News / Africa

Wrestling With Ethics, Saving Ebola Patients

A Spanish priest infected with Ebola was evacuated last week from Monrovia to a hospital in Madrid, where he died on Tuesday, August 12.
A Spanish priest infected with Ebola was evacuated last week from Monrovia to a hospital in Madrid, where he died on Tuesday, August 12.
William Eagle

A Spanish priest and two Americans - a doctor and a hygienist – who contracted the Ebola virus disease were evacuated from Liberia recently. Lengthy testing of several drugs that may save the lives of hundreds of Ebola patients or vaccinate communities against a future epidemic has never been done because no one has stepped forward to fund the final necessary research.

Guinea, Liberia, Sierra Leone and Nigeria are prepared to offer risks that could mean life of death for more than a thousand people.

Doctors for all three sought access to Z-Mapp, a drug treatment that has not been tested on humans. Whether the Madrid hospital where 75-year-old Father Miguel Pajares died this morning had time to give him the drug is not certain. The two Americans, Dr. Kent Brantly and hygienist Nancy Writebole, are being treated with the same drug in an Atlanta hospital, but their recovery is not yet assured.

The World Health Organization (WHO) yesterday approved the use of untested drugs on the grounds that the deadly virus has turned into an international medical emergency. But first, they spent several days wrestling with the ethics of approving Z-Mapp and several other drugs not yet tested in humans.

Do the drugs harm the patient?

“Drugs obviously usually have to go through a three-step process for both safety and effectiveness before they can ever be given to human beings,” says Nancy Kass,  a professor of bioethics at John Hopkins University and the Bloomberg School of Public Health. “None of these Ebola drugs have gone through any kind of human testing.”

The four West African governments now seek access to the experimental drugs. Kass says these governments and WHO need to figure out whether it is appropriate to give an experimental “to a few people with Ebola to see what the effects are or - at the very least – do they need to wait until some safety trials are done to make sure that the drug is at very least not harmful?”

The Liberian ministry of health seeking access to experimental drugs for patients now in quarantine has received permission to receive the Z-Mapp experimental treatment. All four African governments face two critical questions, according to Kass. Will patients experience minor or major side effects of the drugs? Even if the drugs don’t harm the patient, do they do any good?

What if Z-Mapp doesn’t work?

“There is a whole other kind of question about whether the drug is effective,” says the bioethicist. “Giving people an ineffective drug sometimes can also be harmful because it can create distrust or it makes public health people think that they have a solution when they don’t.

“But the biggest risk is the safety risk.”

Will those administering the drugs decide to test the toxicity and dosage of the drugs on uninfected volunteers first?  “It depends how long they want to wait to see what kind of bad effects there are,” Kass says. 

“Safety studies done properly also go gradually. You probably wouldn’t give five people the drug all at the same time in case there is a very serious toxic effect in humans. The best way to do it ethically is to give the drug to humans one at a time and at least wait a couple of days … in case person number one has this horrible an unexpected reaction …To do that safety study would take about a month.” 

Experience with drug trials in low-resource countries in Africa, for example, has a politically toxic history in which patient advocates have charged that drug makers in developed countries are exploiting poor populations. Kass says the countries that produce the drugs now seek paid volunteers within their own country in order to monitor risks of serious side effects.

Kass speculates that given the odds that more than one-thousand Ebola victims currently face a 40-percent chance of survival without any drug, medical authorities and public health administrators may skip the safety trials and hope the drugs they give are not only not dangerous but effective.

Nothing to lose

Kass says Ebola patients do have something to lose if they do not take try a new drug that may not be effective. But she says the decisions are not that easy to make for patients or medical personnel.

“A critical question there would be giving it to people who really understand. There is a way you can figure out whether they really understand that it’s still at a fairly experimental stage.” She says researchers usually find that those who are very sick have a hard time understanding, “not because they are sick but because they’re so hopeful that the treatment will be effective.

"And particularly with it having been given to these two Americans, I think there may be a perception problem now that someone has concluded that these drugs are effective, and it couldn’t be further from the truth.”

 

 

You May Like

Captured IS Militants Explain Why They Fought

Fighters from Turkey, Syria tell VOA Kurdish Service what drew them to extremism, jihad More

Security Experts Split on Kenyan Barrier Wall

Experts divided on whether initiative aiming to keep out al-Shabab militants is long-awaited solution or misguided effort More

Video Philippines Wants Tourists Spending Money at New Casinos

Officials say they hope to turn Manila into the next Macau, which has long been Asia’s gambling hub More

This forum has been closed.
Comment Sorting
Comments
     
by: John
August 13, 2014 4:35 PM
I must agree with the article. People are panicking now, but once someone is injured or killed by an untested drug, the witch hunt will start. At the very least, no drug should be sent to an African country unless its government has very publicly requested it.

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Liberia's Almost Last Ebola Patient Grateful but Still Grievingi
X
Benno Muchler
March 26, 2015 3:41 PM
Beatrice Yardolo was to make history as Liberia’s last Ebola patient. Liberians recently started counting down 42 days, the period that has to go by without a single new infection until the World Health Organization can declare a country Ebola-free. That countdown stopped on March 20 when there was another new case of Ebola, making Yardolo’s story a reminder that Ebola is far from over. Benno Muchler reports from Monrovia.
Video

Video Liberia's Almost Last Ebola Patient Grateful but Still Grieving

Beatrice Yardolo was to make history as Liberia’s last Ebola patient. Liberians recently started counting down 42 days, the period that has to go by without a single new infection until the World Health Organization can declare a country Ebola-free. That countdown stopped on March 20 when there was another new case of Ebola, making Yardolo’s story a reminder that Ebola is far from over. Benno Muchler reports from Monrovia.
Video

Video Cambodian Land Grabs Threaten Traditional Communities

Indigenous communities in Cambodia's Ratanakiri province say the government’s economic land concession policy is taking away their land and traditional way of life, making many fear that their identity will soon be lost. Local authorities, though, have denied this is the case. VOA's Say Mony went to investigate and filed this report, narrated by Colin Lovett.
Video

Video US, South Korea Conduct Joint Military Exercises

The Eighth U.S. Army Division and the Eighth Republic of Korea Mechanized Infantry Division put on a well orchestrated show of force for the media this week during their joint military training exercises in South Korea. VOA’s Seoul correspondent Brian Padden was there and reports the soldiers were well disciplined both in conducting a complex live fire exercise and in staying on message with the press.
Video

Video Space Program Status Disappoints 'Last Man on the Moon'

One of the films that drew big crowds last week at the annual South by Southwest festival in Austin, Texas, tells the story of the last human being to stand on the moon, U.S. astronaut Eugene Cernan. It has been 42 years since Cernan returned from the moon and he laments that no one else has gone there since. VOA’s Greg Flakus reports.
Video

Video Young Filmmakers Shine Spotlight on Giving Back

A group of student filmmakers from across the United States joined President Barack Obama at the White House this month for the second annual White House Student Film Festival. Fifteen short films were officially selected from more than 1,500 entries by students aged 6 through 18. The filmmakers and their families then joined the president and a group of celebrities for a screening of their films. VOA’s Julie Taboh reports.
Video

Video VOA Exclusive: Interview with Afghan President Ashraf Ghani

Afghan President Ashraf Ghani, during his first visit as president to Washington, gave a one-on-one interview with VOA Afghan Service reporter Said Suleiman Ashna, about his request for a change in U.S. troop levels, the threat from the Islamic State, and repairing relations with the United States and Pakistan. The interview was held at Blair House, late Sunday, in Pashto.
Video

Video California Science Center Tells Story of Dead Sea Scrolls

The ancient manuscripts were uncovered in the mid-20th century, and they are still yielding clues about life and religious beliefs in ancient Israel. As VOA's Mike O'Sullivan reports, an exhibit in Los Angeles shows how modern science is bringing the history of these ancient documents to life.
Video

Video Angelina Jolie Takes Another Bold Step

Hollywood actress and filmmaker Angelina Jolie has revealed she had her ovaries and fallopian tubes removed to lower her odds of getting cancer. Doctors say the huge publicity over her decision will help raise awareness about the importance of cancer screening. VOA’s George Putic has more

All About America

Circumventing Censorship

An Internet Primer for Healthy Web Habits

As surveillance and censoring technologies advance, so, too, do new tools for your computer or mobile device that help protect your privacy and break through Internet censorship.
More