August 1, 2015

Ebola vaccine trial

You’ve probably heard that there are positive results from an Ebola vaccine trial (3News, Radio NZ, Stuff, Herald). The stories are all actually good. Here’s the (open-access) research paper

The vaccine was genetically engineered: it’s a live virus for an animal disease that doesn’t spread in humans, modified to produce just one Ebola protein. Having a live virus makes the immune system respond more enthusiastically, but you wouldn’t want to risk a vaccine containing anything even remotely like live Ebola virus. Genetic engineering produces a live virus that contains none of the functional bits of Ebola, so that even if it (improbably ) turned out to be able to spread, it wouldn’t be a big deal.

The basic trial design was to find Ebola cases and vaccinate their contacts and the contacts of their contacts, with randomisation between immediate vaccination and vaccination 21 days later.  The design was a good compromise: the public-health authorities need to know if the vaccine works in order to decide whether it can be used to control future epidemics, but since it probably does little harm, most people would want to be vaccinated.  With this design, everyone the doctors talk to will get the vaccine, either immediately or in three weeks. The design is also cost-effective, since everyone you need to vaccinate is someone the public health system would want to check up on anyway.

In practice, not everyone eligible will be end up being vaccinated: some will refuse, and some will not be contactable. You have to decide how to include the unvaccinated people in the analysis.  In this trial, no-one in the immediate-vaccination group who actually got vaccinated ended up with Ebola, which is what gives the headline 100% success rate. If you compare people who were randomised to immediate vaccination, whether they got it or not, with those who were randomised to delayed vaccination (a more common analysis strategy), the vaccine was still estimated as 75% effective.

There’s still some work to do: when the vaccine is used, it will be important to keep track as far as possible of how well it works. That’s important because we need to know if it’s worth working on a new vaccine, or whether to divert resources to research on treatments for those who are infected, or to other diseases.  For a change, though, this is good news.

 

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Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »