NEJM Interview: Jean Nachega on the importance of investment in equitable partnerships, community trust, and local scientific leadership for outbreak preparedness.

50 years ago, the first recognized Ebola outbreaks occurred in Central Africa. Now the Democratic Republic of Congo and Uganda are facing an outbreak of Bundibugyo virus disease, along with challenges that highlight enduring lessons from Ebola's history. I'm Stephen Morrissey, Managing Editor of the New England Journal of Medicine, and I'm talking with Jean Nsenga, a professor of infectious diseases and the director of the Biomedical Research Institute at Stellenbosch University in South Africa, and an associate professor at the University of Pittsburgh School of Public Health. Dr. Nsenga has co-authored a perspective article about historical accounts of the discovery of Ebola virus and modern lessons for preventing and controlling outbreaks. Dr. Nsenga, as you write in your perspective article, the first recognized Ebola outbreaks occurred in 1976. What steps were taken by local clinicians, public health workers, and communities to support pathogen identification and outbreak control at that time?

The timing is important now. We are approaching 50 years since Ebola was first recognized in 1976, so this was an opportunity for us to reflect on what five decades of experience have actually taught us. And the step where the pioneer at that time, Professor Jean-Jacques Muyembe, one of them investigating a mysterious disease, unexplained disease, and ident-- tried to identify the source. And through a collaboration with the Institute of Tropical Medicine in Antwerp with Professor Peter Piot, they've been able to get some sample from Zaire, now called the Congo, and to be able to try to identify under electronic microscopy a filovirus-type pathogen. And later on, with the collaboration with the U.S. Center for Disease Control, this was proved to be an Ebola virus from Zaire species. So it's quite remarkable that type of collaboration from the field to the bench with really enough staff partnership. That was remarkable.

So you say in your article that recognizing the importance of that collective achievement, of that collaboration, provides important lessons for outbreak response and preparedness, including the importance of focusing on equity before outbreaks occur. So how can equity be advanced through international partnerships and local investments?

I think that's an important point that we want to point out in our perspective. We have made remarkable progress against Ebola disease caused by Zaire, including vaccine therapeutics, uh, diagnostic, and ability to conduct rigorous clinical trial during outbreak. But the current Bundibugyo expose an important asymmetry. Those advances have not translated into equivalent licensed con-countermeasure across pathogenic Ebola virus. So our perspective, therefore, ask a broader question. Have we learned only from biomedical lesson of Ebola, or have we also learned the lesson about trust, equity, local scientific leadership, community partnership, and sustained preparedness? So those are the aspects we want to highlight, that discovery, it's, it's more than just, uh, discovering the virus. Really, it involves, you know, institutions, trained people, functioning laboratory, research platform, community