Why Open Access Matters

It turns out that Ebola, rather than being something never experienced before in Liberia, seems to have caused infections there previously (boldface mine):

The conventional wisdom is wrong. We were stunned recently when we stumbled across an article by European researchers in Annals of Virology: “The results seem to indicate that Liberia has to be included in the Ebola virus endemic zone.” In the future, the authors asserted, “medical personnel in Liberian health centers should be aware of the possibility that they may come across active cases and thus be prepared to avoid nosocomial epidemics,” referring to hospital-acquired infection.

What triggered our dismay was not the words, but when they were written: The paper was published in 1982.

As members of a team drafting Liberia’s Ebola recovery plan last month, we systematically reviewed the literature on Ebola surveillance since the virus’s discovery in central Africa in 1976. We learned that the virologists who wrote that report, who were from Germany, had analyzed frozen blood samples taken in 1978 and 1979 from 433 Liberian citizens. They found that 26 (or 6 percent) had antibodies to the Ebola virus.

Three other studies published in 1986 documented Ebola antibody prevalence rates of 10.6, 13.4 and 14 percent, respectively, in northwestern Liberia, not far from its borders with Sierra Leone and Guinea. These articles, along with other forgotten reports from the 1980s on antibody prevalence in neighboring Sierra Leone and Guinea, suggest the possibility of what some call “sanctuary sites,” or persistent, if latent, Ebola infection in humans.

There is an adage in public health: “The road to inaction is paved with research papers.” In a twist of fate, the same laboratory that confirmed the first positive Ebola test results in Guinea last year, the Pasteur Institute, was the publisher of Annals of Virology. Yet the institute’s April 2014 report said, “This subregion was not considered to be an area in which EBOV was endemic” (using the medical term for the Ebola virus).

One reason why this information was never passed on to Liberian doctors:

Part of the problem is that none of these articles were co-written by a Liberian scientist. The investigators collected their samples, returned home and published the startling results in European medical journals. Few Liberians were then trained in laboratory or epidemiological methods. Even today, downloading one of the papers would cost a physician here $45, about half a week’s salary.

Would have been nice to know that, I think.

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