Ebola - The Search for a Cure Horizon


Ebola - The Search for a Cure

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

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

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

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

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We look forward to deploying more staff next week.

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Chief Science Officer?

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

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At the daily briefing,

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

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The outbreak is bad and it's getting worse.

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

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A couple of weeks ago, it has surpassed

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all previously recorded cases of Ebola.

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..and efforts to contain the outbreak are failing.

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

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I think we're learning from this Ebola outbreak.

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And we hope that we will win

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

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But there is hope.

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I feel so lucky to be alive,

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and there's a lot of people dying elsewhere

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that are not as fortunate as me.

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

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

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

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

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and so no-one can tell.

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

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I mean, can you imagine?

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They take one of your loved ones away

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

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..and follows the scientists racing to find a cure

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for one of the most dangerous killers on Earth.

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

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

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This is an extraordinary story of bravery and determination

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against a deadly enemy.

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Sunday night, two and a half weeks ago.

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An RAF plane flew into London from Sierra Leone.

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On-board, a British nurse suffering from Ebola.

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There were moments on the flight

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when I was feeling quite unwell and was afraid.

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My temperature went up quite quickly.

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It was a scary time.

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I first heard in the middle of the night

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and began to put the plan into operation.

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By the next day, it was in full flow.

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In the ambulance, I remember I had a nurse,

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

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shutting the road off as we drove along.

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This is our business, this is what we do.

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

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we are here for exactly these sorts of problems.

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

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Getting into hospital was...

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yeah, a great comfort to me.

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The world's attention may temporarily have been

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

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

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

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living in a remote village in Guinea, West Africa,

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died from a mysterious fever.

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The boy's symptoms included severe diarrhoea,

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vomiting and internal bleeding.

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His painful death went unnoticed by the outside world,

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and we don't even know his name.

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But epidemiologists call the boy "patient zero" -

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the first suspected case of what has now become

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the largest outbreak of Ebola the world has ever seen.

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

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all died after suffering the same horrific symptoms.

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

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The epidemic had begun.

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How might patient zero have caught Ebola?

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

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

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Many people in Guinea eat these bats and other bush meat

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that could potentially be infected

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and that may be how the virus jumps to humans.

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

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so patient zero's symptoms were not identified.

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Undiagnosed, the virus swept into a neighbouring village,

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

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And then it was taken into another village,

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and then another, and another.

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And so the chain of infection spread ever wider.

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So far, in the current outbreak,

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every single victim can be traced back to patient zero.

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It wasn't until 14 weeks after the first deaths

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that the epidemic was confirmed.

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

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this delay has made the outbreak harder to contain.

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There was a delay in being able to effectively recognise it

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

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you see additional generations of cases develop

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as people don't know what to do

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to protect themselves or protect their communities.

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-RADIO:

-'Scientists in France have identified the Ebola virus

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

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'which is believed to have...'

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-RADIO:

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

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

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the epidemic was already out of control.

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This is one of the few treatment centres in Guinea.

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It's run by Medecins Sans Frontieres,

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the international medical aid agency.

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It's a haven of humanity and compassion

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for those struck down by this terrible disease.

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

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

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

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

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When I look in their eyes

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

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

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SHE SOBS

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Ebola is an especially virulent disease.

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This is what the virus looks like.

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

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

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Then its progeny rampage on, damaging cells

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and replicating in ever greater numbers.

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It infects the endothelial cells that line blood vessels

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and the patient starts bleeding on the inside.

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

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they have terrible bloody diarrhoea, vomiting.

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They feel terrible.

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In the current outbreak,

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almost half the patients managed to fight off the virus.

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

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their vital organs quickly start to fail.

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

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you know that the end is coming quite soon.

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

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Most patients die within 12 days,

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but the dead body of a victim is still contagious.

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

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of catching and then spreading the virus.

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It's a bit like erasing somebody.

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

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you take all their possessions, and you burn then

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and then you clean away their blood and their faeces,

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and then the next patients come.

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We allow relatives to come and view the bodies

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

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

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to make it look pleasanter, if we could,

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and then the relatives would come and see.

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It was always a very hard moment.

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And when Ebola sweeps through a village, it leaves fear

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and suspicion in its wake.

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

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Can you imagine - a car entering your village with people

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

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covered from head to toe.

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And they take one of your loved ones away,

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only to return the loved one in a body bag.

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It can be really difficult for people to understand that

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we're here to help.

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Ebola is a terrible disease, spreading fear and panic.

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

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Scientists have been trying to understand how Ebola works

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and how it's spread.

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

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

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..in the city of Antwerp, Belgium.

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In 1976, a package containing a sample of blood

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arrived at Antwerp's Institute of Tropical Medicine,

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where Peter Piot was working as a young scientist.

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

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Actually, one was broken.

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

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and it came from Kinshasa.

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

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

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

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After preparation,

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the sample was studied under an electron microscope.

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When we saw these worm-like structures coming

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

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

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There was only one way to find out.

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Go to the source of this mysterious epidemic,

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the Congo.

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

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We left at five o'clock in the morning.

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

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

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

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So, after several hours of flight,

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so the plane goes down and lands on this red airstrip

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and we're landing and first of all,

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the pilots never stopped the engines

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because they were so scared and wanted to drop us

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and go back to Kinshasa.

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

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

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the ravaged mission station.

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And so, we arrived there.

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

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I said, "I'm Peter Piot.

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

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"stop the epidemic and to help you."

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

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

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

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15 nuns and nurses

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

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

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that flowed nearby.

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

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They travelled to nearby villages, looking for clues.

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It was already rainy season.

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

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And some, we went by canoe.

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And when they found people who had contracted the virus,

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many were beyond help.

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

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often in excruciating pain, particularly abdominal pain.

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

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The scientists noticed that many carriers of the disease were

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young women who had visited the mission station hospital.

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

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The nuns and local nurses were running it, frankly,

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in a heroic way.

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But they had a major shortage of materials, including syringes

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and needles,

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

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

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five needles and syringes were given to the antenatal consultations.

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And they were reused and reused and reused.

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The needles weren't sterilised and it quickly became clear

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

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

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

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It wasn't just reusing the unsterilized needles.

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The scientists soon realised that the ritual of washing

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bodies before burial was also helping to spread the disease.

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The team had made a significant breakthrough.

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Ebola clearly wasn't an airborne virus,

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but was only spread through physical contact and bodily fluids.

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Ebola was identified at a time when suspicion

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

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It was the Cold War.

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What might happen

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

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

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

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

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'The most dangerous viruses from around the world are sent

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'here for identification and new ones keep turning up.

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

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40 years later,

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

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It's now a public health laboratory

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

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Dr Tim Brooks look after it.

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

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plasma from the whole blood.

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

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'how it interacts with cells,

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'how it affects cells in living animals,'

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

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

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

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service for the United Kingdom for a whole range of unpleasant

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

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In the field, diagnosing patients quickly is an important

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part of trying to contain the outbreak.

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

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the relief effort.

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

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And I was there testing for the patient samples.

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

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to make sure they were safe,

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and then we would test them for the virus.

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

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

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So you would see some people who were very sick,

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

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and would need help in and out of the ward.

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-RADIO:

-'The World Health Organisation says the current

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'outbreak of the deadly Ebola virus in West Africa is

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

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By early April, Ebola was spreading from Guinea to neighbouring

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Sierra Leone and Liberia,

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

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

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Local health facilities had been completely overwhelmed.

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The health workers from MSF visited one hospital in Monrovia.

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

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

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So then I checked the latrines,

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

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They hadn't moved him.

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

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before the burial team came and took him away.

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There were a lot of people in the confirmed area who

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

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If Dante had written a tenth Circle of Hell,

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this would have been it, I think.

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You try to be efficient. Um...

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

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so no-one can tell.

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The British nurse Will Pooley was already

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working as a volunteer in Sierra Leone.

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

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

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had already died after contracting Ebola from their patients.

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Everyone is aware that it could be them next.

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

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you might be risking infection.

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

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

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I woke up in the morning feeling very fatigued.

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

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At lunchtime, I went and spoke to the doctors

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

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Later that day, the results came through.

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

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

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

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Of course, I was scared.

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It feels like you're hosting a really malevolent force

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inside your body.

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Also, the knowledge that however I was feeling,

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especially in the early stages, that the virus could,

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or likely would, get stronger

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and I would have more of it inside me.

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

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The prospect of that was very frightening.

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

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Since 1976, in all the previous recorded outbreaks before this

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

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So this current epidemic is worse than all the previous

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outbreaks put together.

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

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-RADIO:

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

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'the number of people dying

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'from Ebola disease in West Africa.'

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As the number of cases increased, there was

0:23:450:23:48

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

0:23:480:23:53

Ebola captures people's imagination because it springs up

0:23:530:23:57

in the human population unexpectedly and unpredictably.

0:23:570:24:01

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

0:24:010:24:05

And it is the stuff of movies.

0:24:050:24:07

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

0:24:090:24:13

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

0:24:130:24:16

The unit is run by Dr Michael Jacobs.

0:24:180:24:21

This is one of our very special isolation beds.

0:24:230:24:27

And when a patient arrives in the hospital,

0:24:270:24:29

we bring the patient into this unit wearing personal protective

0:24:290:24:32

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

0:24:320:24:37

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

0:24:370:24:40

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

0:24:400:24:45

Then in July, the nightmare scenario that health workers feared

0:24:450:24:49

became a reality.

0:24:490:24:50

Not in Britain, but Lagos, Nigeria.

0:24:550:24:58

A city of over 17 million people.

0:24:580:25:01

On 20th July, a Liberian American called Patrick Sawyer

0:25:040:25:08

collapsed in the Arrivals terminal of Lagos Airport.

0:25:080:25:10

He had just landed...

0:25:120:25:15

on a flight from Monrovia.

0:25:150:25:18

Five days later, he was dead.

0:25:180:25:20

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

0:25:240:25:28

and 16 others were infected.

0:25:280:25:30

There was now a new front in the Ebola crisis.

0:25:310:25:34

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

0:25:360:25:40

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

0:25:400:25:44

FOREIGN-LANGUAGE NEWS REPORTS

0:25:440:25:48

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

0:26:030:26:07

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

0:26:090:26:13

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

0:26:130:26:18

Previous Ebola outbreaks have mostly been confined to remote

0:26:210:26:25

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

0:26:250:26:29

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

0:26:290:26:35

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

0:26:350:26:38

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

0:26:380:26:42

the incentive to find a treatment becomes even more intense.

0:26:420:26:46

And so a network of doctors

0:26:490:26:51

and scientists from around the world have joined a quest.

0:26:510:26:55

They're all following different paths,

0:26:550:26:57

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

0:26:570:27:02

One of those paths started in Uganda.

0:27:050:27:08

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

0:27:080:27:12

in the year 2000.

0:27:120:27:14

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

0:27:140:27:19

425 people were infected.

0:27:190:27:22

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

0:27:220:27:25

These are four of the survivors.

0:27:290:27:32

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

0:27:360:27:40

Walter became ill after he visited a friend, Obedi,

0:27:590:28:02

who was dying in hospital.

0:28:020:28:04

Abraham, a teacher, caught it from his neighbour.

0:28:380:28:41

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

0:29:240:29:26

With no treatment available, over half the patients died.

0:29:400:29:44

But Caroline survived

0:29:440:29:46

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

0:29:460:29:49

These survivors are of great interest to doctors

0:30:200:30:23

and scientists because their immune systems

0:30:230:30:25

are clearly strong enough to defeat the virus,

0:30:250:30:28

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

0:30:280:30:31

Virologist Leslie Lobel has been working with

0:30:450:30:48

Dr Julius Lutwama for 12 years to study groups of Ebola

0:30:480:30:52

survivors from the previous five outbreaks here.

0:30:520:30:56

We're trying to discover what in their immune response

0:30:560:30:59

enabled them to survive.

0:30:590:31:01

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

0:31:010:31:04

successful immune response that can actually fight off the virus.

0:31:040:31:09

What we call neutralise the virus.

0:31:090:31:11

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

0:31:110:31:16

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

0:31:160:31:20

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

0:31:200:31:25

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

0:31:250:31:29

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

0:31:290:31:33

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

0:31:330:31:37

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

0:31:370:31:43

So these survivors actually have a very hard time

0:31:430:31:46

reintegrating into society.

0:31:460:31:48

At the Gulu hospital, Caroline

0:31:530:31:55

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

0:31:550:31:58

Good morning, ladies and gentlemen.

0:32:010:32:04

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

0:32:040:32:09

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

0:32:090:32:15

So we have come again to find out whether your antibodies

0:32:150:32:21

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

0:32:210:32:26

I believe by now you know what the antibodies are.

0:32:260:32:30

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

0:32:300:32:37

got into your body.

0:32:370:32:39

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

0:32:390:32:44

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

0:32:440:32:51

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

0:32:570:33:00

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

0:33:000:33:03

beating Ebola.

0:33:030:33:04

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

0:33:090:33:12

from the survivor group, identify those with the strongest immune

0:33:120:33:15

response, isolate the antibodies from the blood

0:33:150:33:18

that will kill the virus.

0:33:180:33:20

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

0:33:200:33:23

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

0:33:230:33:27

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

0:33:270:33:32

When the team began the study of survivors,

0:33:330:33:35

they hoped that it could lead to a cure.

0:33:350:33:39

-You got infected in the hospital?

-Yes.

-OK.

0:33:390:33:44

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

0:33:440:33:48

then probably this knowledge could be used either by us

0:33:480:33:52

or by some other people to come up with a vaccine

0:33:520:33:55

or come up with a drug that can be used.

0:33:550:33:59

Some survivors have especially strong immunity.

0:33:590:34:03

At least against the strain of Ebola they caught.

0:34:030:34:06

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

0:34:060:34:09

Can it be turned into a treatment or vaccine?

0:34:090:34:13

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

0:34:130:34:17

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

0:34:170:34:21

to control the infection and live.

0:34:210:34:23

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

0:34:250:34:29

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

0:34:290:34:33

Back at the Uganda Virus Research Institute,

0:34:370:34:40

the team begin the process of extracting the antibodies.

0:34:400:34:43

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

0:34:440:34:49

immune system have responded to the Ebola infection.

0:34:490:34:52

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

0:34:570:35:00

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

0:35:000:35:04

We want to learn from nature what the strongest antibodies,

0:35:050:35:10

or the protein molecules in their blood, that we

0:35:100:35:13

know can actually prevent infection and can be used therapeutically.

0:35:130:35:17

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

0:35:190:35:24

They are then tested against live Ebola in cell cultures

0:35:240:35:27

and will soon be tested in infected animals.

0:35:270:35:30

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

0:35:310:35:35

antibodies from survivors of Ebola virus disease.

0:35:350:35:38

In the future, maybe in three to five years,

0:35:380:35:41

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

0:35:410:35:45

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

0:35:450:35:48

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

0:35:540:35:58

science is much closer to a cure.

0:35:580:36:00

The development of a drug has been accelerated by the plight

0:36:010:36:04

of two American missionaries in Liberia.

0:36:040:36:07

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

0:36:070:36:10

hospital in Monrovia where they worked.

0:36:100:36:14

We had anywhere from two to six patients every day.

0:36:150:36:19

Dr Kent Brantley was director of the Ebola unit.

0:36:210:36:25

He had a deep commitment to the people of Liberia.

0:36:250:36:30

He really connected with patients.

0:36:300:36:32

Nancy Writebol was a nurse assistant responsible for decontaminating

0:36:320:36:36

hospital staff.

0:36:360:36:38

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

0:36:380:36:42

and enthusiasm that really affected everyone around her.

0:36:420:36:46

After treating dozens of Ebola patients,

0:36:470:36:50

Dr Brantley caught the virus himself.

0:36:500:36:52

Then Nancy was diagnosed with Ebola too.

0:36:530:36:57

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

0:36:570:37:02

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

0:37:020:37:07

was very high.

0:37:070:37:09

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

0:37:090:37:13

Then events took an extraordinary turn.

0:37:160:37:18

Dr Fankhauser knew scientists had been working on experimental

0:37:180:37:22

drugs that might help.

0:37:220:37:23

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

0:37:250:37:28

A plan was starting to form.

0:37:290:37:32

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

0:37:320:37:36

therapies in Africa, in West Africa.

0:37:360:37:39

But could they get hold of the drug?

0:37:400:37:42

By an amazing stroke of luck,

0:37:460:37:49

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

0:37:490:37:52

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

0:37:520:37:57

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

0:37:570:38:00

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

0:38:000:38:05

The goal was to bring it there, keep it there

0:38:050:38:08

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

0:38:080:38:11

Dr Kobinger received a message from the missionary organisation

0:38:130:38:17

Dr Brantley worked for.

0:38:170:38:19

It was a request for the experimental drug called ZMapp.

0:38:190:38:22

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

0:38:240:38:30

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

0:38:300:38:35

anyway...

0:38:350:38:37

..pinched a cord inside me.

0:38:390:38:40

But ZMapp had not yet been tested in humans.

0:38:430:38:46

My first reflex, and this is what I did,

0:38:460:38:49

I warned against the unknown safety status of the drug.

0:38:490:38:52

There were other concerns too.

0:38:540:38:56

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

0:38:580:39:01

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

0:39:010:39:05

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

0:39:050:39:09

to step aside.

0:39:090:39:11

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

0:39:110:39:14

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

0:39:140:39:17

And everyone had to weigh the risks of taking the untested

0:39:190:39:22

drug against the potential benefit.

0:39:220:39:25

A decision had to made and fast.

0:39:250:39:27

My rationale for offering the drug was that,

0:39:290:39:33

as a group of medical providers,

0:39:330:39:36

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

0:39:360:39:41

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

0:39:410:39:48

And then the decision to give the medications was really made

0:39:480:39:55

after a discussion with Kent and Nancy.

0:39:550:39:58

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

0:39:580:40:03

But there was a problem.

0:40:050:40:07

There were just three doses of ZMapp,

0:40:070:40:10

which was a course of treatment for just one person.

0:40:100:40:13

That was a very difficult moment also.

0:40:130:40:15

How do you save two people with one treatment?

0:40:150:40:18

Because that's all we had.

0:40:180:40:19

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

0:40:190:40:24

They were both willing to sacrifice the medication

0:40:240:40:28

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

0:40:280:40:32

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

0:40:400:40:44

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

0:40:440:40:48

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

0:40:520:40:56

to replace the defective one.

0:40:560:40:58

We wanted a virus that can basically be that vehicle

0:41:000:41:04

that brings the healthy gene into the defective cells.

0:41:040:41:07

The virus is a transport mechanism, a little shuttle.

0:41:070:41:11

Dr Kobinger began looking for a virus

0:41:130:41:15

that was most effective at entering cells.

0:41:150:41:18

He settled on a surprising one.

0:41:180:41:20

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

0:41:210:41:25

And it attaches to cells and it wraps into cells.

0:41:250:41:28

A little bit like Velcro, if you want,

0:41:280:41:30

it will stick to the other part of the Velcro.

0:41:300:41:33

Like other viruses, Ebola enters cells in the body

0:41:350:41:38

using spikes on its surface.

0:41:380:41:41

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

0:41:410:41:45

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

0:41:450:41:49

It's swallowing the virus, if you want,

0:41:520:41:54

and bringing it into the cell.

0:41:540:41:56

As Dr Kobinger began using Ebola spikes to transfer genes,

0:41:580:42:02

he had a startling thought.

0:42:020:42:04

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

0:42:050:42:09

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

0:42:110:42:14

and to start growing and multiplying itself,

0:42:140:42:17

if you can stop that, if you can mount,

0:42:170:42:20

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

0:42:200:42:24

then your defence will attack that same protein

0:42:240:42:26

that allows the virus to enter the cells.

0:42:260:42:28

It was an interesting theory.

0:42:300:42:33

I knew it would be a long road ahead.

0:42:330:42:35

And basically, at the time, everything had failed.

0:42:350:42:37

Nothing had worked to protect against Ebola virus.

0:42:370:42:40

In Phoenix, Arizona, another route was opening up

0:42:450:42:48

that would lead to ZMapp.

0:42:480:42:50

The development of the drug has been anything but conventional.

0:42:500:42:55

If I had been a research director in a pharmaceutical company

0:42:550:43:01

and I went up to my CEO and said,

0:43:010:43:03

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

0:43:030:43:06

they'd look at me like I was nuts.

0:43:060:43:09

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

0:43:090:43:13

Before, it was a few hundred cases per year.

0:43:130:43:16

The people who get the disease are very poor.

0:43:160:43:19

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

0:43:190:43:25

Professor Charles Arntzen is a plant biologist.

0:43:250:43:28

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

0:43:280:43:34

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

0:43:340:43:39

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

0:43:390:43:43

by the military on bio-terrorism.

0:43:430:43:47

Ebola's included in this Category A bio threat.

0:43:490:43:52

So it's sort of jumped from being

0:43:520:43:55

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

0:43:550:44:00

to a Category A bio threat, which meant

0:44:000:44:03

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

0:44:030:44:07

With the new money, Professor Arntzen teamed up

0:44:080:44:10

with other researchers in the private sector to study Ebola.

0:44:100:44:14

I guess we were opportunistic

0:44:150:44:17

and then became infatuated with the disease and the problem.

0:44:170:44:21

This is Canada's National Microbiology Laboratory in Winnipeg.

0:44:310:44:36

A high-security facility that's home to

0:44:360:44:38

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

0:44:380:44:42

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

0:44:450:44:47

If you have an exposure, it's because

0:44:500:44:51

your barrier has been compromised.

0:44:510:44:53

And for this, it means that

0:44:530:44:55

you potentially have been exposed to a high dose.

0:44:550:44:58

So the likelihood of having a fatal outcome

0:44:580:45:02

from a lab exposure is very high.

0:45:020:45:04

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

0:45:080:45:11

I empty my head completely of every little preoccupation

0:45:110:45:14

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

0:45:140:45:18

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

0:45:180:45:23

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

0:45:240:45:28

to fight the Ebola spikes.

0:45:280:45:30

By exposing monkeys to the spikes,

0:45:310:45:33

he found they produced antibodies against them.

0:45:330:45:36

Some of which could be crucial.

0:45:360:45:38

They were antibodies, interestingly,

0:45:400:45:43

specifically targeting the spike of Ebola.

0:45:430:45:47

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

0:45:470:45:51

and if you get this threshold or above,

0:45:510:45:55

you can predict with 99.98% accuracy

0:45:550:45:58

that the animal will survive in non-human primates.

0:45:580:46:01

It was a breakthrough.

0:46:030:46:05

When we started seeing that those antibodies were so important,

0:46:050:46:08

then yes, for sure, then we started thinking,

0:46:080:46:12

"Well, the antibodies are likely to work,

0:46:120:46:15

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

0:46:150:46:18

But the biggest question of all

0:46:180:46:20

was could he use these antibodies to treat Ebola patients

0:46:200:46:23

once they had become infected?

0:46:230:46:26

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

0:46:260:46:30

was to be able to treat symptomatic animals.

0:46:300:46:33

Because people in a natural outbreak,

0:46:330:46:35

when they show up, they have symptoms.

0:46:350:46:37

It's not because they come and they say,

0:46:370:46:39

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

0:46:390:46:42

You know, they come and they have a fever.

0:46:420:46:44

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

0:46:440:46:48

At the mission hospital in Liberia,

0:46:510:46:53

a momentous and potentially risky decision was made.

0:46:530:46:56

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

0:46:570:47:01

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

0:47:010:47:05

This physician at one point had to decide,

0:47:060:47:09

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

0:47:090:47:12

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

0:47:120:47:15

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

0:47:150:47:19

It was reported that Dr Brantly's condition dramatically improved

0:47:190:47:24

after he received the drug.

0:47:240:47:26

He and Nancy Writebol were brought back to Atlanta

0:47:270:47:30

for further treatment with ZMapp.

0:47:300:47:32

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

0:47:320:47:36

The information we received was that the first patient

0:47:370:47:40

had received a dose of an experimental medication

0:47:400:47:42

and seemed to be improving after that medication.

0:47:420:47:46

We did also hear that the second patient

0:47:460:47:49

also had received a dose of that medication

0:47:490:47:51

and seemed to be stable at that time.

0:47:510:47:54

Back in the 2000s, Dr Kobinger had discovered

0:48:030:48:06

there were antibodies that could defeat Ebola.

0:48:060:48:09

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

0:48:110:48:14

because Ebola overwhelms the immune system.

0:48:140:48:17

The virus is so fast that it kills you

0:48:170:48:20

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

0:48:200:48:24

So we thought that we will inject

0:48:240:48:26

those antibodies as our body will do,

0:48:260:48:28

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

0:48:280:48:34

Dr Kobinger exposed mice to the Ebola spikes

0:48:350:48:38

to produce different antibodies.

0:48:380:48:40

The aim was to try to find a combination

0:48:420:48:44

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

0:48:440:48:48

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

0:48:500:48:52

and we're going to buy time.

0:48:520:48:54

We wanted to let the host have enough time

0:48:560:48:58

to build that protective immune response themselves.

0:48:580:49:02

When given to monkeys, Kobinger found that the antibodies

0:49:040:49:07

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

0:49:070:49:12

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

0:49:120:49:16

As the spread of the virus slows down,

0:49:160:49:18

this gives the immune system time to produce its own antibodies

0:49:180:49:21

to help fight the virus.

0:49:210:49:23

And this turned out to be decisive.

0:49:230:49:26

We saw survival when we were starting this treatment

0:49:310:49:35

at 24 hours, which was very late.

0:49:350:49:37

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

0:49:380:49:42

By giving the monkeys two more doses three days apart,

0:49:420:49:45

the animals didn't just survive, they recovered.

0:49:450:49:49

One day didn't mean anything,

0:49:490:49:51

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

0:49:510:49:53

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

0:49:530:49:56

They wanted to see how they looked.

0:49:560:49:58

So that was a very unique moment, I think.

0:49:580:50:00

The results showed that the treatment

0:50:010:50:04

saved 100% of monkeys infected with Ebola.

0:50:040:50:06

For sure, it was exciting.

0:50:060:50:08

I can tell you of some images of people clapping

0:50:080:50:11

in one another's hands in Level Four

0:50:110:50:14

when we started seeing those animals.

0:50:140:50:17

Not only surviving, but doing so well.

0:50:170:50:19

It's like barely they were infected.

0:50:190:50:22

As the cocktail of antibodies was refined

0:50:230:50:26

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

0:50:260:50:29

even when treatment started five days after infection.

0:50:290:50:33

This combination of three antibodies is the drug ZMapp.

0:50:330:50:38

When we saw that after symptoms had been detected

0:50:410:50:44

and we could still cure 100% of them,

0:50:440:50:47

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

0:50:470:50:49

APPLAUSE

0:50:520:50:54

After finishing a course of the drug,

0:50:540:50:56

both missionaries recovered.

0:50:560:50:59

I am thrilled to be alive,

0:51:000:51:02

to be well and to be reunited with my family.

0:51:020:51:06

Amid the relief, some questions were asked.

0:51:060:51:10

Why had the two Americans been given the experimental drug

0:51:120:51:15

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

0:51:150:51:18

If these medications were given to an African

0:51:200:51:23

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

0:51:230:51:28

and that would have led to a bad outcome,

0:51:280:51:33

we'd have been harshly criticised.

0:51:330:51:35

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

0:51:370:51:41

with true informed consent.

0:51:410:51:44

Now, that being said, I am a complete believer

0:51:440:51:48

that we need to strive for equity in this outbreak.

0:51:480:51:52

That Africans should have access to the medications

0:51:520:51:56

that are available to ex-patriots.

0:51:560:51:58

Demand for the experimental treatment skyrocketed

0:52:030:52:06

and the small supply of the drug dwindled.

0:52:060:52:08

Now the race was on to produce more.

0:52:110:52:14

Professor Arntzen developed the method being used to make it.

0:52:140:52:17

This isn't really a greenhouse of tobacco plants.

0:52:200:52:23

It's a production line for drugs.

0:52:250:52:27

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

0:52:300:52:34

you have to have a living system to manufacture it.

0:52:340:52:38

So for the last five, eight years now,

0:52:380:52:41

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

0:52:410:52:46

We take some genes out of that virus,

0:52:460:52:48

put back in some genes that we want,

0:52:480:52:51

then literally inject it into the leaf tissue

0:52:510:52:54

so that every cell starts a viral infection.

0:52:540:52:59

And as that virus replicates,

0:52:590:53:02

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

0:53:020:53:06

These proteins are the antibodies that go into ZMapp.

0:53:070:53:11

Like all living things,

0:53:130:53:14

tobacco plants produce proteins in their cells.

0:53:140:53:17

Their DNA tells them which proteins to make.

0:53:190:53:22

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

0:53:220:53:25

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

0:53:250:53:30

The plant cell then produces the antibodies.

0:53:310:53:33

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

0:53:360:53:40

The actual production run that made the protein

0:53:410:53:46

that was used with the individuals in Africa

0:53:460:53:50

was probably about ten days in the tobacco plant

0:53:500:53:54

and maybe another ten days to two weeks

0:53:540:53:57

to purify the protein out of the plants.

0:53:570:54:00

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

0:54:010:54:06

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

0:54:060:54:11

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

0:54:110:54:15

And to try to scale something up

0:54:150:54:18

from making 50 grams, as we might do now,

0:54:180:54:22

to making kilogram amounts,

0:54:220:54:25

that's like trying to get a little hybrid

0:54:250:54:31

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

0:54:310:54:35

As the outbreak continued, there was one further demand

0:54:380:54:41

for the experimental drug ZMapp.

0:54:410:54:44

Not in Africa, but in Britain.

0:54:440:54:47

'William Pooley, the first person from the UK

0:54:480:54:51

'to contract Ebola in West Africa...'

0:54:510:54:53

'..Is in a special isolation unit

0:54:530:54:54

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

0:54:540:54:57

British nurse Will Pooley

0:54:570:54:59

was to be offered the last available doses of ZMapp.

0:54:590:55:02

Dr Jacobs very clearly told me the risks

0:55:020:55:06

associated with using ZMapp

0:55:060:55:08

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

0:55:080:55:12

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

0:55:130:55:16

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

0:55:160:55:21

Most drugs have been through a very prolonged regulatory process

0:55:210:55:24

to check their safety, as well as their effectiveness.

0:55:240:55:27

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

0:55:290:55:34

that I want to go ahead and use it

0:55:340:55:39

because the ZMapp seemed to be my only option.

0:55:390:55:43

After the first infusion finished, very soon afterwards,

0:55:450:55:51

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

0:55:510:55:54

but I started feeling considerably better.

0:55:540:55:59

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

0:55:590:56:03

We were cautiously optimistic

0:56:050:56:07

once the viral load began to fall.

0:56:070:56:11

He told me about what my blood results had been

0:56:110:56:15

over the last few days and

0:56:150:56:18

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

0:56:180:56:20

told me that my virus load

0:56:200:56:23

had diminished to undetectable levels.

0:56:230:56:26

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

0:56:260:56:33

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

0:56:330:56:38

From a personal point of view,

0:56:380:56:40

I was both exhausted and elated at the outcome.

0:56:400:56:44

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

0:56:470:56:52

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

0:56:520:56:57

and the treatment I received

0:56:570:56:59

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

0:56:590:57:04

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

0:57:050:57:10

don't get that, is heartbreaking.

0:57:100:57:14

Around the world, scientists are continuing their research.

0:57:190:57:22

Trials for another possible vaccine

0:57:230:57:25

are due to start in Oxford next week.

0:57:250:57:28

We may be on the verge of a breakthrough,

0:57:290:57:32

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

0:57:320:57:36

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

0:57:380:57:41

But health workers say many more people are dying

0:57:430:57:46

than are being recorded by the official figures.

0:57:460:57:48

And behind each number

0:57:500:57:53

lies a human story.

0:57:530:57:54

One of them was a man in his 40s.

0:57:570:58:00

He was quite a character and he was called Horatio.

0:58:000:58:02

His situation, it gradually deteriorated.

0:58:020:58:07

He was in the most awful pain.

0:58:070:58:09

Rolling on the floor and very, very distressed.

0:58:090:58:12

But unfortunately, the pharmacy that was there

0:58:120:58:14

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

0:58:140:58:18

or anything for palliative care.

0:58:180:58:21

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

0:58:210:58:25

myself and the rest of the MSF team

0:58:250:58:27

were going around pharmacies trying to find medicine for him.

0:58:270:58:31

But he died.

0:58:310:58:33

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

0:58:330:58:36

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