Everything about the Ebola epidemic in West Africa has been worst-case – the scope, the toll, the response. The Centers for Disease Control and Prevention published projections Tuesday with an upper range of 550,000 to 1.4 million cases by the end of January. The World Health Organization, which earlier estimated 20,000 cases overall, now predicts that number will be reached by early November.

A note of caution was contained in a report by the WHO Ebola Response Team, published in the New England Journal of Medicine. The team warned that there is a possibility that the disease “will become endemic among the human population of West Africa.” With a case fatality rate of 70 percent, that could mean a long period of death and illness among populations of millions.

Good public health practices – locating and isolating the sick, containing the virus with cordons to stop the chain of transmission – are still the basic weapons against a disease for which there is no cure, vaccine or therapeutic. But if the traditional approach fails, vaccines and therapeutics will become essential. Unfortunately, not a single drug or vaccine is ready.

Much U.S. biomedical basic research is supported by the government, but the development of new drugs largely occurs in the private sector, driven by the market. Until this year, there was no market for Ebola virus treatments because earlier outbreaks were all relatively small.

Intense development work on experimental drugs and vaccines is underway in the U.S. and the U.K., but it is not simple to create a new treatment, put it through clinical trials and manufacture it. Rigorous testing for safety and efficacy cannot be short-circuited. But the government, researchers and the private sector must make the quest for therapeutics and vaccines a high priority in case the worst-case scenarios come true.

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