AP/ Sunday Alamba
A Nigerian health official waits to screen passengers at an airport.
No one knows how to cure the Ebola virus.
But speculation about the experimental treatment that was given to two Ebola-infected US citizens, along with panic over Ebola — unwarranted in the United States, more logical in West Africa — has people questioning why something that many have said may have cured the two Americans was given only to them, while the African body count continues to climb.
"This is something that has made our job most difficult," Tolbert Nyenswah, Liberia's assistant health minister, told the Wall Street Journal. "The population here is asking: 'You said there was no cure for Ebola, but the Americans are curing it?'"
Many have the same question.
So the secret serum used to cure 2 Americans from Ebola is too secret to reach Africans dying like flies? #JustAsking
— @MrBasabose August 5, 2014
wait so let me understand they've had this 'secret' serum to save two Americans while hundreds of Africans are dying? http://t.co/dLyLfal4z5
— Amina Doherty (@sheroxlox) August 5, 2014
A desperate situation and fascination with the idea of a cure, especially one that has been cast as "secret" — it's merely experimental and unapproved — has obscured the fact that we don't know that the treatment Kent Brantly and Nancy Writebol received actually did anything for them. While Ebola is highly fatal, some people do survive without any extraordinary interventions.
The supportive medical care that they received — and had access to, unlike many Africans suffering from the disease — may have had just as much to do with the fact that their condition is reportedly improving.
It's important to note that the treatment had not been tested on humans ever before. Larry Zeitlin, the president of Mapp Biopharmaceuticals, the company that developed the treatment, told Business Insider that the results of studies on the therapy have not even been published yet.
A treatment that's never been tested on humans might only not work, it could potentially have fatal side effects — which is why Writebol and Brantly had to provide consent saying they understood the risks of being injected with an unknown drug.
It should also be noted that the medicine given to Brantly and Writebol was arranged by Samaritan's Purse, not the National Institutes of Health, Centers for Disease Control and Prevention, or the U.S. government.
Pharmaceutical companies may hesitate to start distributing untested drugs into an epidemic that the world is watching — some have a bad history of testing drugs on people in Africa and Asia who don't even know they are being experimented on, sometimes with fatal results.
What To Do About Experimental Drugs
Still, an outbreak of a disease that can kill up to 90% of infected patients — the fatality rate in West Africa is currently 60% — has many saying that now is the time to deploy experimental drugs just in case they work.
Top Ebola experts Peter Piot, who co-discovered the Ebola virus in 1976; David L. Heymann of the Chatham House Center on Global Health Security; and Jeremy Farrar, director of the Wellcome Trust recently released a statement saying that infected Africans should be given the same choice as the two Americans: to try an experimental drug, even one that has unknown risks.
The picture might be very different if the heart of the outbreak were closer to home, they said: "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."
They continued: "The African countries where the current outbreaks of Ebola are occurring should have the same opportunity. African governments should be allowed to make informed decisions about whether or not to use these products, for example to protect and treat healthcare workers who run especially high risks of infection."
So far, a spokesman for the WHO told Reuters they "would not recommend any drug that has not gone through the normal process of licensing and clinical trials."
But on Wednesday August 6 the WHO released a statement saying they would convene early next week to discuss the ethics of using experimental drugs.
Could An Experimental Drug Provide A Solution?
So far, various drugs — including ZMapp, given to Brantly and Writebol — have been called promising, but none have been proven to be effective.
While some experts have said that experimental drugs should be more readily available to people who are open to the risk, others have been critical of the idea.
Arthur Caplan, director of the medical ethics division at New York University Langone Medical Center, told the Los Angeles Times that if doctors were to start giving out experimental drugs, "there's a fairly good chance that it could do more harm than good." He added, "the drug could kill you faster, or make you die more miserably."
There's also a question about whether experimental drugs could be produced in sufficient quantity in time.
Some people have said that significant quantities of experimental drugs could be produced quickly.
Charles Arntzen, a professor at the Biodesign Institute at Arizona State University who has worked with Mapp Biopharmaceuticals, estimated in a conversation with the Washington Post that significant quantities of ZMapp could be ready in two months. But the company who produced the drug itself told the Post it would take at least "several months."
The CDC said in a statement today that the manufacturer had a very limited supply and did not have the ability to produce large quantities of the drug. They said they still don't know of any effective, safe treatment, and that standard treatment is still supportive care.
None of this answers criticism about why the only people allowed to try the experimental drug were two U.S. citizens. But it's far from the only blatant global inequality in healthcare.
There are still an estimated 200,000 cases and 30,000 deaths a year from Yellow fever, mostly in Africa. That death is similar to Ebola, but is entirely preventable with a vaccine. Preventable diseases continue to kill tens of thousands of people every year.
There's also the fact that Ebola could not gain a foothold in the U.S. or Europe, because it's a disease that can be contained with adequate facilities. Meanwhile, in West Africa, doctors and nurses work 15-16 hour days, often without the facilities or sanitary equipment necessary to prevent spread.
Making containment more effective, as it would be in the U.S., is probably a safer strategy than the widespread use of untested drugs. And on the front lines of the Ebola outbreak, there is much more that can be done toward that end.
From West Africa, Hot Zone author Richard Preston recently described a doctor's arrival at a clinic where "the floor was splashed with blood, vomitus, feces, and urine," and a doctor and a single nurse cared for 30 patients.
In his recent Reddit AMA, Preston said "we need more doctors and nurses — not even a space suit can totally protect you if the ward is really a mess."
"This is a kind of war with a non-human enemy," he continued. "It is a fairly clever and very aggressive enemy. However, if you are in a jam it is never a good idea to panic."
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