From a purely scientific standpoint, the news about the Ebola outbreak has been encouraging. New genomic technologies enable unprecedented surveillance of the virus. There are drugs and vaccines in clinical trials. And in response to the urgency of the crisis, both drugmakers and regulatory agencies are making efforts to expedite the process of getting weapons against Ebola through the regulatory process and into the field, where they are needed. (See BioWorld Today, Oct. 22, 2014.)

But for all that, the outbreak is still growing as the number of cases approaches 10,000 and the number of deaths 5,000. And anyone considering the bigger picture of the outbreak might reasonably conclude that the issues that have allowed the epidemic to reach its current proportions in the first place are not, at their heart, medical ones. Getting the current outbreak under control, and preventing the next one, will require fundamental changes to the societies where those outbreaks occur, and have been continuously occurring since about 1990, albeit not on anywhere near the current scale.

In general, "so far, Ebola and modern medicine haven't really collided. And when they have, it hasn't been in Liberia, Sierra Leone or Guinea," the three countries hit hardest by the current epidemic, said Paul Farmer of Partners in Health.

George Gao of the Chinese CDC described the situation from Sierra Leone, where the capital, Freetown, has an estimated population of 1.2 million people who were serviced by six ambulances when he arrived there earlier this year.

The West African nations where the epidemic is still growing "need science and technology," he said. But they also need far more mundane materials – isolation units, beds, motorcycles for health workers to reach outlying villages.

And they need a public health system that the general population trusts. "It's [a] social problem here," Gao said.

Nevertheless, Gao and others stressed in two separate briefings on the Ebola crisis held earlier this week, modern medical science has a critical part to play in addressing the outbreak. And an effective medical arsenal, in turn, can help with some of the other issues that make the fight against the epidemic so difficult.

One briefing was hosted by Cell Press and the other by The New England Journal of Medicine.

In the briefings, those fighting the epidemic painted a vivid portrait of the many challenges that hamper the fight against Ebola – but also of the critical role that biomedical advances can play in addressing some of those challenges, going beyond their ability to protect or treat individual patients.

The contrast between what is possible scientifically and how the epidemic continues to unfold in practice can be jarring. At the Cell Press briefing, Harvard University's Pardis Sabeti described her team's work in Sierra Leone in sequencing samples from almost 150 Ebola patients, piecing together 99 full-length sequences from 78 patients to date.

Those sequences have given insight into the details of how Ebola spreads, and how it changes as it spreads, in a way that is unprecedented. "We know what the virus is doing as it's doing it," Sabeti said.

Sequencing surveillance allowed Augustine Goba, director of the Lassa fever laboratory at Sierra Leone's Kenema Government Hospital, to diagnose Sierra Leone's first case in May 2014 as soon as it appeared. Surveillance in March and April had not turned up any cases.

If such surveillance had been in place before the outbreak started, it might have been able to stop the epidemic in its track. As it was, though, by the time Goba diagnosed the first case in Sierra Leone, the epidemic had been going on for months and had been breeding for many months in Liberia and Guinea, and moved to exponential growth, leaving the surveillance that was in place in Sierra Leone powerless to actually change the trajectory of the epidemic.

The Wellcome Trust's Jeremy Farrar belabored that point in his presentation. "Surveillance is critical, but surveillance itself will not solve the problem," he said. "Once something has emerged, our response time . . . lags way behind what it needs to be in the 21st century."

Farrar said that classic public health measures will be the key to gaining control of the current outbreak. But such public health measures "can be complemented by rapid diagnostics, vaccines and drugs."

Vaccines, especially, will be critical for protecting not just the vaccinated individuals, but in a sense the entire frontline response to the epidemic.

Ebola poses a disproportionate risk to health care workers. So far, more than 400 health care workers have been infected with Ebola, and about 65 percent of them have died. And Partners in Health's Farmer pointed out that the West African health systems "were already grotesquely understaffed prior to this year's losses."

While "improving care for caregivers is a ranking concern," drugs would of course benefit all patients. And offering patients tangible options and benefits would clearly improve the quality of the Ebola treatment centers, where, Farmer bluntly noted, care "has been poor."

Such improvements, in turn, could increase acceptance of the treatment centers, making isolation efforts easier, and lessen stigma, increasing the respect and dignity accorded to the infected, and the still infectious dead.

Ideally, such changes in treatments and attitudes could interlock into a virtuous cycle.

Farrar compared the situation of impotence on the part of the medical community, stigma and distrust on the part of the patients to the early years of the HIV pandemic. "It was amazing, the change that occurred both in lives, but also in attitudes. . . when we developed antiretroviral drugs," he said. The resulting shift from antagonism to (mostly) cooperation between HIV infected individuals and the medical establishment, in turn, played a role in turning HIV from a death sentence into a chronic disease in the West.

Though there are not guarantees, the current Ebola outbreak may be on the wane by the time a drug or vaccine is approved, and so in the short run, "the drugs may not change the epidemic curve," Farrar said. "But they will change the relationship between health care workers and the community."