Ebola - The Search for a Cure Horizon

It's 10am at the Centers for Disease Control in Atlanta, Georgia.

It has again been a busy week and there's going to be

a lot of issues that we need to address today, so some of the

priority issues are going to be thinking about staffing for Senegal.

We look forward to deploying more staff next week.

Chief Science Officer?

We've started to tackle the issue of the potential mutation of the virus.

At the daily briefing,

American officials are tracking the spread of the deadly Ebola virus.

The outbreak is bad and it's getting worse.

This is the worst Ebola epidemic there's ever been...

A couple of weeks ago, it has surpassed

all previously recorded cases of Ebola.

..and efforts to contain the outbreak are failing.

Do you feel that we're winning against this Ebola outbreak?

I think we're learning from this Ebola outbreak.

And we hope that we will win

but I think we have a lot of work ahead of us.

But there is hope.

I feel so lucky to be alive,

and there's a lot of people dying elsewhere

that are not as fortunate as me.

I believe you all have heard about the outbreak in West Africa.

If we succeed, we would be able to control certain kinds of situations.

Horizon meets the medics fighting Ebola on the front line...

Luckily, in a protective suit, no-one can see if you're crying

and so no-one can tell.

People are very fearful of health care workers and I can understand.

I mean, can you imagine?

They take one of your loved ones away

only to return with the loved one in a body bag.

..and follows the scientists racing to find a cure

for one of the most dangerous killers on Earth.

To scale this up to make 1,000 doses, or 5,000 doses,

that's like trying to get a little hybrid to compete with a Maserati.

This is an extraordinary story of bravery and determination

against a deadly enemy.

Sunday night, two and a half weeks ago.

An RAF plane flew into London from Sierra Leone.

On-board, a British nurse suffering from Ebola.

There were moments on the flight

when I was feeling quite unwell and was afraid.

My temperature went up quite quickly.

It was a scary time.

I first heard in the middle of the night

and began to put the plan into operation.

By the next day, it was in full flow.

In the ambulance, I remember I had a nurse,

I remember her telling me about the police bikes doing relays,

shutting the road off as we drove along.

This is our business, this is what we do.

So, 24 hours a day, seven days a week,

we are here for exactly these sorts of problems.

Will Pooley was about to receive an experimental treatment called ZMapp.

Getting into hospital was...

yeah, a great comfort to me.

The world's attention may temporarily have been

on Britain's first Ebola patient, but the story of the outbreak

began nine months ago, when fear and devastation came to West Africa.

On 6th December last year, a child, much like this one,

living in a remote village in Guinea, West Africa,

died from a mysterious fever.

The boy's symptoms included severe diarrhoea,

vomiting and internal bleeding.

His painful death went unnoticed by the outside world,

and we don't even know his name.

But epidemiologists call the boy "patient zero" -

the first suspected case of what has now become

the largest outbreak of Ebola the world has ever seen.

Within days, the boy's mother, sister and grandmother

all died after suffering the same horrific symptoms.

Then, two local nurses who had treated the family also died.

The epidemic had begun.

How might patient zero have caught Ebola?

Scientists aren't sure, but they think the virus is carried

by African fruit bats, that are not affected by the disease.

Many people in Guinea eat these bats and other bush meat

that could potentially be infected

and that may be how the virus jumps to humans.

But there had never been an outbreak of Ebola in Guinea before,

so patient zero's symptoms were not identified.

Undiagnosed, the virus swept into a neighbouring village,

probably taken there by mourners who had attended the first funerals.

And then it was taken into another village,

and then another, and another.

And so the chain of infection spread ever wider.

So far, in the current outbreak,

every single victim can be traced back to patient zero.

It wasn't until 14 weeks after the first deaths

that the epidemic was confirmed.

At the Centers for Disease Control in Atlanta, Dr Inger Damon believes

this delay has made the outbreak harder to contain.

There was a delay in being able to effectively recognise it

and then to respond to it, and the delay in response,

you see additional generations of cases develop

as people don't know what to do

to protect themselves or protect their communities.

-RADIO:

-'Scientists in France have identified the Ebola virus

'as the source of an outbreak of haemorrhagic fever in Guinea

'which is believed to have...'

-RADIO:

-'..vingt-trois infectes par la fievre Ebola.'

But in late March, as news of the Ebola outbreak was first reported,

the epidemic was already out of control.

This is one of the few treatment centres in Guinea.

It's run by Medecins Sans Frontieres,

the international medical aid agency.

It's a haven of humanity and compassion

for those struck down by this terrible disease.

The medical staff work in conditions most would find hard to imagine.

It's very difficult to interact with people through three pairs of gloves.

I try to touch people and stroke people, because they won't have

had any physical contact with anybody since they've been in there.

When I look in their eyes

and people still don't understand the situation, I see a lot of fear.

If they haven't become confused, I quite often see despair.

SHE SOBS

Ebola is an especially virulent disease.

This is what the virus looks like.

When it enters the body, it courses through the bloodstream,

hijacking the victim's own cells to reproduce as fast as it can.

Then its progeny rampage on, damaging cells

and replicating in ever greater numbers.

It infects the endothelial cells that line blood vessels

and the patient starts bleeding on the inside.

They start to bleed from their gums, from their nose,

they have terrible bloody diarrhoea, vomiting.

They feel terrible.

In the current outbreak,

almost half the patients managed to fight off the virus.

But for those whose immune system isn't strong enough,

their vital organs quickly start to fail.

Quite often when you see the blood, or they start to hiccup,

you know that the end is coming quite soon.

You know they've got maybe one or two days left.

Most patients die within 12 days,

but the dead body of a victim is still contagious.

So, those preparing the deceased for burial are at a very high risk

of catching and then spreading the virus.

It's a bit like erasing somebody.

You put their body and seal it in a body bag,

you take all their possessions, and you burn then

and then you clean away their blood and their faeces,

and then the next patients come.

We allow relatives to come and view the bodies

before we seal the bags, so we bring the bodies to the fence.

I would always try and put flowers or toys around the face of the child

to make it look pleasanter, if we could,

and then the relatives would come and see.

It was always a very hard moment.

And when Ebola sweeps through a village, it leaves fear

and suspicion in its wake.

People are very fearful of health care workers and I can understand.

Can you imagine - a car entering your village with people

who are speaking a language that isn't necessarily your own,

covered from head to toe.

And they take one of your loved ones away,

only to return the loved one in a body bag.

It can be really difficult for people to understand that

we're here to help.

Ebola is a terrible disease, spreading fear and panic.

There has never been a more urgent need to find a cure.

Scientists have been trying to understand how Ebola works

and how it's spread.

It was first identified less than 40 years ago and the extraordinary

story of its discovery begins a long way from tropical Africa...

..in the city of Antwerp, Belgium.

In 1976, a package containing a sample of blood

arrived at Antwerp's Institute of Tropical Medicine,

where Peter Piot was working as a young scientist.

One day, we received a blue Thermos which contained two vials.

Actually, one was broken.

And in some ice, was swimming in there in water and ice,

and it came from Kinshasa.

The scientists in Antwerp had heard reports of a frightening new disease

that had swept through a remote mission station in Central Africa.

The specimen of blood came from a Belgian nun who had died there.

After preparation,

the sample was studied under an electron microscope.

When we saw these worm-like structures coming

out of the electron microscope, we were all a bit breathless,

frankly, and said, "What the hell is this?"

There was only one way to find out.

Go to the source of this mysterious epidemic,

the Congo.

I really couldn't sleep. I was so excited.

We left at five o'clock in the morning.

I didn't know what to think. Central Africa is overwhelming.

It's like flying over a green sea with a river in the middle.

I was just very impatient to get there and to start working.

So, after several hours of flight,

so the plane goes down and lands on this red airstrip

and we're landing and first of all,

the pilots never stopped the engines

because they were so scared and wanted to drop us

and go back to Kinshasa.

The team filmed their expedition, as this rare footage shows.

From the airstrip, they headed off to their final destination -

the ravaged mission station.

And so, we arrived there.

We stopped and we saw three Flemish nuns there and a priest.

I said, "I'm Peter Piot.

"I'm from the Institute of Tropical Medicine and we're coming here to

"stop the epidemic and to help you."

At 27, you think you can really save the world.

And they said, "No, don't come near, don't come

"near because we're all going to die."

15 nuns and nurses

and an unknown number of villagers had already been struck down.

The team decided to name the mystery virus after the Ebola river

that flowed nearby.

Their first priority was to work out how the virus was being spread.

They travelled to nearby villages, looking for clues.

It was already rainy season.

Some villages, we could not reach by road, and some we had to walk to.

And some, we went by canoe.

And when they found people who had contracted the virus,

many were beyond help.

They had this look in their eyes, staring at us,

often in excruciating pain, particularly abdominal pain.

They were coughing. Several of them had blood coming out of their nose.

The scientists noticed that many carriers of the disease were

young women who had visited the mission station hospital.

What we found was that this was a hospital with no doctor, basically.

The nuns and local nurses were running it, frankly,

in a heroic way.

But they had a major shortage of materials, including syringes

and needles,

and so we found that the antenatal consultation was very popular.

And at the consultation, they would get an injection, and every morning,

five needles and syringes were given to the antenatal consultations.

And they were reused and reused and reused.

The needles weren't sterilised and it quickly became clear

that this was how the virus was being spread from person to person.

But then, what we also found was that about one week after a funeral

of someone with Ebola infection, you could see another outbreak.

It wasn't just reusing the unsterilized needles.

The scientists soon realised that the ritual of washing

bodies before burial was also helping to spread the disease.

The team had made a significant breakthrough.

Ebola clearly wasn't an airborne virus,

but was only spread through physical contact and bodily fluids.

Ebola was identified at a time when suspicion

and distrust between the West and the Soviet Union ran deep.

It was the Cold War.

What might happen

if an enemy tried to use the virus in a biological weapon?

Could a treatment, or even a vaccine, be developed?

At Porton Down, Britain's military research base, scientists

took a close interest in the new disease, as Horizon reported.

'The most dangerous viruses from around the world are sent

'here for identification and new ones keep turning up.

'It wasn't until 1976 that this virus was identified. It's called Ebola.'

40 years later,

this part of Porton Down is no longer attached to the military.

It's now a public health laboratory

and it's home to a store of live Ebola virus.

Dr Tim Brooks look after it.

So what you're doing is you're taking the separated

plasma from the whole blood.

'The more we know about how this virus is put together,

'how it interacts with cells,

'how it affects cells in living animals,'

the easier it is for us to work out how to control the disease and to

begin to develop both vaccines and drugs that might cure the disease.

Part of our work here, then, is to provide the front line diagnostic

service for the United Kingdom for a whole range of unpleasant

diseases that can be brought back here, one of which is Ebola.

In the field, diagnosing patients quickly is an important

part of trying to contain the outbreak.

So Porton Down scientists have been sent to the front line to help

the relief effort.

I was in Guinea, at the epicentre, in Gueckedou.

And I was there testing for the patient samples.

The samples would come to us double-contained in a bleach bucket

to make sure they were safe,

and then we would test them for the virus.

Outside of these labs, there was a perimeter fence where patients would

be allowed to walk around and sit outside in the sun or in the shade.

So you would see some people who were very sick,

who would just want some fresh air, and would be sitting down,

and would need help in and out of the ward.

-RADIO:

-'The World Health Organisation says the current

'outbreak of the deadly Ebola virus in West Africa is

'one of the most challenging it has ever faced.'

By early April, Ebola was spreading from Guinea to neighbouring

Sierra Leone and Liberia,

where there is one doctor for every 71,000 people, compared to

Britain, which has approximately one doctor to every 350 people.

Local health facilities had been completely overwhelmed.

The health workers from MSF visited one hospital in Monrovia.

There was supposed to be a doctor in there, who I'd heard had died

the day before, and I couldn't find him on any of the beds.

So then I checked the latrines,

and the poor man had died in the toilet and was still there.

They hadn't moved him.

And apparently, he was there for another two days after that,

before the burial team came and took him away.

There were a lot of people in the confirmed area who

were in great pain and groaning, or being sick, or calling out.

If Dante had written a tenth Circle of Hell,

this would have been it, I think.

You try to be efficient. Um...

Luckily, in a protective suit, no-one can see if you're crying,

so no-one can tell.

The British nurse Will Pooley was already

working as a volunteer in Sierra Leone.

As the outbreak spread, he went to one of the worst affected

areas of the country to help at a hospital where several nurses

had already died after contracting Ebola from their patients.

Everyone is aware that it could be them next.

And as you're providing that care for those colleagues,

you might be risking infection.

And so the team, they soldier on. But everyone... There's fear.

And then one night, Will went to bed with a sore throat.

I woke up in the morning feeling very fatigued.

My body was aching all over. I had a headache and a temperature.

At lunchtime, I went and spoke to the doctors

and they recommended that I have a blood test to test for Ebola.

Later that day, the results came through.

When the doctor told me that I was positive for Ebola...

Obviously, having seen what Ebola does to people, it was worrying.

I remember my very first concern was having to tell my parents.

Of course, I was scared.

It feels like you're hosting a really malevolent force

inside your body.

Also, the knowledge that however I was feeling,

especially in the early stages, that the virus could,

or likely would, get stronger

and I would have more of it inside me.

And knowing the consequences for my body of that increasing viral load.

The prospect of that was very frightening.

But for all the fear about Ebola, it is in fact a very rare disease.

Since 1976, in all the previous recorded outbreaks before this

one, a total of around 1,700 people have died.

So this current epidemic is worse than all the previous

outbreaks put together.

And as spring turned to summer, the death toll rose higher and higher.

-RADIO:

-'The World Health Organisation has reported a sharp increase in

'the number of people dying

'from Ebola disease in West Africa.'

As the number of cases increased, there was

an even greater risk of the disease being spread further afield.

Ebola captures people's imagination because it springs up

in the human population unexpectedly and unpredictably.

And when it does so, it has potentially devastating consequences.

And it is the stuff of movies.

In London, the high-level isolation ward at the Royal Free Hospital

was on stand-by should an infected carrier arrive in Britain.

The unit is run by Dr Michael Jacobs.

This is one of our very special isolation beds.

And when a patient arrives in the hospital,

we bring the patient into this unit wearing personal protective

equipment and clothing, and we then help the patient into this bed.

And once they're in the bed, the whole area becomes

separated from the outside, with a controlled airflow going through it.

Then in July, the nightmare scenario that health workers feared

became a reality.

Not in Britain, but Lagos, Nigeria.

A city of over 17 million people.

On 20th July, a Liberian American called Patrick Sawyer

collapsed in the Arrivals terminal of Lagos Airport.

He had just landed...

on a flight from Monrovia.

Five days later, he was dead.

Within a month, four people who he had come into contact with died,

and 16 others were infected.

There was now a new front in the Ebola crisis.

If an ill passenger could carry the disease from Liberia to Lagos,

they could just as easily take it to anywhere on Earth.

FOREIGN-LANGUAGE NEWS REPORTS

In Atlanta, the implications of the Sawyer case were clear.

It was a turning point in terms of showing, sort of, the effect that

one could see travel then through air and spread to a distant country.

Previous Ebola outbreaks have mostly been confined to remote

areas of tropical Africa and to people who don't travel far,

but this epidemic has spread to big cities and to people who do.

Add the fact that Ebola can incubate in the body for up

to 21 days before the victim shows any symptoms and suddenly,

the incentive to find a treatment becomes even more intense.

And so a network of doctors

and scientists from around the world have joined a quest.

They're all following different paths,

but all hoping to arrive at the same destination - a cure for Ebola.

One of those paths started in Uganda.

Before this epidemic, the biggest outbreak of Ebola was here,

in the year 2000.

It was centred around the town of Gulu, in the north of the country.

425 people were infected.

But almost half of them managed to fight off the disease.

These are four of the survivors.

Caroline worked as a nurse, treating some of the first patients.

Walter became ill after he visited a friend, Obedi,

who was dying in hospital.

Abraham, a teacher, caught it from his neighbour.

All the doctors could do was to try to ease their pain.

With no treatment available, over half the patients died.

But Caroline survived

because her immune system managed to fight off the virus on its own.

These survivors are of great interest to doctors

and scientists because their immune systems

are clearly strong enough to defeat the virus,

so now they each play a crucial role in the search for a cure.

Virologist Leslie Lobel has been working with

Dr Julius Lutwama for 12 years to study groups of Ebola

survivors from the previous five outbreaks here.

We're trying to discover what in their immune response

enabled them to survive.

We're trying to identify, which we've already done, those with a very

successful immune response that can actually fight off the virus.

What we call neutralise the virus.

Today the team are heading to Gulu to take more blood samples so they

can study how the survivors' strong immune responses work, and whether

their encounter with Ebola has given them any form of lasting protection.

The survivors that we follow in Gulu and in other parts of Uganda,

we view these people as the blessed ones, those that have the

gold in their blood that enabled them to survive this serious disease.

However, society interestingly views them as the cursed ones, pariahs.

So these survivors actually have a very hard time

reintegrating into society.

At the Gulu hospital, Caroline

and some of the other survivors have gathered to meet the researchers.

Good morning, ladies and gentlemen.

This group of people, you, are the only people in the whole world

who have been followed up after having had Ebola for a long time.

So we have come again to find out whether your antibodies

are still at the same level, or whether there is a decline.

I believe by now you know what the antibodies are.

So it is like your body goes to war with whatever foreign body has

got into your body.

So when we find out which ones are able to stop the enemy,

then we will be able to use those to provide security for other people.

Leslie and his team believe the antibodies in Caroline's blood

and that of the other survivors could hold one of the keys to

beating Ebola.

The basic premise of what we're doing is to take blood

from the survivor group, identify those with the strongest immune

response, isolate the antibodies from the blood

that will kill the virus.

Reproduce it in our lab and produce a therapeutic from that.

We're also studying the long term effects of Ebola virus on the

immune system or the persistence of immunity in Ebola virus survivors.

When the team began the study of survivors,

they hoped that it could lead to a cure.

-You got infected in the hospital?

-Yes.

-OK.

We said if we get enough information, if we get enough money,

then probably this knowledge could be used either by us

or by some other people to come up with a vaccine

or come up with a drug that can be used.

Some survivors have especially strong immunity.

At least against the strain of Ebola they caught.

But exactly how it works is the focus of this research.

Can it be turned into a treatment or vaccine?

What we don't know right now is what is so special about these people.

What is so special about their immune system that has allowed them

to control the infection and live.

The blood samples need to be rushed back to Entebbe, halfway

way across the country, within 12 hours before they start to degrade.

Back at the Uganda Virus Research Institute,

the team begin the process of extracting the antibodies.

They also need to understand exactly how other parts of the survivors'

immune system have responded to the Ebola infection.

So we're back after a 14-hour day. We have our samples here.

The team that we have in Entebbe is now going to process these.

We want to learn from nature what the strongest antibodies,

or the protein molecules in their blood, that we

know can actually prevent infection and can be used therapeutically.

Once the antibodies are identified, they are produced in the laboratory.

They are then tested against live Ebola in cell cultures

and will soon be tested in infected animals.

At this point, we've isolated a whole library of human

antibodies from survivors of Ebola virus disease.

In the future, maybe in three to five years,

these can be then tested in humans, in terms of safety testing,

so that they can be used as passive vaccines or treatments.

The work in Africa continues, but in the United States,

science is much closer to a cure.

The development of a drug has been accelerated by the plight

of two American missionaries in Liberia.

When Ebola hit, Dr John Fankhauser was helping run the mission

hospital in Monrovia where they worked.

We had anywhere from two to six patients every day.

Dr Kent Brantley was director of the Ebola unit.

He had a deep commitment to the people of Liberia.

He really connected with patients.

Nancy Writebol was a nurse assistant responsible for decontaminating

hospital staff.

Nancy was the kind of person who had a level of energy

and enthusiasm that really affected everyone around her.

After treating dozens of Ebola patients,

Dr Brantley caught the virus himself.

Then Nancy was diagnosed with Ebola too.

I was very surprised and then I also just had a deep sense of concern

because I knew that Ebola was a disease in which the mortality

was very high.

These were two friends of mine who were facing a deadly battle.

Then events took an extraordinary turn.

Dr Fankhauser knew scientists had been working on experimental

drugs that might help.

We had, of course, heard of novel therapies for Ebola.

A plan was starting to form.

We were also aware that there were some doses of one of these novel

therapies in Africa, in West Africa.

But could they get hold of the drug?

By an amazing stroke of luck,

by the time the missionaries became ill in Liberia, Dr Gary Kobinger

was nearby in Sierra Leone, helping diagnose cases of Ebola.

For nearly a decade, he had been working on a treatment

for the virus and he'd brought the experimental drug with him.

The goal was to bring it there, keep it there

and then bring it back here and then test it to see the potency.

Dr Kobinger received a message from the missionary organisation

Dr Brantley worked for.

It was a request for the experimental drug called ZMapp.

It was, from inside, a request from the heart, a request from the soul.

Without being emotional, the request was formulated in a way that...

anyway...

..pinched a cord inside me.

But ZMapp had not yet been tested in humans.

My first reflex, and this is what I did,

I warned against the unknown safety status of the drug.

There were other concerns too.

There was a lot of ethical questions. You know, why them?

Why not the kids I have seen dying in front of me, you know?

But you feel at one point that either you have to stand or you have

to step aside.

And at the time, I thought, what I had to do,

the right thing for me to do was to step aside.

And everyone had to weigh the risks of taking the untested

drug against the potential benefit.

A decision had to made and fast.

My rationale for offering the drug was that,

as a group of medical providers,

with all of the medical information that we had, we had the feeling

that it had a very high probability of being of value to Kent and Nancy.

And then the decision to give the medications was really made

after a discussion with Kent and Nancy.

And after, they expressed their interest in getting the medication.

But there was a problem.

There were just three doses of ZMapp,

which was a course of treatment for just one person.

That was a very difficult moment also.

How do you save two people with one treatment?

Because that's all we had.

At the mission hospital in Monrovia, there seemed an impossible choice.

They were both willing to sacrifice the medication

that was beneficial to them in order to help their colleague and friend.

The story of how the ZMapp drug was developed began 15 years ago

when Dr Kobinger was working on a gene therapy for cystic fibrosis.

He needed a way of transporting a healthy gene into lung cells

to replace the defective one.

We wanted a virus that can basically be that vehicle

that brings the healthy gene into the defective cells.

The virus is a transport mechanism, a little shuttle.

Dr Kobinger began looking for a virus

that was most effective at entering cells.

He settled on a surprising one.

The Ebola virus is a very long virus. It's like a string.

And it attaches to cells and it wraps into cells.

A little bit like Velcro, if you want,

it will stick to the other part of the Velcro.

Like other viruses, Ebola enters cells in the body

using spikes on its surface.

These spikes are special proteins that bind to the cell membrane.

When the virus latches on, the cell is forced to engulf it.

It's swallowing the virus, if you want,

and bringing it into the cell.

As Dr Kobinger began using Ebola spikes to transfer genes,

he had a startling thought.

Perhaps the spikes of the virus could be used against itself.

The fact that the virus is using the spike to enter cells

and to start growing and multiplying itself,

if you can stop that, if you can mount,

if you can stimulate your defence to attack that same spike,

then your defence will attack that same protein

that allows the virus to enter the cells.

It was an interesting theory.

I knew it would be a long road ahead.

And basically, at the time, everything had failed.

Nothing had worked to protect against Ebola virus.

In Phoenix, Arizona, another route was opening up

that would lead to ZMapp.

The development of the drug has been anything but conventional.

If I had been a research director in a pharmaceutical company

and I went up to my CEO and said,

"You know, we should really develop a drug against Ebola,"

they'd look at me like I was nuts.

I mean, this is a disease which now has a few thousand cases.

Before, it was a few hundred cases per year.

The people who get the disease are very poor.

I mean, there just was no return on investment for big pharma.

Professor Charles Arntzen is a plant biologist.

In the 1990s, he was working on a possible vaccine for hepatitis B.

Then the world changed with the 9/11 terrorist atrocity.

9/11 brought a new interest, a focus, I guess I'd say,

by the military on bio-terrorism.

Ebola's included in this Category A bio threat.

So it's sort of jumped from being

a poorly-studied, not-much-known-about disease

to a Category A bio threat, which meant

there's going to be research funding available to do something.

With the new money, Professor Arntzen teamed up

with other researchers in the private sector to study Ebola.

I guess we were opportunistic

and then became infatuated with the disease and the problem.

This is Canada's National Microbiology Laboratory in Winnipeg.

A high-security facility that's home to

some of the world's most deadly viruses, including Ebola.

The one thing for sure is you don't get a second chance.

If you have an exposure, it's because

your barrier has been compromised.

And for this, it means that

you potentially have been exposed to a high dose.

So the likelihood of having a fatal outcome

from a lab exposure is very high.

I will, you know, take the time to be calm before going in.

I empty my head completely of every little preoccupation

I may have during that day or in the past or in the future

and I go in just concentrating on what I have to do.

His first idea was to get the body's own immune system

to fight the Ebola spikes.

By exposing monkeys to the spikes,

he found they produced antibodies against them.

Some of which could be crucial.

They were antibodies, interestingly,

specifically targeting the spike of Ebola.

So these antibodies, if you look at those antibodies in an animal

and if you get this threshold or above,

you can predict with 99.98% accuracy

that the animal will survive in non-human primates.

It was a breakthrough.

When we started seeing that those antibodies were so important,

then yes, for sure, then we started thinking,

"Well, the antibodies are likely to work,

"it's just how we're going to use them is the question."

But the biggest question of all

was could he use these antibodies to treat Ebola patients

once they had become infected?

What we call the Holy Grail of Ebola research for all these years

was to be able to treat symptomatic animals.

Because people in a natural outbreak,

when they show up, they have symptoms.

It's not because they come and they say,

"Well, I was exposed to that person, can I get treated?"

You know, they come and they have a fever.

I knew this. I had gone to an outbreak already.

At the mission hospital in Liberia,

a momentous and potentially risky decision was made.

The first American missionary who'd caught Ebola, Dr Brantly,

was given a dose of ZMapp nine days after becoming ill.

This physician at one point had to decide,

"Am I going to really inject this thing that I don't know much of?"

There was a lot of unknowns for that person. A lot of pressure.

And so I think, to me, that's a hero.

It was reported that Dr Brantly's condition dramatically improved

after he received the drug.

He and Nancy Writebol were brought back to Atlanta

for further treatment with ZMapp.

Dr Aneesh Mehta was part of the team who would treat them.

The information we received was that the first patient

had received a dose of an experimental medication

and seemed to be improving after that medication.

We did also hear that the second patient

also had received a dose of that medication

and seemed to be stable at that time.

Back in the 2000s, Dr Kobinger had discovered

there were antibodies that could defeat Ebola.

But often after infection, the body can't produce enough of them

because Ebola overwhelms the immune system.

The virus is so fast that it kills you

before you get that level of antibody that can protect you.

So we thought that we will inject

those antibodies as our body will do,

but we will inject them faster, if you want, than what the body does.

Dr Kobinger exposed mice to the Ebola spikes

to produce different antibodies.

The aim was to try to find a combination

that would slow down the spread of the virus when given to monkeys.

So we're going to put the lid on the infection

and we're going to buy time.

We wanted to let the host have enough time

to build that protective immune response themselves.

When given to monkeys, Kobinger found that the antibodies

latched onto Ebola's spikes and stopped them sticking to cells.

Unable to get in, the virus can't replicate.

As the spread of the virus slows down,

this gives the immune system time to produce its own antibodies

to help fight the virus.

And this turned out to be decisive.

We saw survival when we were starting this treatment

at 24 hours, which was very late.

From there, we started thinking, "Well, maybe we can make it better."

By giving the monkeys two more doses three days apart,

the animals didn't just survive, they recovered.

One day didn't mean anything,

but when we were three, four, five, six days in,

a week, two weeks in, people were coming to see them.

They wanted to see how they looked.

So that was a very unique moment, I think.

The results showed that the treatment

saved 100% of monkeys infected with Ebola.

For sure, it was exciting.

I can tell you of some images of people clapping

in one another's hands in Level Four

when we started seeing those animals.

Not only surviving, but doing so well.

It's like barely they were infected.

As the cocktail of antibodies was refined

with the help of other researchers, all of the monkeys survived,

even when treatment started five days after infection.

This combination of three antibodies is the drug ZMapp.

When we saw that after symptoms had been detected

and we could still cure 100% of them,

to me, this was a cure, clearly. Yes, it was.

APPLAUSE

After finishing a course of the drug,

both missionaries recovered.

I am thrilled to be alive,

to be well and to be reunited with my family.

Amid the relief, some questions were asked.

Why had the two Americans been given the experimental drug

ahead of the African Ebola patients they were there to help?

If these medications were given to an African

by a team that was of a different culture and a different background

and that would have led to a bad outcome,

we'd have been harshly criticised.

I think this was a time where we could offer these medications

with true informed consent.

Now, that being said, I am a complete believer

that we need to strive for equity in this outbreak.

That Africans should have access to the medications

that are available to ex-patriots.

Demand for the experimental treatment skyrocketed

and the small supply of the drug dwindled.

Now the race was on to produce more.

Professor Arntzen developed the method being used to make it.

This isn't really a greenhouse of tobacco plants.

It's a production line for drugs.

Any time you want to make a protein drug, a vaccine,

you have to have a living system to manufacture it.

So for the last five, eight years now,

we've really focused on viruses which infect the tobacco plant.

We take some genes out of that virus,

put back in some genes that we want,

then literally inject it into the leaf tissue

so that every cell starts a viral infection.

And as that virus replicates,

it makes a copy of the protein that we're interested in.

These proteins are the antibodies that go into ZMapp.

Like all living things,

tobacco plants produce proteins in their cells.

Their DNA tells them which proteins to make.

To turn the plant into a factory making antibodies for ZMapp,

extra DNA is injected into the leaf inside a plant virus.

The plant cell then produces the antibodies.

Other cells make more, as they are infected in the same way.

The actual production run that made the protein

that was used with the individuals in Africa

was probably about ten days in the tobacco plant

and maybe another ten days to two weeks

to purify the protein out of the plants.

To scale this up to make 1,000 doses or 5,000 doses,

that's much harder to, um...come up with a timescale for that

because it's equipment-driven, it's people-driven.

And to try to scale something up

from making 50 grams, as we might do now,

to making kilogram amounts,

that's like trying to get a little hybrid

to compete with a Maserati in terms of taking off on a timescale.

As the outbreak continued, there was one further demand

for the experimental drug ZMapp.

Not in Africa, but in Britain.

'William Pooley, the first person from the UK

'to contract Ebola in West Africa...'

'..Is in a special isolation unit

'after being flown back to Britain by the RAF.'

British nurse Will Pooley

was to be offered the last available doses of ZMapp.

Dr Jacobs very clearly told me the risks

associated with using ZMapp

and some of the unknowns around the use of the drug.

It's a very unusual situation for us to use a drug

which actually hasn't been used in humans extensively before.

Most drugs have been through a very prolonged regulatory process

to check their safety, as well as their effectiveness.

I was very keen to use the drug and I said this to Dr Jacobs,

that I want to go ahead and use it

because the ZMapp seemed to be my only option.

After the first infusion finished, very soon afterwards,

we don't know whether this was due to the ZMapp or not,

but I started feeling considerably better.

My temperature had come down, I felt a lot more comfortable.

We were cautiously optimistic

once the viral load began to fall.

He told me about what my blood results had been

over the last few days and

then, with a bit of a smile on his face,

told me that my virus load

had diminished to undetectable levels.

So, effectively, I was free of the, er...free of the virus.

And on telling me, obviously, I was over the moon.

From a personal point of view,

I was both exhausted and elated at the outcome.

People worked so hard to get me those last doses of ZMapp.

And I want everyone to be able to have the care that I received

and the treatment I received

because it makes a difference in whether you live or die.

To know that people, just because they're living in West Africa,

don't get that, is heartbreaking.

Around the world, scientists are continuing their research.

Trials for another possible vaccine

are due to start in Oxford next week.

We may be on the verge of a breakthrough,

but until it comes, the disease will continue to haunt West Africa.

Nine months into the epidemic, the death toll keeps rising.

But health workers say many more people are dying

than are being recorded by the official figures.

And behind each number

lies a human story.

One of them was a man in his 40s.

He was quite a character and he was called Horatio.

His situation, it gradually deteriorated.

He was in the most awful pain.

Rolling on the floor and very, very distressed.

But unfortunately, the pharmacy that was there

didn't have much in the way of sedatives or sleeping pills

or anything for palliative care.

And, um...I must admit, at 10:00 at night,

myself and the rest of the MSF team

were going around pharmacies trying to find medicine for him.

But he died.

So he died on his own without any pain relief at all.