Even as the Ebola crisis rages onward in west Africa, a World Health Organization panel concluded on August 11 that offering patients promising experimental Ebola drugs with unknown side effects and efficacy would be ethical.
The 12-member panel from the United Nations agency left aside questions about who should get the limited drugs and how that should be decided until it meets again at the end of the month. WHO says the difference between this outbreak and the circumstances in prior episodes is the sheer scale of the affected areas, which rendered traditional public health approaches to containing Ebola inadequate.
As of August 9, 1,013 patients have died so far in the current Ebola outbreak, which has dwarfed every prior one. There have been 1,848 cases so far. Last week, the director of the U.S. Centers for Disease Control and Prevention told a congressional panel that the current outbreak was on a trajectory to soon surpass all earlier Ebola events—combined.
The WHO panel conclusions come after two Ebola-stricken U.S. missionaries and a Spanish patient were reportedly offered experimental treatments that have not been offered to patients in Guinea, Sierra Leone, Liberia and Nigeria. The disparity has set off a furor of controversy, and the first doses of experimental Ebola treatment, enough to treat two Liberian physicians, are reportedly en route to Liberia now.
Further complicating matters, to date there is only a limited amount of the experimental serum. The treatment—called ZMapp—is virtually out of stock, according to WHO. That medication is a collection of monoclonal antibodies developed by a San Diego–based pharmaceutical company, Mapp Biopharmaceutical, that had been previously tested in primates. The ZMapp medication appears to have had a “dramatic and very rapid effect” on the two U.S. patients, says Marie-Paule Kieny, assistant director general for health systems and innovation at WHO, although she cautioned in a telephone briefing with reporters this morning that clinicians still do not know for sure if it is effective and that treated patients must still receive further doses of the drug. The Spanish patient has died, but it remains uncertain if he received the therapy and when.
Still, there are other types of medications and vaccines that could be candidates for treatment or prevention, Kieny adds. She outlined three types of products that could be tried: blood serums like ZMapp, meant to spur a patient’s own immune system response; antivirals (of which there are more than three but fewer than 10 types); and vaccines, she says. Decisions about which drugs to administer would hinge on preliminary testing in monkeys that suggest which compounds look potentially efficacious, she says. Meanwhile, U.S. federal officials have announced they plan to begin clinical trials for a potential Ebola vaccine next month and they are working to quickly approve a potential Ebola treatment.
Later this month the WHO panel will consider what conditions or criteria should guide future choices about who should get priority for the treatment or prevention. Kieny, asked if the current distribution of the limited drug supply has been fair, says, “I don’t think there could be any fair distribution of something that is available in such a small quantity. We find ourselves facing a dilemma,” she says. “If these treatments can save lives as the animal studies suggest, should we not use them to save lives? Far too many lives have been lost right now.”
The panel’s findings may be somewhat moot because there are not unlimited supplies of any of these medications, and just because a team of bioethicists has concluded it would be ethical to give the drug to patients does not mean it will happen.
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