International News
Ethical Issue: Who Gets Experimental Ebola Drug?
WASHINGTON (AP) — The use of an
experimental drug to treat two Americans
diagnosed with Ebola is raising ethical
questions about who gets first access to
unproven new therapies for the deadly dis-
ease. But some health experts fear debate
over extremely limited doses will distract
from tried-and-true measures to curb the
growing outbreak — things like more rapid-
ly identifying and isolating the sick.
The World Health Organization is con-
vening a meeting of medical ethicists next
week to examine what it calls “the respon-
sible thing to do” about whatever supplies
eventually may become available of a med-
icine that’s never been tested in people.
At least one country involved in the out-
break is interested in the drug. Nigeria’s
health minister, Onyenbuchi Chukwu, said
at a news conference that he had asked U.S.
health officials about access but authorities
say the manufacturer would have to agree.
There is no proven treatment or vaccine
for Ebola, which so far has infected more
than 1,700 people and killed more than 930
in West Africa in what has become the
worst outbreak of this viral hemorrhagic
fever.
“How many times have we found magic
therapies that ended up ... doing more harm
than good?” cautioned University of Min-
nesota professor Michael Osterholm, who
advises the U.S. government on infectious
disease threats.
“Vaccine and drug treatment right now is
not going to be the main way you bring this
to a stop,” he added.
Scientists stress that there’s no way to tell
if the experimental drug ZMapp really
made a difference for two American aid
workers infected while working in Liberia.
“We don’t even know if it works,”
stressed Dr. Anthony Fauci of the National
Institutes of Health, which helped fund
(AP PHOTO/WHO, CHRISTOPHER BLACK, FILE)
Lauran Neergaard
AP Medical Writer
In this 2007, file photo, a 43 year old Congolese patient, center, who has been confirmed to have Ebola hemorrhagic
fever, following laboratory tests, is comforted by Medecins Sans Frontieres (Doctors without Borders) nurse Isabel Grovas,
left, and Doctor Hilde Declerck, right, in Kampungu, Kasai Occidental province, Congo. In the four decades since the
Ebola virus was first identified in Africa, treatment hasn’t changed much. There are no licensed drugs or vaccines for
the deadly disease. A number are being developed, but none have been rigorously tested in humans. One
experimental treatment, though, was tried this week in an American aid worker sick with Ebola, according to the U.S-
based group that she works for in Liberia. Without a specific treatment, doctors and nurses focus on easing the
disease’s symptoms — fever, headache, vomiting and diarrhea — and on keeping patients hydrated and
comfortable.
tists are looking into ways to ramp up pro-
duction, necessary to attempt formal testing
‘How many times have we found magic
therapies that ended up ... doing more harm
than good?’
research that led to the drug’s development.
The drug is a cocktail of three antibodies
engineered to recognize Ebola and bind to
infected cells so that the immune system
can kill them. People’s immune systems
make antibodies to fight off various dis-
eases, and attempts to cull those antibodies
— from the blood of people who survive an
illness, or from animals — date back to the
19th century and early diphtheria treatment.
Using modern techniques to fight Ebola,
scientists culled antibodies from laboratory
mice, Fauci said, and ZMapp’s maker now
grows the antibodies in tobacco plants and
then purifies them.
That process is “painfully slow,” he
added, saying the manufacturer has told the
government that it would take two to three
months to produce even “a modest
amount.”
“We’ve got to do better than that,” Fauci
said. The NIH and other government scien-
or to consider more so-called compassion-
ate use, he said.
“We’re hoping the outbreak is going to
die down soon, but it doesn’t look that
way,” said Fauci, director of NIH’s National
detect Ebola. Early symptoms — fever,
vomiting and diarrhea — can be confused
with other illnesses. The test was developed
by the Defense Department, and is only for
use in DOD-designated laboratories.
This week, the WHO is convening an
emergency committee to determine if the
outbreak warrants being declared a “public
health emergency of international concern,”
meaning it poses significant risk to other
countries and requires more of an interna-
tional response.
The WHO said that particularly in
Liberia, health officials face community
resistance from residents who fear going to
the hospital and secretly care for ill loved
ones
at
home,
thus
exposing
The NIH and other government scientists are
looking into ways to ramp up production,
necessary to attempt formal testing or to
consider more so-called compassionate use
Institute of Allergy and Infectious Diseases.
“Everybody’s trying to speed things up.”
To help improve diagnosis in affected
countries, the Food and Drug Administra-
tion on Wednesday authorized emergency
use of an experimental blood test to
themselves. Ebola is transmitted only
through direct contact with the blood and
other bodily fluids of someone who is sick.
But health care workers have to recognize
the virus, too. Authorities in Nigeria have
acknowledged that they didn’t immediately
suspect Ebola in the first known patient to
travel to that country.
Only if they suspect the virus can author-
ities trigger public health precautions —
those tried-and-true methods that Minneso-
ta’s
Osterholm
fears
could
be
overshadowed by misunderstanding about
any availability of the experimental drug.
“If the Americans had this serum all the
time, why didn’t they send it to us Africans
to help save lives?” said Winston Ojukutu
Macauley, a social commentator in Sierra
Leone.
But taking an experimental drug requires
making sure the patients fully understand
there’s no proof it will help — and it might
even harm, said Osterholm, noting that 40
percent of Ebola patients are surviving. And
would it be appropriate for the U.S. to offer
a drug to people in developing countries
that hasn’t been tested on its own citizens?
That’s among the things the WHO meet-
ing could address. Even if enough doses
were available for wider experimental use,
“we need to find a way to do this in a fair
manner so that we can live with ourselves
when someone asks why this person got it
and why not that person?” said Dr. Heinz
Feldmann, NIAID’s virology chief.
AP Medical Writer Maria Cheng reported
from London. Associated Press writers
Clarence Roy-Macaulay in Freetown, Sier-
ra Leone, and Bashir Adigun in Abuja,
Nigeria, contributed to this report.
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