Comentário do Examinador sobre Habilidade em Organizar Pesquisa Interdisciplinar para Redação

Examiners commentary The ability to organize a very wideranging research base is a necessary skill in world studies essays which demand an interdisciplinary response This essay is a powerful example of how to use concise analytical writing to do that The student controls the research by having selected pivotal aspects of it and structured these into an argument that continually opens into discussion and analysis The sources are also critiqued as evidence is weighed so that judgment can follow in an informed and comprehensive manner The student continually challenges their own findings and looks to triangulate research whenever they can The sifting of knowledge and understanding through different subject filters captures the essence of the interdisciplinary essay and this is a remarkably adept example of how this can be done Long and detailed conclusions are often a feature of sophisticated research in this context In that respect the conclusion is a model of its kind The IB believe that content owners have the right to protect their property from theft We are working to make digital content widely available while protecting it through strategies that meet our community expectations Piracy is best addressed through consumer education the enforcement of current copyright laws and new technologies and business models that make legal access to digital content easy convenient and affordable Any violation of IBs copyright will be prosecuted to the fullest extent of the law Examiners commentary The ability to organize a very wideranging research base is a necessary skill in world studies essays which demand an interdisciplinary response This essay is a powerful example of how to use concise analytical writing to do that The student controls the research by having selected pivotal aspects of it and structured these into an argument that continually opens into discussion and analysis The sources are also critiqued as evidence is weighed so that judgment can follow in an informed and comprehensive manner The student continually challenges their own findings and looks to triangulate research whenever they can The sifting of knowledge and understanding through different subject filters captures the essence of the interdisciplinary essay and this is a remarkably adept example of how this can be done Long and detailed conclusions are often a feature of sophisticated research in this context In that respect the conclusion is a model of its kind The IB believe that content owners have the right to protect their property from theft We are working to make digital content widely available while protecting it through strategies that meet our community expectations Piracy is best addressed through consumer education the enforcement of current copyright laws and new technologies and business models that make legal access to digital content easy convenient and affordable Any violation of IBs copyright will be prosecuted to the fullest extent of the law Table of Contents INTRODUCTION 3 EBOLA VIRUS PATHOPHYSIOLOGY AND ANALYSIS OF rVSVZEBOV 4 PATHOPHYSIOLOGY 4 rVSVZEBOV ANALYSIS 5 ZAIRE OUTBREAK 1976 8 WEST AFRICAN OUTBREAK 20132016 10 DRC OUTBREAK 2018 PRESENT 12 CONCLUSION 14 WORKS CITED 16 Introduction On the 24th of July 2018 the most recent outbreak of Ebola Virus Disease EVD in Équateur Province Democratic Peoples Republic of Congo DRC has been declared officially over Boseley Lasting two months since May the outbreak caused 53 cases and 29 deaths Boseley yet a massive containment effort successfully limited the outbreak from causing further casualties However the WHO has also acknowledged the effectiveness of a new Ebola vaccine in combating EVD stating that Ring vaccination is a new and vital tool in the control of Ebolathis is a major milestone in public health WHO These sources suggest that advances in medicine and the effectiveness of response efforts both helped to suppress the 2018 EVD outbreak with relatively few casualties However this was not always the case for previous EVD outbreaks with some causing thousands of deaths and massive economic losses to the SubSaharan region EVD first began as an outbreak in Zaire now the DRC in 1976 The main reasons for EVDs lethality is its tendency to reappear intermittently in previously infected areas especially SubSaharan Africa its highly variable mortality rate ranging from 25 to an astonishingly high 90 and its highly contagious nature Some studies have suggested that the perceived threat of bioterrorism associated with these viruses have triggered tremendous interest in these viruses Hoenen et al Therefore it is of utmost importance to identify the key methods of limiting the spread of such diseases to prevent further damage to society As such this Extended Essay explores the question To what extent has the development of biotechnology in the late 20th and early 21st centuries affected the combat of Ebola Virus Disease in SubSaharan Africa compared with other factors This Extended Essay will focus on three major local outbreaks of EVD namely Zaire 1995 West Africa 20132016 and the DRC 2018 The essay will evaluate the extent to which biotechnology impacted the epidemics by contrasting this An investigation on the extent to which biotechnology development affects the combat of Ebola Virus Disease To what extent has the development of biotechnology in the late 20th and early 21st centuries affected the combat of Ebola Virus Disease in SubSaharan Africa compared to other factors World Studies Extended Essay Health and Development History and Biology Word Count 3998 with the quality of health infrastructure and response efforts and finally the relationship with local populations By approaching the investigation from the perspectives of History and Biology the essay provides a multifaceted perspective on how viral outbreaks may be best contained and how future outbreaks may even be prevented In this investigation I explore the pathophysiology of EVD in addition to the mechanism of the rVSVZEBOV vaccine I will also analyse secondary data pertaining to the efficacy of the rVSVZEBOV virus and explore its implications and limitations Furthermore from a historical perspective I aim to contrast the relative importance of biotechnology with other factors such as the quality of healthcare infrastructure response times and local relationships in each outbreak This will be compared to the results of previous outbreaks to determine the overall relative importance of biotechnology in supressing EVD outbreaks I will use a variety of sources including books academic journals and memoirs to draw meaningful conclusions and these sources will be evaluated and analysed In the conclusion I aim to conclude whether or not developments in biotechnology can be argued to be the major factor in the repression of EVD outbreaks or if other factors were more important and finally to suggest actions for future outbreaks of EVD or similar diseases Ebola Virus Pathophysiology and analysis of rVSVZEBOV Pathophysiology EVD is a viral hemorrhagic fever and can be found in humans and other primates The disease if left untreated is oftentimes fatal with a case fatality rate ranging from 25 to 90 depending on the level of treatment The disease often begins with a sudden fever Internal bleeding develops in 57 days often resulting in death caused by multiorgan failure from rapid viral infection of multiple cell types and unusually high rate of viral replication in infected cells Sridhar Ebola was first transmitted to humans from fruit bats which are natural hosts of the Ebola virus through contact with bodily fluids WHO Fact Sheet Humans may be infected if they come into direct contact with bodily fluids of the 5 infected or with contaminated surfaces and materials This means that healthcare workers are at extreme risk of being infected as they are in frequent contact with infected patients After entering the body the virus first attacks dendritic cells which act as the brains of the immune system Roghanian These infected cells carry the virus to various lymph nodes in the body where they mature and replicate spreading throughout the body This prompts the body to initiate apoptosis programmed cell death in white blood cells weakening the immune response Endothelial cells which constitute membrane linings also undergo apoptosis which causes internal bleeding in many parts of the body eventually leading to organ damage and failure Baize et al while the attack on the innate immune system indirectly suppresses the adaptive immune response as Tcells are no longer activated suppressing Bcell and plasma cell activation Essentially widespread immunosuppression due to EVD causes a dysfunctional innate immune response leading to little to no adaptive immune response causing multiple organ failure rVSVZEBOV Analysis As of 2018 The rVSVZEBOV Recombinant vesicular stomatitis virus Zaire Ebolavirus vaccine provides high levels of protection against EVD in clinical trials The vaccine consists of a vesicular stomatitis virus which has been genetically engineered with Zaire ebolavirus antigens Jones et al which refers to a particle used by cells to identify foreign pathogens in the body This allows the vaccine to provoke a more effective immune response since the viral vector is alive and specifically tailored to Zaire ebolavirus while VSV is harmless to humans This causes an adaptive immune response as B and T lymphocytes fight off the infection Some B and T cells differentiate into memory B and T lymphocytes and stay present in the blood for long periods ensuring an accelerated and stronger immune response in the presence of an actual EVD infection in the future To corroborate this below is data from a study conducted by HenaoRestrepo et al in Guinea testing the efficacy and effectiveness of an rVSVvectored virus in preventing EVD in randomized trials 6 Group A Cluster 1 Cluster 2 Cluster 3 Cluster 4 All vaccinated in immediate group A All vaccinated in immediate group A All eligible in immediate group A All contacts and contacts of contacts in immediate group A No of individuals 2108 2108 3212 4513 Cases of EVD 0 0 7 10 Attack rate 000 000 022 022 Fig 1 Table showing EVD statistics for Group A randomized clusters Cluster refers to the patient in addition to of all their contacts and contacts of contacts HenaoRestrepo et al Group B Cluster 1 Cluster 2 Cluster 3 Cluster 4 All eligible and consented on day 0 visit in delayed group B All eligible in delayed group B All eligible in delayed group B All contacts and contacts of contacts in delayed group B No of Individuals 1429 3075 3075 4529 Cases of EVD 10 16 16 22 Attack rate 070 052 052 049 Fig 2 Table showing EVD statistics for Group B randomized clusters Vaccine effects Cluster 1 Cluster 2 Cluster 3 Cluster 4 Vaccine efficacy 95 CI 100 635 to 1000 100 689 to 1000 646 465 to 914 646 442 to 913 pvalue 00471 000450 034400 037610 Fig 3 Table showing vaccine efficacies Clusters 1 and 2 are calculated using a βbinomial distribution clusters 3 and 4 using a Cox Proportional Hazards Model In biology a common method of testing for validity is to use pvalues and confidence intervals CI This study utilizes a 95 CI which indicates that there is a 95 chance that the range calculated contains the mean GraphPad In clusters 3 and 4 we can observe that the range of values is significantly larger than clusters 1 and 2 This suggests that in the former there is a wider spread of data around the mean In clusters 1 and 2 the reported vaccine efficacy is 100 suggesting that there is conclusive evidence to show that there is a causal relationship between immediate vaccine implementation and the chance of developing EVD This is adduced by a pvalue of 00471 The p value is a probability which reflects the measure of evidence against the null hypothesis If the p value is below a predefined limit the results are designated as statistically significant Prel et al By general consensus the pvalue was set to 005 and thus we can see that the results of Clusters 1 and 2 are statistically significant but not for Clusters 3 and 4 This poses a problem when comparing Clusters 2 and 3 as they have different Group A variables yet identical Group B variables However we may still conclude that based on observation of the cases the vaccine when administered immediately after EVD confirmation is still largely effective for EVD prophylaxis This is supported by Cluster 4 where the attack rates of all individuals in contact with the patient in addition to their contacts has risen from 022 in the immediate group to 049 in the delayed group However the conclusion is limited as the researchers were forced to end randomized trials in favour of immediate vaccination for the remaining sample due to health concerns In addition the study may potentially be biased as medical study teams remained with the immediate group to detect additional sideeffects and this continuous interaction would have affected the knowledge and behaviour eg awareness of disease symptoms of the participants which in turn would have affected disease transmission Metzger et al Yet we can still conclude that the rVSVZEBOV is highly protective against EVD in infected populations although not reaching 100 Metzger et al also highlighted the need for the vaccine to be used in conjunction with the support of medical teams and the cooperation of locals In addition a historical analysis is needed to contrast the efficacy of the vaccine with other factors that could impact the transmission of EVD such as the quality of health infrastructure and response timings in order to reach a fully evaluated conclusion Zaire Outbreak 1976 In 1976 the first outbreak of EVD was recorded in Zaire now the DRC in a town named Yambuku Out of a recorded 318 patients 88 died by the end of the epidemic almost reaching a 90 mortality rate Oldstone 130 The virus had originated from a school headmaster who had sought treatment at a local hospital Piot but due to the disease being hitherto undiscovered containment procedures were not available and the disease rapidly spread to other patients Some sources argue that the lack of biological understanding of EVD was a key factor in the emergence of the epidemic Laurie Garett notes that due to EVD being an unknown disease many cases were misidentified as malaria and patients were given quinine Garett100 Quinine is an antimalarial drug which is effective against parasites such as Plasmodium by interfering with their ability to digest haemoglobin Foley Viruses lack their own metabolism thus they remain unaffected This perspective is supported by Breman et al noting that Several patients were given vitamins and other medicines by injection injections were favoured by patients and medical staff The source emphasizes the lack of medical knowledge in the hospital staff and patients in addition to the flouting of medical protocol Therefore we may observe that contemporary biotechnology and medicine was lacking at the time as medical professionals could not accurately determine diseases such as EVD and prescribe effective treatments for those infected However some argue that another factor was the poor quality of health infrastructure in the region Breman et al argued that the DRC was not equipped with a functioning health system capable of countering an unknown disease noting Five glass syringes and metal needles were used repeatedly without sterilization and only occasionally were rinsed Breman et al The source highlights the appalling medical protocol in local hospitals and suggests that this was a key factor in the spread of the epidemic This perspective is supported by Peter Piot a member of the team which From NO TIME TO LOSE A LIFE IN PURSUIT OF DEADLY VIRUSES by Peter Piot Copyright 2012 by Peter Piot Used by permission of W W Norton Company Inc West African Outbreak 20132016 The West African Ebola epidemic was most severe Ebola epidemic in history beginning in 2013 and ending in 2016 with approximately 28616 cases and 11310 deaths in Sierra Leone Guinea and Liberia however these figures understated the magnitude of the outbreak Meltzer et al Although the years between the outbreaks saw developments in biotechnology and funding for health agencies such as the WHO and Médecins Sans Frontières MSF many sources point to the inaction of the WHO and its oversights in organization for the large number of casualties causing a major paradigm shift in public health doctrine Sources note that the West African Ebola Outbreak was one of the worst disease outbreaks in history Siedner et al Some sources argue that the stagnation of biotechnological development into EVD was a main factor in its spread Coltart et al noted that clinical trials of vaccines occurred too late to have any significant impact on this outbreak This suggests that although there was research into EVD vaccines none of them proved safe enough for clinical use WHO Statement on Ebola Therapies However a limitation of the source is that it does not go into detail about the science behind the clinical trials of vaccines during that time This source is substantiated by Folayan et al who noted that At present there is no approved specific therapy or vaccine for EVDSupportive clinical care has been the most promising care for EVD patients in the affected West African countries This suggests that even with the development of EVD vaccines it has not been effective enough as evident by the continuing use of supportive care as a main form of treatment Therefore we may argue that the delay in biotechnological development specifically EVD vaccines played a role in the outbreaks emergence as they could have potentially saved more lives than pure supportive therapy However we must acknowledge the fact that the vaccines were in clinical trials thus the problem arises in the implementation of vaccines not their development unknown sideeffects could also arise due to its unlicensed nature and some facilities were not technologically advanced enough to implement the logistical procedures needed such as coldchain transport Nevertheless the inability to deploy EVD vaccines in the West African outbreak was still a crucial factor in managing the spread of the outbreak into other countries Others argue that the inadequate and protracted early response by the WHO coupled with the location of the disease mainly Guinea Sierra Leone and Libya countries classified as lowincome countries World Bank was the main reason for the outbreaks exacerbation in comparison to the Yambuku outbreak Breman et al notes that the Zaire outbreaks waning was undoubtedly due to the isolation of the affected Yambuku community effective control measures and relatively low transmission potential Breman et al suggesting that the effective isolation of patients decreased EVDs transmission potential in Yambuku The notion that location was a main factor is supported by Siedner et al noting that Guinea Sierra Leone and Liberia are all recovering from prolonged periods of civic unrest and suffering from decimated health systems with limited human resource capacity Siedner et al suggesting that due to the sizes of the countries afflicted controlling the spread of the epidemic was substantially harder than in Yambuku Siedner et al also noted that regional health infrastructure was quickly overwhelmed teaching us that a need for external assistance ought to become a primary condition for declaring a PHEIC Here PHEIC refers to a Public Health Emergency of International Concern the source emphasizes the fact that the WHO had prioritized the present number of cases instead of the need for external assistance This led to the severe underestimation of the epidemics scale as it quickly overran neighbouring countries with similarly weak health systems Although a PHEIC may only be declared when outbreaks transcend a national border WHO Siedner et al argued that the West African epidemic had already killed many in Guinea and severely destabilized the region even before its spread to Sierra Leone and Liberia They conclude that delaying an announcement of PHEIC imperils lives and does more economic damage and undermines political legitimacy in the long run Siedner et al Another closelylinked factor was the peoples distrust of health authorities and international agencies Siedner et al notes that hospital and school closures quarantines and border closuresengendered widespread public distrust of health authorities suggesting that a failure to reassure local populations heavily impacted containment efforts This is supported by The Lancets report of families forcibly removing their relatives from health facilities as health workers were preoccupied with other patients The Lancet The source contrasts the West African outbreak with the previous Zaire Outbreak noting that the Zaire response prioritized early cooperation with local authorities along with effective leadership logistics and communication with local villagers to ensure that control measures are culturally appropriate Therefore there is substantial evidence to suggest that a protracted early response coupled with fraught relations with the locals were the main reasons for the spread of EVD However we must consider the fact that EVD vaccines were not employed in this outbreak which could have potentially saved many lives Yet we must also acknowledge that a protracted early response would have significantly hampered the administration of treatments to the local population and that EVD vaccines in 2016 had not yet shown remarkable efficacy even in clinical trials DRC Outbreak 2018 present The 2018 Ebola outbreaks consists of the May July Équateur outbreak and the August Kivu Outbreak which is currently ongoing at the time of writing The outbreak marks the first time an EVD vaccine has been used in an effort to combat EVD The outbreaks are the largest since the West African Outbreak of 2016 however compared to the West African outbreak the Équateur outbreak was contained in a relatively short time causing only 33 deaths Sources argue that the main factor leading to the quick suppression of the epidemic was the early utilization of the rVSVEBOV vaccine A WHO situation report notes that since the launch of the vaccination exercise on 21 May 2018 a total of 3330 people have been vaccinated WHO External Situation Report 07 a mere 10 days after the outbreaks announcement The source is valuable as it is an official WHO account detailing the successes of the ring vaccination programme which was effective due to its early implementation The source suggests that the international community has learnt from its failures during the West African outbreak and this is corroborated by a Reuters article noting that Ross Therefore we can see that the vaccine was highly successful in containing the disease within limited areas and was a main factor in the quick suppression of the outbreak Despite the vaccines relative success others argue that the main factor was the swift response by the WHO Nature notes that the speed with which the WHO responded to the outbreak releasing US2 million within hours and deploying additional personnel will have been a major factor in limiting the spread of infection Nature The source suggests that the WHO has learnt from its failures in previous years and now strives to predict and prevent possible health emergencies This is supported by a WHO statement WHO continues to support neighbouring countries to take action on Ebola preparedness and to develop national contingency response plans WHO However a statement from the WHO itself can imply bias as they are less likely to report any major shortcomings in the procedure Nevertheless the time frame of this outbreak was much shorter than the West African outbreak and the number of casualties also dropped significantly and this can be attributed to the quick response by international agencies along with landmark utilization of EVD vaccines 13 Conclusion The three major EVD outbreaks have each had multifactorial causes and each can be argued to have had a significant impact Through the perspective of biology we have analysed data pertaining to the efficacy of the Ebola Virus and have concluded with the use of confidence intervals and pvalues that the rVSVZEBOV vaccine does have a significant effect on the prevention of EVD with a reported 100 efficacy although this is disputed due to numerous aforementioned limitations of the study However through the perspective of history the essay has contrasted the biological analysis with a historical investigation of multiple factors affecting the combat of EVD outbreaks including the development of the rVSVEBOV vaccine the quality of local health infrastructure response timings and the relationships with local populations A combination of both primary and secondary sources allows for a broader understanding into public health policy For example primary sources were used in describing the challenges faced by WHO personnel in establishing local relationships and administering treatments while secondary sources were used in the analysis of WHO response procedures and in the consideration of other perspectives Thus both types of sources are useful as they ensure that the essay reaches a valid and purposeful evaluation However we must acknowledge that each type of source has potential bias and that the historian cannot force a balance when considering each perspective We can therefore conclude that the development of biotechnology has not successfully impacted the majority of EVD outbreaks in the late 20th to early 21st centuries The spread of an Ebola outbreak is often influenced by a variety of factors the rVSVEBOV vaccine is expensive to produce and requires extensive storage and transport procedures a small spread may not justify the costs of using the vaccine We must also acknowledge the stagnation of biotechnology in the West African Ebola outbreak of 20132016 showing limited advancement from the previous Zaire outbreak One may also observe that with regards to EVD vaccines and potential treatments have only been deployed in 2018 and have not been licensed pointing to potential flaws in their design and longterm use However there is substantial evidence to suggest that early response time is the most significant factor in combating EVD outbreaks as in each of the three outbreaks analysed early response timings in Yambuku and Équateur managed to decrease the number of casualties along with the support of decent health infrastructure and correct medical protocol while in the West African outbreak evidence indicates that a late declaration of a public health emergency from the WHO lead to an inadequate early response indirectly resulting in many casualties Despite this this conclusion has limitations The essay does not consider the effect of geopolitics and environmental conditions during outbreaks which have a large impact on vector transmission The essay also has not considered other smaller EVD outbreaks thus the sample size from which this essay draws conclusions is quite small In addition the essay does not provide detail on the causes of local tensions such as traditional African religion and indigenous practices Nevertheless based on the limited scope of this investigation it is prudent to suggest that factors such as response time relationships with locals and good healthcare infrastructure play a far more important role than biotechnology in quelling EVD outbreaks in less economically developed areas such as SubSaharan Africa Yet we must not deny the role of biotechnology in providing effective and accurate cures for EVD In case of future outbreaks efforts should be more focused on educating the local population about EVD ensuring effective medical infrastructure and declaring public health emergencies earlier along with the simultaneous early use of biotechnology to suppress outbreaks Further study is also needed to evaluate factors in epidemics in more economically developed areas and with different disease vectors Works Cited Baize S et al Inflammatory Responses in Ebola VirusInfected Patients Clinical Experimental Immunology vol 128 no 1 2002 pp 163168 httpswwwncbinlmnihgovpmcarticlesPMC1906357 Boseley Sarah DRC Ebola Outbreak Is Officially Declared Over The Guardian Guardian News and Media 24 July 2018 httpswwwtheguardiancomworld2018jul24drcebolaoutbreakofficiallydeclaredover Breman Joel G and Karl M Johnson Ebola Then and Now New England Journal of Medicine vol 371 no 18 2014 pp 16631666 httpswwwnejmorgdoifull101056NEJMp1410540 Breman Joel G et al Discovery and Description of Ebola Zaire Virus in 1976 and Relevance to the West African Epidemic During 20132016 Journal of Infectious Diseases vol 214 no suppl 3 2016 httpswwwncbinlmnihgovpmcarticlesPMC5050466 Coltart Cordelia E M et al The Ebola Outbreak 20132016 Old Lessons for New Epidemics Philosophical Transactions of the Royal Society B Biological Sciences vol 372 no 1721 2017 p 20160297 httpswwwncbinlmnihgovpmcarticlesPMC5394636 Ebola Data and Statistics World Health Organization 13 May 2016 appswhointghodataviewebolasitrepebolasummarylatestlangen Ebola in West Africa Gaining Community Trust and Confidence The Lancet vol 383 no 9933 7 June 2014 p 1946 httpswwwthelancetcomjournalslancetarticlePIIS0140673614609387fulltext Ebola Vaccine Provides Protection and Hope for HighRisk Communities in the Democratic Republic of the Congo World Health Organization 30 May 2018 wwwwhointnewsroomfeaturestoriesdetailebolavaccineprovidesprotectionandhopeforhighriskcommunitiesinthedemocraticrepublicofthecongo Ebola Virus Disease Democratic Republic of the Congo External Situation Report 07 World Health Organization 2018 appswhointirisbitstreamhandle10665274530SITREPEVDDRC20180918engpdfua1 Ebola Virus Disease World Health Organization 12 Feb 2018 wwwwhointnewsroomfactsheetsdetailebolavirusdisease Folayan Morenike Oluwatoyin et al Ebola Vaccine Development Plan Ethics Concerns and Proposed Measures BMC Medical Ethics vol 17 no 1 2016 httpswwwncbinlmnihgovpmcarticlesPMC4746804CR3 Foley M Quinoline Antimalarials Mechanisms of Action and Resistance and Prospects for New Agents Pharmacology Therapeutics vol 79 no 1 1998 pp 5587 httpswwwncbinlmnihgovpubmed9719345 Garrett Laurie The Coming Plague Newly Emerging Diseases in a World out of Balance Penguin 1996 accessed 28th September 2018 GraphPad Interpreting a Confidence Interval of a Mean GraphPad Statistics Guide 2017 wwwgraphpadcomguidesprism7statisticsindexhtmstatmoreaboutconfidenceintervalhtm HenaoRestrepo Ana Maria et al Efficacy and Effectiveness of an RVSVVectored Vaccine in Preventing Ebola Virus Disease Final Results from the Guinea Ring Vaccination OpenLabel ClusterRandomised Trial Ebola Ça Suffit The Lancet vol 389 no 10068 22 Dec 2017 pp 505518 httpswwwthelancetcomjournalslancetarticlePIIS01406736281629326216fulltextseccestitle150 Hoenen Thomas et al Current Ebola Vaccines Expert Opinion on Biological Therapy vol 12 no 7 2012 pp 859872 httpswwwncbinlmnihgovpmcarticlesPMC3422127 International Health Regulations 2005 Second Edition World Health Organization 2005 appswhointirisbitstreamhandle10665438839789241580410engpdfjsessionid7FE79739D6BE8CDE156FB3C844C8F814sequence1 Jones Steven M et al Assessment of a Vesicular Stomatitis VirusBased Vaccine by Use of the Mouse Model of Ebola Virus Hemorrhagic Fever The Journal of Infectious Diseases vol 196 no s2 2007 httpsacademicoupcomjidarticle196Supplement2S404861993 Meltzer Martin I et al Estimating the Future Number of Cases in the Ebola Epidemic Liberia and Sierra Leone 20142015 Centers for Disease Control and Prevention 7 Oct 2014 wwwcdcgovmmwrpreviewmmwrhtmlsu6303a1htmscidsu6303a1w Metzger Wolfram G and Sarai VivasMartínez Questionable Efficacy of the RVSVZEBOV Ebola Vaccine The Lancet vol 391 no 10125 2018 p 1021 httpswwwthelancetcomjournalslancetarticlePIIS0140673618305609fulltext Nature Editorial Team Rising to the Ebola Challenge Again Nature Microbiology vol 3 no 9 2018 pp 965965 httpswwwnaturecomarticless4156401802432 Oldstone Michael B A Viruses Plagues and History Past Present and Future Oxford University Press 2010 wwwquestiaschoolcomlibrary83255525virusesplaguesandhistory accessed August 24th 2018 Piot Peter My Journey Back to Ebola Ground Zero Financial Times 1 May 2014 wwwftcomcontent4c1711c2d00411e3a2b700144feabdc0 Piot Peter Part Two A Virologists Tale of Africas First Encounter with Ebola Science AAAS American Association for the Advancement of Science 10 Dec 2017 wwwsciencemagorgnews201408parttwovirologiststaleafricasfirstencounterebola Prel JeanBaptist Du et al Confidence Interval or PValue Part 4 of a Series on Evaluation of Scientific Publications Deutsches Aerzteblatt Online 2009 httpswwwncbinlmnihgovpmcarticlesPMC2689604 Roghanian Ali Dendritic Cells British Society for Immunology wwwimmunologyorgpublicinformationbitesizedimmunologycellsdendriticcells Ross Aaron Congo Approves Use of Ebola Vaccination to Fight Outbreak Reuters Thomson Reuters 30 May 2017 afreuterscomarticletopNewsidAFKBN18P0WYOZATP Siedner Mark J et al Strengthening the Detection of and Early Response to Public Health Emergencies Lessons from the West African Ebola Epidemic PLOS Medicine vol 12 no 3 2015 httpsjournalsplosorgplosmedicinearticleid101371journalpmed1001804 Sridhar Saranya Clinical Development of Ebola Vaccines Therapeutic Advances in Vaccines vol 3 no 56 2015 pp 125138 httpswwwncbinlmnihgovpmcarticlesPMC4667768 Statement on the WHO Consultation on Potential Ebola Therapies and Vaccines World Health Organization 9 Dec 2015 wwwwhointmediacentrenewsstatements2014ebolatherapiesconsultationen World Bank Country and Lending Groups World Bank 2018 datahelpdeskworldbankorgknowledgebasearticles906519worldbankcountryandlendinggroups EERPPF For use from MayNovember 2018 Page 13 Candidate personal code Extended essay Reflections on planning and progress form Candidate This form is to be completed by the candidate during the course and completion of their EE This document records reflections on your planning and progress and the nature of your discussions with your supervisor You must undertake three formal reflection sessions with your supervisor The first formal reflection session should focus on your initial ideas and how you plan to undertake your research the interim reflection session is once a significant amount of your research has been completed and the final session will be in the form of a viva voce once you have completed and handed in your EE This document acts as a record in supporting the authenticity of your work The three reflections combined must amount to no more than 500 words The completion of this form is a mandatory requirement of the EE for first assessment May 2018 It must be submitted together with the completed EE for assessment under Criterion E Supervisor You must have three reflection sessions with each candidate one early on in the process an interim meeting and then the final viva voce Other checkin sessions are permitted but do not need to be recorded on this sheet After each reflection session candidates must record their reflections and as the supervisor you must sign and date this form First reflection session Candidate comments My World Studies EE is related to the theme of health and development and the two subjects I have decided to focus on are History and Biology The title of the EE is To what extent has the development of biotechnology affected the combat of disease in subSaharan Africa I was intrigued by the idea of the World Studies EE as it could allow me to explore global perspectives and at the same time submit a piece of academia which I had personal interest I aspire to work in the fields of health and medicine and thus I chose biotechnology as a potential topic for study as it represents a growing field of biology aided by continual developments in technology I had some difficulties in choosing this topic as it was hard to reconcile the two subjects Ultimately I decided on a historyessay based approach with biological elements as complement Date 23042018 Supervisor initials EERPPF Page 23 Interim reflection Candidate comments As of now I have finished my first draft of the Extended Essay Throughout the writing process there were several challenges I realized that my research question was too narrow in scope as I had focused on contrasting the development of biotechnology along with other factors such as education and infrastructure therefore the research question should be changed to reflect this In addition some of the historical sections were a bit too repetitive thus analysis and critical thinking in the historical should become more concise in addition to adding the definition of biotechnology for conciseness Currently I argue in my essay that biotechnology was not the defining factor in repressing Ebola Virus Disease outbreaks and that other factors such as the location of outbreaks local education and relations with the population and medical and highway infrastructure that were more crucial in combating Ebola Virus disease outbreaks Date 26092018 Supervisor initials Final reflection Viva voce Candidate comments Over the course of the EE I have gained an understanding of public health policy and biotechnological developments through investigating the effects of biotechnology international response and local relationships on the treatment of Ebola Virus Disease in SubSaharan Africa This EE allowed me to truly realize the importance of interdisciplinary study and research in its application to reallife issues around the globe Looking back at the writing process there were many challenges including the need to integrate in the essay methodologies used in biology with methodologies used in historical investigation whilst maintaining a balance between the two the difficulty in locating a variety of secondary sources on currently ongoing outbreaks and a need for constant refinement of language to ensure its conciseness and accuracy However these challenges were overcome by support from my supervisor and good timemanagement and organizational skills with regards to interim deadlines and extensive research The EE unexpectedly revealed that improvements in biotechnology as a whole was not a major factor in the suppression of the studied EVD outbreaks instead local relationships and a fast international response were more important Overall I believe that I was able answer the research question sufficiently while displaying critical thinking Date 04122018 Supervisor initials