The decision to use an experimental drug to treat two Americans
infected with Ebola, while nearly 1,000 Africans have already died
from the deadly epidemic, has sparked controversy -- but US experts say
it was ethically justified.
The World Health Organization announced Wednesday it was convening a
special meeting next week to explore using experimental drugs in the
West African outbreak, after two health workers from the US charity
Samaritan's Purse were treated with a drug called ZMapp.
The experimental drug is still in an extremely early phase of
development and had only been tested previously on monkeys. It has
never been produced on a large scale. There is no proven treatment or
cure for Ebola.
Samaritan's Purse members Kent Brantly and Nancy Writebol, however,
have shown improvements since taking the drug.
- Why not in Africa? -
The news has prompted calls to make the drug available to hard-hit
Guinea, Liberia and Sierra Leone.
Nigeria, where there have been seven confirmed cases so far, has
already announced talks with the US Centers for Disease Control on the
possibility of getting access to ZMapp.
And three leading Ebola experts, including Peter Piot, who
co-discovered the Ebola virus in 1976 and is director of the London
School of Hygiene and Tropical Medicine, urged the drug be made more
widely available.
"It is highly likely that if Ebola were now spreading in Western
countries, public health authorities would give at-risk patients
access to experimental drugs or vaccines," said the joint statement
Wednesday, according to the Los Angeles Times.
"The African countries where the current outbreaks of Ebola are
occurring should have the same opportunity," it added.
Mapp Pharmaceuticals, the US company behind the drug, said any
decision to use the drug should be made by treating doctors within
regulatory guidelines, and added it is working to increase production.
- Risk the untested? -
But US President Barack Obama said Wednesday afflicted countries
should focus on proven public health measures, rather than an untested
drug.
However, "I will continue to seek information about what we're
learning with respect to these drugs going forward," he added.
Experts said extending the use of ZMapp is not cut and dry.
They also dismissed questions over the fairness of offering ZMapp
first, and so far only, to the two white Americans who have been
infected.
"When you have that high a fatality rate, the pressures might appear
irresistable. but you do have to remember there is harm that can come
from unproven treatments," said G. Kevin Donovan, director of
Georgetown University center for bioethics.
He said Brantly and Writebol were good candidates for taking the risky
drug, since their medical training would have helped them understand
the extent of the danger.
Furthermore, he said, they were especially deserving because "these
are people who deliberately put themselves in harms way."
Many of the dead have been African health workers and doctors, also
infected while caring for patients. Sierra Leone's top Ebola doctor,
Omar Khan, died July 29.
But Arthur Kaplan, director of New York University's medical ethics
division, said the key difference is that "the religious mission (the
Americans) worked for took it on themselves to find the drug," he
said.
"I think we do need a system to ration scarce drugs, but no
international group has suggested anything," he said.
He further stressed that even though they have had a good response so
far, it is "far, far" from proven that the drug is actually
beneficial.
"The ethical plan to follow is to redouble efforts to stop the
epidemic by prevention."
Nancy Kass, a Johns Hopkins professor who formerly worked on the WHO's
ethics committee, stressed that "there is a reason why drugs have to
be tested before we give them to people."
It's "very easy to paint it as if there's nothing to lose," she said,
but "I think there is something to lose."
Beyond the risk of the drug being harmful, it can be harder to
understand the effects of a drug outside the controlled parameters of
a study protocol, she said.
Whether it's ultimately worth it, is "a decision that should be made
by the top experts in the world," Kass said, something she hopes will
happen next week at the WHO.
AFP
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