Medical ethicists to meet on use of experimental Ebola drugs

Medical ethicists will meet next week to discuss the use of experimental medicines in the West African Ebola outbreak. The World Health Organization (WHO) announced the talks in the wake of a controversial decision to treat two infected American aid workers with ZMapp, an Ebola serum never before tested on humans. The move sparked debate over whether using experimental Ebola treatments is ethical — and why Africans have not been offered the same option.

“We are in an unusual situation in this outbreak. We have a disease with a high fatality rate without any proven treatment or vaccine,” Marie-Paule Kieny, assistant director-general at the WHO, said in a Thursday statement announcing the meeting. “We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.” The statement did not give a location for the meeting. On Friday the WHO declared the outbreak an international public health emergency. Nigeria declared a state of emergency hours later, the fourth country to do so.

The New York Times reported that the U.S. government is forming a group to consider the same issues.

Meanwhile, Tekmira Pharmaceuticals, based in Vancouver, Canada, announced Thursday that the U.S. Food and Drug Administration has amended the trials of Tekmira’s drug TKM-Ebola to “partial hold” status — which the company said in a news release enables potential treatment with the drug for those already infected.

“This current outbreak underscores the critical need for effective therapeutic agents to treat the Ebola virus. We recognize the heightened urgency of this situation and are carefully evaluating options for use of our investigational drug within accepted clinical and regulatory protocols,” Tekmira CEO and president Mark Murray said in a statement issued on Thursday.

On Wednesday three of the United Kingdom’s leading Ebola specialists — including the Peter Piot, who discovered the deadly virus in 1976 — called in a joint statement for Africans governments to be “allowed to make informed decisions about whether or not to use these products.”

The most recent Ebola outbreak has killed at least 932 people in Liberia, Sierra Leone and Guinea. The WHO said Friday that the potential consequences of a wider contagion from the disease were “particularly serious,” given the virulence of Ebola. The hemorrhagic fever, which is transmitted through bodily fluids, often results in bleeding from the eyes, ears and mouth.

ZMapp was given to the two aid workers from North Carolina–based charity Samaritan’s Purse by the private biotechnology company that manufactures the drug. Although the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) helped facilitate communication between the company and Samaritan’s Purse, the agencies were not involved in approving, transporting or administering the treatment.

The Americans are still alive and appear to be recovering — which is significant, since the mortality rate of the current outbreak is about 60 percent and past Ebola outbreaks has been seen a death rate as high as 90 percent.

On Wednesday, Nigerian Health Minister Onyenbuchi Chukwu said at a news conference that he had asked the CDC about access to the drug. The New York Times reported that Liberia has also expressed interest in ZMapp.

At a Wednesday news conference, President Barack Obama said that standard public health measures would be able to curb the Ebola outbreak and that it was not yet clear whether available Ebola treatments were effective and safe. “We’ve got to let the science guide us,” he said.

The countries hit by the crisis may not have the health infrastructure to cope with it. Liberia’s health system in particular has nearly collapsed since the outbreak began. Health workers have stopped showing up for work out of fear of contracting the disease, and people infected with Ebola have reportedly been turned away from hospitals. Protesters took to the streets of the capital, Monrovia, this week in protest over infected bodies’ being left in the streets.

“They should have started quarantining entire areas months ago,” said Robert Garry, who is an expert in viral pathogens at Tulane University and has worked extensively in West Africa. “But it’s spread all over, so you’re essentially talking about quarantining entire countries if you want to contain it.”

Some experts have pointed out that because of past controversial drug testing by Western companies on Africans, the perception of the U.S. government or private companies first offering experimental drugs to African governments could have been very negative. 

“It would have been the front-page screaming headline — ‘Africans used as guinea pigs for American drug company’s medicine,’” Salim S. Abdool Karim, director of Caprisa, an AIDS research center in South Africa, said in an interview with The New York Times.