The recent use of an experimental serum on American health workers Kent Brantly and Nancy Writebol has created buzz around the world. These individuals received an experimental serum called ZMAPP from California-based Mapp Pharmaceuticals. A number of pharmaceutical companies and biomedical laboratories in Canada, the United States, and the United Kingdom are working on other vaccines and serums, but many of these efforts are in the early stages, and those in more advanced research stages have limited stock.
The fact that existing stock cannot treat all the current patients raises questions about how the serum will be distributed in West Africa and what happens if the virus continues to spread outside the original site of transmission. Government officials, medical professionals, and international teams need to develop a collaborative, multi-tier plan for how these experimental drugs will be distributed. The issues to consider include whether experimental pharmaceuticals should be given to countries like Liberia, which appears to be the current epicenter of transmission, or whether the focus should be on places like Nigeria or Guinea, which seem to be making more strides. So far, medical personnel have been the primary beneficiaries of the drugs; will patients in the gravest danger receive drugs, or will those with the best likelihood of survival be the first to receive the serums? Discussions are beginning, but an immediate distribution plan for the use of these drugs is imperative.
After ZMAPP was publicized, different groups began to lobby for more widespread use of the serum. President Obama responded to these early requests at the U.S.-Africa Summit and said that any request for Ebola pharmaceutical intervention was premature and that he wanted to weigh the issue further, adding:
I think we've got to let the science guide us. And I don't think all the information is in on whether this drug is helpful. What we do know is that the Ebola virus, both currently and in the past, is controllable if you have a strong public-health infrastructure in place. And the countries that have been affected are the first to admit that what's happened here is that their public-health systems have been overwhelmed.
A few days later the government of Liberia would receive the remaining ZMAPP doses for Liberian health professionals. At the same time the Canadian government pledged to send an experimental vaccine, called VSV-EBOV, to Sierra Leone. The vaccine could treat 800 to 1,000 people. It is administered prior to exposure to try to prevent an onset of Ebola and has been tested in animals but not in humans.
The use of ZMAPP to treat Ebola in the American charity workers prompted much debate. The cacophony of voices criticized the failure to use the drug earlier in the outbreak and the fact that no nationals of Sierra Leone, Liberia, or Guinea had been offered the drug beforehand and questioned the ethics of experimenting on humans. One likely early contender for the serum would have been a well-known Sierra Leonean physician, Dr. Sheik Umar Khan. In the final days of his life, a group of medical professionals discussed the possibility without consulting him. The day after he died, the serum was given to Ken Brantly and Nancy Writebol.
Yes, some history of drug trials and other experiments in the developed world and on marginalized groups in the West exists. Some of the examples are birth control drug trials on women in Puerto Rico and the Tuskegee syphilis experiment on African-American men. However, in this case of the Ebola serum, patients or their relatives would give informed consent to gain access to Ebola serums or vaccines. The chance of survival with the serum outweighs the risks associated with taking an experimental drug. This makes this case different from other cases where populations were targeted without being fully informed. In fact, it makes the use of ZMAPP in West African Ebola patients akin to human trials for vaccines and pills in the U.S.
When a CNN reporter recently asked medical ethicist Harriet Washington about outrage in using West African Ebola patients as guinea pigs, Washington replied:
These people would be wrong because it happens all the time. Some people are always the first to get a drug and increasingly these people are in the developing world where two out of five of all clinical trials are being held in the developing world.
Arguments against the use of the serum include not knowing the full risks associated with the use of the drug, such as the possibility of death or the exacerbation of any existing health conditions. Drugs are sometimes used on a case-by-case basis for compassionate requests, but no large-scale experimental drug has been used outside clinical trials.
The World Health Organization (WHO), as well as physicians, citizens, and government officials from West Africa, are calling for more widespread use of ZMAPP and other Ebola pharmaceutical interventions. In the case of such apparent need, a special case may be instituted to expedite the research, development and wider production of Ebola drugs to contain the current outbreak. The use of experimental pharmaceuticals is a first step, and it needs to be coupled with the bolstering of local healthcare networks for long-term success in fighting Ebola.