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

China’s Influence Grows With New Infrastructure Bank

Multibillion-dollar China-backed and BRICS-supported Asian Infrastructure Investment Bank seen as possible challenger to such lenders as IMF, World Bank More

Video Rabbi Hits Road to Heal Jewish-Muslim Relations in France

Rabbi Michel Serfaty makes the rounds in his friendship bus to encourage dialogue and break down barriers between the two groups More

Post-deal Iran Leaders Need 'Economic Momentum' to Solidify

Economists say deal could inject more than $100 billion into coffers - not enough to entirely rescue ailing economy - but maybe adequate to create 'economic momentum' 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.
US Gay Marriage Ruling Yields Real-life Impacti
X
Michael Bowman
June 28, 2015 10:05 PM
Friday’s landmark Supreme Court decision legalizing same-sex marriage throughout the United States is an outcome few thought possible just years ago, and shows a nation that increasingly tolerates and even celebrates the hopes and aspirations of gay people. VOA’s Michael Bowman spoke to a same-sex couple that will benefit from the high court ruling, and to a Christian scholar who is apprehensive about its potential consequences for America’s faith community.
Video

Video US Gay Marriage Ruling Yields Real-life Impact

Friday’s landmark Supreme Court decision legalizing same-sex marriage throughout the United States is an outcome few thought possible just years ago, and shows a nation that increasingly tolerates and even celebrates the hopes and aspirations of gay people. VOA’s Michael Bowman spoke to a same-sex couple that will benefit from the high court ruling, and to a Christian scholar who is apprehensive about its potential consequences for America’s faith community.
Video

Video Syrians Flee IS Advance in Hasaka

The Syrian government said Monday it has taken back one of several districts in Hasaka overrun by Islamic State militants. But continued fighting elsewhere in the northern city has forced thousands of civilians from their homes. In this report narrated by Bill Rodgers, VOA Kurdish Service reporter Zana Omer describes the scene in Amouda, where some of the displaced are taking refuge.
Video

Video Rabbi Hits Road to Heal Jewish-Muslim Relations in France

France is on high alert after last week's terrorist attack near the city Lyon, just six months after deadly Paris shootings. The attack have added new tensions to relations between French Jews and Muslims. France’s Jewish and Muslim communities also share a common heritage, though, and as far as one French rabbi is concerned, they are destined to be friends. From the Paris suburb of La Courneuve, Lisa Bryant reports about Rabbi Michel Serfaty and his friendship bus.
Video

Video S. Korea Christians Protest Gay Rights Festival

The U.S. Supreme Court decision mandating marriage equality nationwide has energized gay rights supporters around the world. Gay rights remain a highly contentious issue in a key U.S. ally, South Korea, where police did a deft job Sunday of preventing potential clashes between Christian protesters and gay activists. Kurt Achin reports from Seoul.
Video

Video Saudi Leaks Expose ‘Checkbook Diplomacy’ In Battle With Iran

Saudi Arabia’s willingness to wield its oil money on the global diplomatic stage appears to have been laid bare, after the website WikiLeaks published tens of thousands of leaked cables from Riyadh’s Ministry of Foreign Affairs. VOA's Henry Ridgwell reports.
Video

Video Nubians in Kenya Face Land Challenges

East Africa's ethnic Nubians have a rich cultural history that dates back thousands of years, but in Kenya they are facing hardships, including the loss of lands they have lived on for generations. They say the government has reneged on its pledge to award them title deeds for the plots. VOA's Lenny Ruvaga reports.
Video

Video Syrian Refugees Return to Tal Abyad

Syrian refugees in Turkey confirm they left their hometown of Tal Abyad because of intense fighting and coalition airstrikes, not because Kurdish fighters were engaged in ethnic cleansing, as some Turkish officials charged. VOA Kurdish Service reporter Zana Omer, in Tal Abyad, finds that civilians coming back to the town agree, as we hear in this report narrated by Roger Wilkison.
Video

Video Military Experts Question New Russian Tank Capabilities

Russia has been showing off its new tank design – the Armata T-14. Designers claim it is 20 years ahead of current Western designs - and driving it feels like playing a computer game. But military analysts question those assertions, and warn the cost could be too heavy a burden for Russia’s struggling economy. Henry Ridgwell reports.
Video

Video In Kenya, Police Said to Shoot First, Ask Questions Later

An organization that documents torture and extrajudicial killings says Kenyan police were responsible for 1,252 shooting deaths in five cities, including Nairobi, between 2009 and 2014, representing 67 percent of all gun deaths in the areas reviewed. Gabe Joselow has more from Nairobi.
Video

Video In Syrian Crisis, Social Media Offer Small Comforts

Za’atari, a makeshift city in Jordan, may be the only Syrian refugee camp to tweet its activities, in an effort to keep donors motivated as the war in Syria intensifies and the humanitarian crisis deepens. Inside the camp, families say mobile phone applications help hold together families that are physically torn apart. VOA’s Heather Murdock reports.
Video

Video Chemical-Sniffing Technology Fights Australia's Graffiti Vandals

Cities and towns all over the world spend huge amounts of resources battling graffiti writers who deface buildings, public transport vehicles and even monuments. Authorities in Sydney, Australia, hope a new chemical-sniffing technology finally will stop vandals from scribbling on walls in the passenger areas of commuter trains. VOA’s George Putic has more.
Video

Video Cambodia Struggling to Curb Child Labor

Earlier this year a United Nations report found 10 percent of Cambodian children aged 7-14 are working – one of the highest rates in the region – and said one in four children in that age bracket are forced to quit school to help their families. Although the child labor rate has dropped over the past decade, Cambodia has a lot more to do – including keeping more children in school. Robert Carmichael reports for VOA from Phnom Penh.

VOA Blogs