A doctor who just returned from treating Ebola patients in West Africa predicts the current Ebola outbreak will go on for more than a year, and will continue to spread unless a vaccine or other drugs that prevent or treat the disease are developed.

Dr. Daniel Lucey, an expert on viral outbreaks and an adjunct professor at Georgetown University Medical Center, recently spent three weeks in Sierra Leone, one of the countries affected by the Ebola outbreak. While there, Lucey evaluated and treated Ebola patients, and trained other doctors and nurses on how to use protective equipment.

The current Ebola outbreak, which is mainly in Guinea, Sierra Leone and Liberia, has so far killed at least 1,552 of the more than 3,000 people infected, making it the largest and deadliest Ebola outbreak in history. It is also the first outbreak to spread from rural areas to cities. Strategies that have worked in the past to stop Ebola outbreaks in rural areas may not, by themselves, be enough to halt this outbreak, Lucey said.

"I don't believe that our traditional methods of being able to control and stop outbreaks in rural areas … is going to be effective in most of the cities," Lucey said yesterday (Sept. 3) in a discussion held at Georgetown University Law Center that was streamed online. While the World Health Organization has released a plan to stop Ebola transmission within six to nine months, "I think that this outbreak is going to go on even longer than a year," Lucey said. [5 Things You Should Know About Ebola]

In addition, without vaccines or drugs for Ebola, "I'm not confident we will be able to stop it," Lucey said. There are a few studies of Ebola treatments and prevention methods under way, but more research is needed to show whether they are safe and effective against the disease.

One strategy that could help with the current outbreak is to implement public health "command centers" whose job it is to make sure that tools and equipment sent to the affected regions are properly distributed to places that need them, Lucey said.

When Lucey was in Sierra Leone, protective equipmentfor health care workers made its way to the capital city, but not to the hospital where he was working, he said. "We did not have gloves that I felt safe with," Lucey said, noting that the gloves would tear easily. "We didn't have face shields. We had goggles that had been washed so many times you couldn't see through them," Lucey said.

Another important factor in stemming the outbreak will be community engagement and education to help people in the region understand the behaviors that spread the disease, said Dr. Marty Cetron, director of Global Migration and Quarantine at the Centers for Disease Control and Prevention. It is also important to understand the culture of an area so that control strategies are culturally acceptable, Cetron said.

This large Ebola outbreak could have been prevented with an effective public health response at the beginning, said Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University. But the weak health systems of the affected countries left them unprepared to respond to the outbreak, Gostin said.

The international community should have been more generous in supporting poorer countries so they could develop the response capacities needed to contain the outbreak, Gostin and colleagues wrote in a recent briefing for the O'Neill Institute.

To help with the current outbreak, and prevent future ones, Gostin called for the establishment of an international "health systems fund," which would be supported by high-resource countries. The money would be used to strengthen the health systems in those countries, he said.

"We want to avoid leaving these countries in the same kind of fragile health condition" that they are in now, and that is being worsened, Gostin said.

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