Thesis (Ph. D.)--McMaster University, 2005. / Advisor: Vic Stzewich. Includes bibliographical references (leaves 267-290). Also available online.

abstract: In this dissertation the potential impact of some social, cultural and economic factors on Ebola Virus Disease (EVD) dynamics and control are studied. In Chapter two, the inability to detect and isolate a large fraction of EVD-infected individuals before symptoms onset is addressed. A mathematical model, calibrated with data from the 2014 West African outbreak, is used to show the dynamics of EVD control under various quarantine and isolation effectiveness regimes. It is shown that in order to make a difference it must reach a high proportion of the infected population. The effect of EVD-dead bodies has been incorporated in the quarantine effectiveness. In Chapter four, the potential impact of differential risk is assessed. A two-patch model without explicitly incorporate quarantine is used to assess the impact of mobility on communities at risk of EVD. It is shown that the overall EVD burden may lessen when mobility in this artificial high-low risk society is allowed. The cost that individuals in the low-risk patch must pay, as measured by secondary cases is highlighted. In Chapter five a model explicitly incorporating patch-specific quarantine levels is used to show that quarantine a large enough proportion of the population under effective isolation leads to a measurable reduction of secondary cases in the presence of mobility. It is shown that sharing limited resources can improve the effectiveness of EVD effective control in the two-patch high-low risk system. Identifying the conditions under which the low-risk community would be willing to accept the increases in EVD risk, needed to reduce the total number of secondary cases in a community composed of two patches with highly differentiated risks has not been addressed. In summary, this dissertation looks at EVD dynamics within an idealized highly polarized world where resources are primarily in the hands of a low-risk community – a community of lower density, higher levels of education and reasonable health services – that shares a “border” with a high-risk community that lacks minimal resources to survive an EVD outbreak. / Dissertation/Thesis / Doctoral Dissertation Applied Mathematics 2018

Introduction: Since the first outbreaks of Ebola virus disease 1976 in the Democratic Republic of the Congo (DRC) and Sudan there has been recurrent epidemics. The biggest outbreak so far hit West Africa between 2013-2016 when at least 28 600 people were estimated to have been infected and approximately 11 300 died in the most severely affected countries Guinea, Sierra Leone and Liberia. Ebola hemorrhagic fever (EHF) or Ebola virus disease (EVD) is caused by a virus that together with the Marburg virus belongs to the Filovirus family. The Ebola virus can cause hemorrhagic bleeding, has a rapid disease progression rate and a high mortality (25-90%). The symptoms are initially headache, fever, sore throat and muscle pain but during the latter part of the disease the characteristic bleedings from all bodily orifices occurs. Many internal organs do damage and survivors often have persistent sequels and long convalescense. EVD is a zoonosis and might infect antelopes, monkeys, porcupines among others. The natural reservoir is believed to be different species of bats. In august 2018, another outbreak of Ebola was reported in DRC. This was the tenth time the disease hit the country. However, for the first time there was candidate vaccine in clinical trial that could be used during an emergency. Experts within the WHO recommended that vaccination was initiated using Merck`s Ebolavaccine rVSV-∆G-ZEBOV-GP that was ready for a phase III clinical trial. This vaccine had already been used during the West African outbreak and had been known to provide a good safety profile as well as immunogenicity. The second vaccine to be used was a two-dose heterologous prime-boost vaccine regimen called Ad26.ZEBOV/MVA-BN-Filo which was marketed by Johnson&Johnson. Ad26.ZEBOV was given as a first dose to prime the immune system and then MVA-BN-Filo was administered as a second dose approximately 8 weeks later as a booster. This vaccine regimen had also been showing promising results in phase I and II clinical trials. Objective: This degree project was made in attempt to answer the issue: How effective and safe are the new Ebola vaccines against EVD? Methods: To answer this question, a literature study was conducted. The outbreak in DRC was ongoing by the time of this degree project and there were no phase III trials conducted for the Ad26.ZEBOV/MVA-BN-Filo vaccine regimen. A lot of information was therefore retrieved from WHO, Doctors without borders, and so on. Merck`s vaccine had been prequalified and received the generic name Ervebo in the fall of 2018. Randomised clinical trials (RCT) and clinical trials regarding Ervebo was downloaded from the internet using the search engine PubMed that`s accessing different databases. Results: Both Ervebo and the 2-dose vaccine regimen Ad26.ZEBOV/MVA-BN-Filo initiated an immune response against ebolavirus that was almost 100%. The most frequent solicited local and systemic adverse events were injection site pain and headache, myalgia and fever. All adverse events were reported to be mild and resolved in a short period of time. No severe adverse events were reported. Discussion: The biggest challenge in the future will concern how to initiate vaccination strategies in countries with a lack of financial resources and infrastructure as well as ongoing armed conflicts (mainly DRC). Conclusion: The new vaccines against Ebola virus infection are all effective with a good safety profile. / Bakgrund: Sedan de första utbrotten av ebolafeber 1976 i Demokratiska republiken Kongo (DRK) och Sudan har epidemier blossat upp med jämna mellanrum. Det hittills största utbrottet drabbade Västafrika 2013-2016 då minst 28 600 beräknades ha smittats och minst 11 300 avled i de hårdast drabbade länderna Guinea, Sierra Leone och Liberia. Ebolafeber, eller ebola hemorragisk feber, orsakas av ett virus som tillsammans med Marburgviruset hör till familjen Filovirus. Ebolaviruset kan orsaka hemorragiska blödningar, har snabbt sjukdomsförlopp och hög dödlighet (25-90%). Symptomen är inledningsvis influensaliknande men under den senare delen av sjukdomsförloppet förekommer de karaktäristiska blödningarna från alla kroppsöppningar. Många inre organ tar skada och överlevare har ofta bestående men och lång konvalescens. Ebolafeber är en zoonos och kan drabba antiloper, olika sorters apor m fl. Den naturliga reservoaren tros vara olika arter av fladdermöss. I augusti 2018 rapporterades om ännu ett utbrott av ebolafeber i DRK, det 10:e i ordningen. En avgörande skillnad vid detta utbrott var att det nu fanns kandidatvaccin i kliniska studier att tillgå. En expertgrupp inom WHO rekommenderade att vaccination inledddes med rVSV-∆G-ZEBOV, ett ebolavaccin tillverkat av Merck redo för kliniska studier fas III. Detta vaccin hade använts redan under utbrottet i Västafrika och visat goda resultat vad gällde immunogenicitet och säkerhet. Det andra vaccinet att sättas in var Ad26.ZEBOV/MVA-BN-Filo, tillhandahållet av Johnson&Johnson. Detta bestod av två olika doser som gavs med ca 8 veckors mellanrum, ofta kallat ”prime/boost”-vaccin. Även för Ad26.ZEBOV/MVA-BN-Filo fanns dokumenterade positiva resultat. Syfte: Detta examensarbetet gjordes med syftet att svara på frågeställningen: Hur effektiva och säkra är de nya vaccinen mot ebolafeber? Metod: För att svara på frågan gjordes en litteraturstudie. När detta examensarbete författades pågick fortfarande utbrottet i DRK och fas III studierna för Ad26.ZEBOV/MVA-BN-Filo var inte avslutade. Mycket information fick hämtas från olika hemsidor, bl a WHO och Läkare utan gränser. Mercks vaccin prekvalificerades hösten 2019 och gavs handelsnamnet Ervebo. För detta vaccin fanns fler RCT-studier tillgängliga, vilka uteslutande valdes m h a sökmotorn PubMed som är länkad till olika databaser. Resultat: Både singeldosvaccinet Ervebo och dubbeldosvaccinen Ad26.ZEBOV/MVA-BN-Filo konstaterades ge ett nästan 100%-igt immunsvar mot ebolavirus. I den mån biverkningar förekom var de milda och övergående. Den mest rapporterade lokala biverkningen var ömhet vid injektionsstället och de vanligaste systemiska biverkningarna var huvudvärk, myalgi och feber. Diskussion: Den största utmaningen i framtiden blir att inleda vaccinationsprogram i länder med bristande finansiella resurser och infrastruktur samt pågående väpnade konflikter (främst DRK). Slutsatsen blev att de nya vaccinen mot ebolafeber är effektiva och säkra vid behandling mot ebolavirusinfektion.

Background: The Ebola virus disease (EVD) outbreak 2014 received extensive news media coverage, which faded out before the outbreak ended. News media coverage impacts risk perception; it is, however, unclear if the components of risk perception (affective and cognitive responses) change differently over time. Methods: In an online panel, we asked participants (n = 1376) about EVD risk perceptions at the epidemic's peak (November 2014) and after news media coverage faded out (August 2015). We investigated worry (affective response), perceived likelihood of infection, perceived personal impact, and coping efficacy (dimensions of cognitive response), and knowledge about transmission. Differences between the surveys with respect to manifestations of affective and cognitive dimensions were tested using the Wilcoxon signed-rank test. The association between individual change in knowledge and worries about EVD in the first survey was investigated using linear regression. Results: In November 2014, the survey was filled in by 974 participants. Ten months later, 662 of them were still members of the online panel and were invited to the follow-up survey. Among the 620 respondents, affective response decreased between the surveys. Knowledge about EVD also decreased; however, participants worried about EVD in 2014 had increased knowledge in 2015. Perceived likelihood of infection decreased over time, while perceived personal impact and coping efficacy did not. Conclusions: Risk communication appealing to cognitive reactions by informing clearly on the risk of infection in unaffected countries may decrease inappropriate behaviors.

This study critically explores the pervasive issue of corruption in humanitarian assistance, focusing on the Liberia Red Cross Society (LRCS) during the Ebola outbreak in Liberia from 2014-2016. For a country grappling with broken infrastructure and fragile healthcare systems due to a 14-year-long civil war, the Ebola crisis in Liberia was an unprecedented disaster as evidenced by 10,672 recorded cases and 4,808 reported fatalities between 2014 and 2016. The LRCS was a prominent local humanitarian actor in the Ebola response and recovery efforts, but its work was marred by corruption stemming from organizational, contextual, and motivational factors. This study sheds light on the nature and extent of corruption within humanitarian action from the perspective of the LRCS and the Ebola epidemic in Liberia, contributing to humanitarianism as a discipline and a profession. The study utilized the principal-agent theory and the organizational culture theory of corruption in humanitarian assistance, which had been employed in earlier studies of a similar nature. In terms of methodology, a qualitative approach with retrospective review was employed to address two research questions regarding the drivers and impact of corruption in the Ebola response and recovery operations conducted by the LRCS. Data for the study were collected from a mix of 14 pre-existing sources, including documents originating from the LRCS and its consortium of donors and partners, as well as published news content from notable local and global media outlets. The results were generated through document analysis facilitated by ATLAS.ti, a qualitative data analysis software, which considered patterns, trends, and insights within the sources gathered for the study. Multiple rounds of analyses on the data were conducted to validate the results of the study.  The findings of this study reveal a complex web of corruption within humanitarian aid delivery during crisis and disaster. Corrupt practices within the LRCS included fraud and misuse of Ebola relief funds and resources, driven by individual motivations coupled with a number of organizational and contextual factors. The corruption had adverse effects on the efficiency, effectiveness, and accountability of relief efforts, potentially leading to reduced donor confidence in the LRCS and funding reduction. The study also stresses the importance of leadership, decision-making processes as well as resource management in preventing or enabling corruption within humanitarian aid organizations. These findings underscore the need for robust internal oversight, accountability mechanisms, and ethical leadership in humanitarian organizations to prevent and address corruption effectively.

No description available.

The purpose of this study was to explore the securitization of communicable disease in the case of the Ebola outbreak in West Africa 2014. Applying the Copenhagen School’s theory of securitization, this thesis conducted a discourse analysis of speech acts occurring at different levels of the global community in relation to the outbreak. The focus lay on two major events, namely the UN Security Council meeting on 18 September 2014 and the UN high-level meeting on Ebola a week later. Investigating to what extent the securitizing discourse apparent in Resolution 2177 which identified Ebola as a “threat to international peace and security” was upheld and justified by the speakers at these events, this study determined that Ebola virus disease has been “successfully” securitized on all levels of global governance. Despite the incredible amount of human suffering which the Ebola outbreak provoked in West Africa, the discourse employed by global governance identified the referent object nearly exclusively at the state-level. Further research is suggested in the concluding parts of this thesis that can build upon the findings of this study.

En dépit d’épidémies répétées, il n’existe pas à ce jour de thérapeutique ayant démontré son efficacité dans la maladie à virus Ebola. Sur la base d’expérimentations réalisées chez la souris et le macaque dans le cadre du consortium Reaction!, l’objectif de cette thèse visait à caractériser l’effet d’une molécule antivirale, le favipiravir, via l’implémentation de modèles mathématiques mécanistiques de l’infection et de la réponse immunitaire associée. L’approche utilisée pour construire ces modèles et en estimer les paramètres reposait sur les modèles non linéaires à effets mixtes. Un premier travail a permis d’explorer la relation concentration-effet sur la charge virale plasmatique chez la souris. Le second projet a conduit à caractériser la pharmacocinétique non linéaire dose et temps dépendante du favipiravir chez le macaque, en vue d’identifier les schémas posologiques pertinents pour la réalisation des études d’efficacité chez l’animal infecté. Au décours de leur réalisation, l’intégration des données virologiques et immunitaires générées au sein d’un modèle conjoint a permis de caractériser un effet modéré du favipiravir sur la réplication virale, mais suffisant pour limiter le développement d’une réaction inflammatoire délétère, et ainsi améliorer le taux de survie des animaux traités. Les simulations réalisées avec ce modèle ont pu souligner l’impact déterminant du délai d’initiation du traitement sur la survie. Ces résultats incitent à la poursuite de l’évaluation clinique du favipiravir, en favorisant des essais de prophylaxie ou post exposition. Enfin, un dernier travail a démontré l’absence de potentialisation du favipiravir par la ribavirine dans Ebola. / In spite of recurrent outbreaks, no therapeutics with demonstrated clinical efficacy are available in Ebola virus disease. Based on experimentations performed by Reaction! Consortium in mice and macaques, this thesis aimed to characterize the effect of an antiviral drug, favipiravir, using mechanistic mathematical models of the infection and associated immune response. The approach to build models and estimate parameters relied on nonlinear mixed effect models. The first project of this thesis explored the concentration-effect relationship on the viremia in mice. Then, a second project allowed to characterize the pharmacokinetics of favipiravir in macaques, underlying dose and time non linearity, and to identify relevant dosing regimen for efficacy experiments in infected animals. Once these experiments completed, the integration of the virological and immunological data into a mechanistic joint model shed light on the effect of favipiravir. The moderate inhibition of the viral replication resulting from the favipiravir plasma concentrations was enough to limit the development of a deleterious inflammatory response, and thus improve the survival rate of treated macaques. Simulations performed with this model underlined the crucial impact of the treatment initiation delay on survival. These results encourage the pursuit of the clinical evaluation of favipiravir in prophylaxis or post exposure trials. Finally, a last project demonstrated the lack of benefit of ribavirin addition to favipiravir in Ebola virus disease.

LLM / Department of Public Law / Human rights are those inalienable rights of an individual by virtue of being a human being. They are guaranteed by various domestic and international instruments. This research argues that despite the existence of these instruments and wide acceptances of international human rights standards that seek to protect the right to healthcare, the people infected with Ebola Virus Disease (EVD) are victims of a wide range of constraints to their right to healthcare as a result of the failure by the governments of the respective nations where the impacts of the EVD are mostly felt to discharge their obligations under those instruments. The rights of the people infected with EVD are often violated because of their presumed or known EVD status, causing them to suffer both the burden of the disease and the social burden of discrimination and stigmatisation which could deter the infected persons from accessing available treatment. This would invariably contribute to the spread of the disease. The research further exposes the dilemma posed by the EVD to the healthcare system, where healthcare providers are caught between the rock of selfpreservation from a highly virulent disease and the hard place of discharging their Hippocratic Oath which prescribes ethical guidelines for the discharge of the duties of the medical profession. The present research, which is novel in the field of medico-legal research, seeks to proffer answers to this conundrum.

Health officials estimate that the 2014 Ebola crisis disproportionately victimized women, who made up 75% of the disease's victims. This interdisciplinary study has two main goals. The first is to evaluate the news media's performance in relation to their representation of women caught up in the Ebola crisis because the media play an important role in influencing public responses to health. This study sought to understand the information behavior patterns of journalists who covered the Ebola crisis by analyzing how job tasks influence a journalist's information behavior. This study employed qualitative methods to study the perceptions of journalists who covered the 2014 Ebola outbreak. Semi-structured interviews were conducted with Liberian and American journalists who covered the outbreak to understand the choices that guided their reporting of the Ebola crisis. A content analysis of The New York Times, The Times, and The Inquirer was also conducted to examine the new media's representation of women in an outbreak which mostly victimized women. The findings suggest that covering a dangerous assignment like Ebola affected the information behavior patterns of journalists. Audience needs, the timing of coverage, fear, and the accessibility of sources, were some of the factors that influenced the news gathering decisions taken by the reporters. The findings also suggest that women were mostly underrepresented by the media as sources, experts and subjects.