was an outbreak of a mysterious disease at a Catholic mission run by Belgian nuns in Yambuku, in the north of the country. The health minister sent me and Dr K Omombo to take a look. Yambuku was a remote village in the forest and when I arrived, the place was deserted. It was as if nobody lived there. It was the same at the hospital. Most of the nurses were dead, and all the patients had fled except for one patient, a child. The mother said the child had malaria, but then the child died in the night. The next day villagers showed up at the hospital. They’d heard that we had come from Kinshasa with medicine. Many of them had fever and diarrhoea. I thought they perhaps had typhoid fever, and I collected blood samples. But I noticed that when I removed the needle from people’s arms, the puncture wounds bled a lot. My fingers and hands were covered in blood. So I used water and soap to wash it off.
Q: You didn’t wear gloves?
A: Back then, we used our bare hands, we had no protective clothing. Later, I took some liver samples from two corpses, using a steel rod and so of course there was even more blood, and again I washed with soap and water. The liver biopsies were inconclusive, but then I examined a Belgian nun who had developed a fever, and I said to her, “since we don’t know how to diagnose this disease, I’m going to take you to Kinshasa.” She said: “I can’t leave because they’re going to think that I’m escaping because of the disease.” Finally, we persuaded her and we left. When we got to Kinshasa, we took a blood sample from her and sent it to the Institute of Tropical Medicine in Antwerp (Belgium) where Peter Piot worked. It was from the blood of this nun that Piot first isolated the Ebola virus.
Q: It’s amazing that you survived.
A: Yes, it is extraordinary. If I had not washed my hands, I would have died. After Yambuku there were no more outbreaks for a long time. Then, in 1995, I got a call from the director of Kikwit General Hospital saying that there had been an outbreak of bloody diarrhoea that had already caused several deaths. I also got a message from the Diocese of Kikwit asking me to come and help. I suspected that it was shigellosis or something like that and that I could resolve the problem quickly, so I left with only two pairs of trousers. When I got there, however, and had a look around, I realised it was not shigellosis. It was Ebola. And Kikwit was different to Yambuku; this was a town, not a village, so the risk of the disease spreading was far greater. People said to me, how can it be Ebola? We are at least 1000 kilometres away from Yambuku. But I was quite sure. So, I collected samples and sent them to the Centers for Disease Prevention and Control through the Institute of Tropical Medicine in Antwerp. Two days later, they confirmed that it was Ebola.
Q: What happened then?
A: There was complete panic, but I started setting up teams to care for the patients at the hospital. I met with a group of doctors and asked who was ready to go into quarantine with the patients. Nobody looked at me, but after a few minutes one of them got up and said “I am.” He was a young doctor. I said “Are you sure? You will be put in isolation and won’t be able to leave for at least 48 hours.” He agreed. So did the nurses. That was the beginning of the emergency response. Then WHO was notified and sent experts led by Dr David Heymann to join us. I led the response to the epidemic, which eventually killed at least 254 people. Since then, of course, more Ebola outbreaks have occurred in my country, in 2007, 2008, 2009, 2012, 2014, 2017 and now two in 2018. I have been present at all of them. I’ve spent all my life and my entire career fighting Ebola.
Q: How do you use the knowledge you’ve acquired over all these years to fight against the Ebola epidemic today?
A: I and my colleagues have given presentations at more than 50 conferences. We’ve also published a number of papers. However, my most significant contribution to the fight against Ebola virus disease may be my work on the use of antibodies as the basis for therapeutic medicines, a line of inquiry that is based on observations made during the Kikwit epidemic. My team collected blood from Ebola survivors in Kikwit and gave it to eight patients infected with the virus. Seven of those patients recovered, suggesting the antibodies in convalescent blood acted as a protection. This idea was not accepted by most scientists at the time, but I remained convinced that antibodies could work, so in 2004 I took one of the survivors of the Kikwit epidemic and sent him to the United States of America, where colleagues, including Dr Nancy Sullivan, collected some blood cells from him and cultured them. They managed to produce monoclonal antibodies and gave them to monkeys infected with Ebola. The monkeys all recovered.
Q: There is an ongoing discussion about five experimental therapeutics.
A: Yes, and these studies with antibodies and monkeys led to one of them – mAB 114. So that is certainly an important contribution to finding an effective and safe treatment for Ebola. However, now in the Democratic Republic of the Congo we are focusing on research into the reservoirs of the virus, because we still don’t know where Ebola comes from. For a long time we thought that bats were the reservoir, but we’ve examined thousands of samples and haven’t found it. So we must continue to search.
Q: You have also helped set up research facilities. Can you tell us about how you came to participate in the construction of your research institute?
A: That is a long story. It starts back in 1975 when the Minister of Health asked me to develop the design for an institute like the Pasteur Institute in Paris. At first I was only involved in the design process. Then in 1998, I was appointed director-general of our National Institute for Biomedical Research. WHO set up its polio research laboratory here in 1988 and then the CDC added its influenza lab. I also got a mobile lab which has been paid for by United States Agency for International Development. Last year I signed a contract with the Japan International Cooperation Agency (JICA) to build a US$ 23 million state-of-the-art lab complex, which will include a centre for clinical tests, a conference centre, three biosafety level 3 labs (suitable for work with pathogens which can cause serious/lethal diseases via the inhalation route), and three biosafety level 2 labs (suitable for work with pathogens representing moderate potential hazard). It will be fantastic.
Q: Do you have a lab where you can test for Ebola?
A: We do, but it is not adequate. To date none of my lab technicians or doctors has been infected, which is very important. With the JICA investment we’ll have a high security lab (biosafety level 3) where we can work safely with Ebola samples.
Q: What are the challenges for improving the detection of Ebola in rural areas?
A: Well to begin with our country is huge, about 2.4 million square kilometres, much of it inaccessible by road. So even without the kind of conflict and instability that we have experienced, surveillance is a challenge. The country is divided into 516 health zones and we have a surveillance system in each zone. Community volunteers report health events in their villages, and these reports are collected at the central level. When a health event is considered potentially significant, the province dispatches epidemiologists who can investigate and collect samples. Unfortunately, it can take a week for the sample to arrive at our institute. That’s why we are planning to build labs in each province.
Q: What are the main challenges with the current Ebola outbreak?
A: We are facing many challenges to end this outbreak. The biggest challenge is the security situation, which is characterized by the presence of several active armed groups, the lack of community engagement in some places, and the geographic spread of the transmission in multiple foci.
Q: How is your country managing the outbreak?
A: We have put in place strategies that have been successful in previous outbreaks: early detection of cases, contact tracing, community engagement, safe burial, clinical management of symptoms and psychosocial care. We have also added two new tools since the May 2018 outbreak: vaccination and the use of experimental therapeutics. For the first time we are offering these therapeutics to patients infected with the Ebola virus in the Democratic Republic of the Congo under a compassionate-use protocol and planning to evaluate their efficacy in a randomized controlled trial.
Additional materials from WHO bulletin and The Lancet