Make us your home page

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Perspective: Why two Americans got Ebola treatment (w/video)

What should happen if a massive viral outbreak appears out of nowhere and the only possible treatment is an untested drug? And who should receive it?

The two American missionaries who contracted the almost-always-fatal virus in West Africa were given access to an experimental drug cocktail called ZMapp. It consists of immune-boosting monoclonal antibodies that were extracted from mice exposed to bits of Ebola DNA. Now in isolation at an Atlanta hospital, they appear to be doing well.

It's an opportunity the 900 Africans who've died so far never had. Is there a case to suspend ethical norms if lives might be saved by deploying an experimental drug?

The reasons for different treatment are partly about logistics, partly about economics and, partly about a lack of any standard policy for giving out untested drugs in emergencies. Before this outbreak, ZMapp had only been tested on monkeys.

Mapp, the tiny, San Diego based pharmaceutical company that makes the drug stated two years ago: "When administered one hour after infection (with Ebola), all animals survived. … Two-thirds of the animals were protected even when the treatment, known as Zmapp, was administered 48 hours after infection."

But privileged humans were always going to be the first ones to try it. ZMapp requires a lot of refrigeration and careful handling, plus close monitoring by experienced doctors and scientists — better to try it at a big urban hospital than in rural West Africa, where no such infrastructure exists.

And because of the drug's experimental nature, it's unclear that it should go to anyone else. Even if the drug is cooled correctly, success in a few monkeys (less than 20) tells us little about what will happen in a lot of humans who'd had the infection for more than two days.

No one knows how much drug to give, how often, what other pre-existing medical conditions might influence its efficacy or even what route is best, be it IV, pill, syrup, or even surgically right into the liver. With an untested drug, there is always a chance you will kill the first human subject who might otherwise have lived.

And the two Americans who got it in Africa had been infected for more than a week, making its efficacy completely unknown. Still, because they are a small group in such a carefully controlled setting, they are better candidates for the drug than others might be.

But it's about more than logistics. Drugs based on monoclonal antibodies usually cost a lot — at least tens of thousands of dollars, and a tiny company won't enthusiastically give away its small supply of drugs for free.

It is likely that if they were going to donate drugs, it would be to people who would command a lot of press attention and, thus, investors and government money for further research — which is to say, not to poor Liberians, Nigerians or Guineans.

The Americans got the experimental drug because the evangelical Christian International Relief organization they work for, Samaritan's Purse, reached out to the CDC and the NIH to see if there was any drug. They were referred to Mapp Pharmaceuticals and evidently struck some kind of deal to get the drug to their employees who were in Africa at the time.

The FDA has little oversight over what goes on abroad, and the federal government has no program to consider appeals for use — much less payment — of experimental drugs that have only been tried on animals. Without an organization pushing, no one might have received access to any sort of treatment. The chance of a poor African getting an experimental drug is about the same as Donald Trump contracting Ebola (which is apparently his greatest current fear).

There is no accepted set of rules for a sick person to request compassionate access to a drug that is experimental, expensive and in short supply. Access to experimental drugs remains a long shot full of risk. While most people would want to do something rather than nothing, the decision about gaining access is more in the hands of the drug manufacturer than the subject.

The dying may feel more cavalier about entering a drug experiment — the rewards (life) could justify the risks (since death approaches anyway) — but a company may still withhold a drug from a volunteer for fear that it will fail and reduce investor interest or increase attention from malpractice attorneys.

An ethical case can surely be made for an organization that puts health care workers in harm's way to acquire access to experimental drugs and bring staff home to get the best possible care. But that's neither fair nor just for deciding what to do when an emergency arises and rationing is the only option.

This Ebola outbreak has taught us two things: that we need to act quickly to shut down emerging epidemics wherever they occur, and it is long past time to have a transparent public policy about what to do when not everyone gets a chance to live.

Arthur L. Caplan is the director of the Division of Medical Ethics at New York University's Langone Medical Center's Department of Population Health.

© 2014 Washington Post

How is Ebola spread?

Let's start with the basics: Ebola is spread only through bodily fluids from an infected person, or from objects such as needles that have been in contact with infected bodily fluids. Ebola is not spread through air, food, water or by touching money and keyboards. The doomsday scenario of Ebola being brought to the United States and spread via passengers on airplanes is very unlikely, unless an infected and symptomatic person is allowed to board and then swaps spit with or bleeds on fellow passengers.

Jane Hu, Slate

The head nurse speaks

We are caring for these patients because it is the right thing to do. These Americans generously went to Africa on a humanitarian mission to help eradicate a disease that is especially deadly in countries without our health-care infrastructure. They deserve the same selflessness from us. As human beings, we all hope that if we were in need of superior health care, our country and its top doctors would help us get better. We can either let our actions be guided by misunderstandings, fear and self-interest, or we can lead by knowledge, science and compassion. We can fear, or we can care.

Susan Mitchell Grant is chief nurse for Emory Healthcare, where two Americans, Dr. Kent Brantly and missionary Nancy Writebol, were flown for care.

Perspective: Why two Americans got Ebola treatment (w/video) 08/08/14 [Last modified: Saturday, August 9, 2014 6:08pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times


Join the discussion: Click to view comments, add yours

  1. Florida woman weighing 325 pounds charged with killing girl by sitting on her


    PENSACOLA — A 325-pound (150-kilogram) Florida woman is charged with killing her 9-year-old cousin by sitting on the child as punishment.

    This Oct. 14, 2017 photo made available by the Escambia County Sheriff's Office, Fla., shows Veronica Green Posey under arrest. Posey is charged with killing her 9-year-old cousin by sitting on the child as punishment. Posey, who weighs 325 pounds, first punished the girl with a ruler and metal pipe before sitting on her for at least 10 minutes. [Escambia County Sheriff's Office via AP]
  2. Girl, 8, got on 'tippy toes' to peer over cruise ship railing, then fell to her death


    MIAMI — A family cruise to paradise turned into a nightmare on Saturday, when an 8-year-old tumbled over the inner railings of a ship and fell to her death.

    Friends and family mourn Zion Smith, the 8-year-old girl who fell to her death aboard a Carnival cruise in Miami this weekend. [Image from Facebook]
  3. Bucs Cannon Fodder podcast: Looking back at what went wrong


    In his latest Cannon Fodder podcast, Greg Auman says Monday brought good news relating to Jameis Winston's shoulder injury.

    A frustrated Mike Evans sits on the bench during the second half of the Bucs' loss to the Cardinals Sunday in Arizona. [LOREN ELLIOTT   |   Times]
  4. Syrian commander says Raqqa has been captured from militants


    BEIRUT — U.S.-backed Syrian forces liberated the city of Raqqa on Tuesday from Islamic State militants, a senior commander said, in a major defeat for the collapsing extremist group that had proclaimed it to be the capital of its "caliphate."

    This frame grab from video released Sunday, Oct. 15, 2017 and provided by Furat FM, a Syrian Kurdish activist-run media group, shows Syrian Islamic State group fighters who surrendered entering a base of the U.S.-backed Syrian Democratic Forces (SDF), in Raqqa, Syria. A spokesman for the SDF in Syria says it will be in control of the northern city of Raqqa "within a few days" after attacking the last pocket held by the Islamic State group. SDF fighters launched an operation to retake the last IS-held pocket of Raqqa after some 275 militants and their family members surrendered. [Furat FM via AP]
  5. Drug czar nominee Marino withdraws name amid report he weakened DEA


    WASHINGTON — President Donald Trump said Tuesday that his nominee to be the nation's drug czar is withdrawing from consideration for the job.

    U.S. Rep. Tom Marino, R-Pa., left, sponsored the law that weakened the DEA's enforcement abilities. Seen with Rep. Trey Gowdy, R-S.C., in 2015, Marino is nominated to be the nation's drug czar. [Andrew Harrer | Bloomberg]