Chief Science Correspondent
The use of a "secret serum" to successfully treat three patients suffering from Ebola has drawn criticism from some observers, who say the action points to inequality in global health care.
When American missionary physician Dr. Kent Brantly fell ill overseas, he requested the first dose of ZMapp, a highly experimental drug manufactured by San Diego-based company Mapp Biopharmaceutical, Inc. The drug was also used on Brantly's colleage, Nancy Writebol and, most recently, Spanish priest Miguel Pajares.
The drug, which is a mix of three antibodies designed to induce immunological protection against the highly deadly disease, appears to have been effective. Brantly and Writebol reportedly showed significant improvement following the drug's administration, and Pajares is said to be in stable condition.
"Americans are very selfish. They only care about the lives of themselves and no one else.
-Anthony Kamara, Sierra Leone
The Ebola virus emerged in West Africa last February, originating in Guinea and spreading to Liberia, Sierra Leone and Nigeria. The outbreak has infected 1,779 individuals and claimed the lives of 961, and is by far the largest recorded outbreak to date.
Ebola is undeniably a ruthless disease, with no current vaccine or effective treatment options. Yet these high infection and mortality rates are likely due, at least in part, to the living conditions in the affected areas. There's no doubt that these patients would benefit from the luxury of being transported to a high-technology hospital where they would receive personalized care. And I believe the vast majority of these patients would have happily consented to try ZMapp.
Many see the practice as discriminatory, a highlight of social inequality. Many reporters have cited a quote from Anthony Kamara, "a 27-year-old man riding a bicycle in Freetown, Sierra Leone." I am not sure why this man was singled out for an interview, or why his statement has become so widely used, but his words are certainly powerful - and possibly a bit uncomfortable for many to read.
"Americans are very selfish," Kamara said. "They only care about the lives of themselves and no one else."
It is true that Brantly requested the medication (which was available in extremely limited quantities) be administered to him and his colleague, rather than an African patient. It is understandable why Kamara saw this decision as selfish. However, it is important to remember that Brantly, Writebol and Pajares are volunteer workers. Essentially, they left the comfort of their first-world lives to try and stop the outbreaks. Although their prioritized treatment may be unjust in a larger context, I think most would agree that these individuals have acted unselfishly.
It is certainly unfair that thousands of patients will never have a chance at seeing, let alone receiving ZMapp. Yet even the distribution to a few patients is a difficult decision to make at this point.
Could ZMapp even be used to treat more than just three foreign volunteers? Apart from the drug's currently very limited quantity, ZMapp remains widely untested. Generally, drugs are first tested on animals for effectiveness. Then, they move to small human trials for safety testing. Then, they go to a larger human trial. Then, if these trials are successful, the drug will be made available on the market.
Most drugs will never make it this far and, if they do, the process can take years.
ZMapp was far from approved for market use, as it had only been tested previously on eight monkeys oost-exposure in a study published last October. Although these results were promising (seven out of the eight monkeys survived), this test is far from a perfect indicator of the drug's effectiveness in humans - or, more importantly, its safety.
Essentially, ZMapp is currently too dangerous to administer to more than a few select individuals. Let's say Mapp Biopharmaceutical was able to mass produce ZMapp, and the U.S. government paid for the drug to be distributed throughout West Africa. Essentially, the U.S. would be performing a science experiment on thousands of people at once - thousands of impoverished, likely desperate people would would do anything for a cure. And doctors have essentially no idea how ZMapp could affect humans long-term. As tragic as this situation is, the current outbreak's mortality rate is a little over 50 percent. If ZMapp does prove to be dangerous, its distribution could have deadly impact on nearly 1,000 people who would have lived without it.
As an example of how hasty drug approval can have catastrophic consequences, Google "Thalidomide." [Warning: Images may be graphic] The drug was created during the 1950s with good intentions: to ease morning sickness in expectant mothers. Thalidomide resulted in severe birth defects, affecting thousands of children.
We don't need to see history repeat itself. There may be a day that ZMapp becomes a standard and widespread treatment for Ebola. However, scientists are simply not yet at that point.
Brently, Writebol and Pajares have essentially agreed to be the part of an early human trial. This was actually a very valuable course of action, as the intermittent disease is difficult to test in a clinical setting. It certainly might be valuable to select a few further individuals for testing. But ultimately, there is no real "right" way to choose who to treat.
If the company does choose to continue trials on more individuals, the decision will only become more difficult. It is a decision that must be made, but with extreme caution.