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Bioethicist: Ebola Treatment to West Is Troubling, Bad Science

Giving experimental treatment to three Westerners and no Africans is not only ethically questionable, it's bad science, Arthur Caplan writes.
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Spanish officials say a 75-year-old Roman Catholic priest who was infected with Ebola and flown back to Spain has received the same therapy as two American aid workers: an experimental treatment called ZMapp never before tested in humans.

ZMapp is not the answer to the Ebola epidemic ravaging West Africa. There is no chance of getting a significant amount of this drug made for many months. Deploying more health care workers, face guards, moon suits, gloves and antiseptic, along with restrictions on travel and burying the dead, is the only way to get the epidemic under control.

That said, it is very troubling that the only people known to have gotten the drug to date are two Americans and a Spaniard. The drug's maker, Mapp Biopharmaceutical Inc., said Monday that it also responded to a request for ZMapp from a West African nation and that its supply “is exhausted.” It did not name the nation or say whether a patient there had received the drug.

The Americans appear to have gotten the drug because their missionary organization asked for it first. But since then, the Nigerian government and others in Africa have made requests without apparent success. More than 1,700 Africans have been infected with Ebola in the current outbreak, and the World Health Organization is convening a panel of medical ethicists this week to explore the use of experimental treatments.

The fact that a 75-year-old has been given the scarce drug is especially disturbing, not because he is 75 but because 75-year-olds do not have strong immune systems — something very important in battling a virus like Ebola. Moreover 75-year-olds often have other medical problems that complicate the ability of scientists to figure out if the drug is safe and if it is really working.

In testing unapproved, highly risky drugs like ZMapp, it is crucial that recipients not be so sick that they may well die regardless of whether they get the drug or not. Indeed, the recipients ought not be very sick so that side-effects can be seen and efficacy determined. To do that, doctors need to be able to monitor experimental subjects for months to make sure the drug does not damage their livers or cause any other fatal side-effect. So not every person infected with Ebola makes for the best recipient — younger, those more recently infected and those who can be closely monitored are among the "best" candidates.

Is money playing a role in the distribution of the drug? Yes, if for no reason other than the drug has been flown to the three recipients and they have been flown to top-flight hospitals in the hopes they will recover.

When all is said and done, we need more transparency about what the tiny company in San Diego is doing in rationing its small supply of drugs.

There are lots of people on the frontlines of the Ebola epidemic who are justifiably wondering what the moral basis is to-date for treating the three people who have gotten access to a last-ditch experimental treatment.