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

Multimedia Obama Defends Immigration Action

Obama says with his executive action on immigration, enforcement resources will be focused on 'felons, not families; criminals, not children' More

US-Led Airstrikes in Syria Kill Over 900: Monitoring Group

British-based Syrian Observatory for Human Rights says the toll includes more than 50 civilians, five of them women and eight of them children More

Report: Obama Broadens US Combat Role in Afghanistan

The New York Times says resident Barack Obama has signed a classified order extending the role of US troops in Afghanistan for another year 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.
New Skateboard Defies Gravityi
X
November 21, 2014 5:07 AM
A futuristic dream only a couple of decades ago, the hoverboard – a skateboard that floats above the ground - has finally been made possible. While still not ready for mass production, it promises to become a cool mode of transport... at least over some surfaces. VOA’s George Putic reports.
Video

Video New Skateboard Defies Gravity

A futuristic dream only a couple of decades ago, the hoverboard – a skateboard that floats above the ground - has finally been made possible. While still not ready for mass production, it promises to become a cool mode of transport... at least over some surfaces. VOA’s George Putic reports.
Video

Video Falling Gas Prices Impact US Oil Extraction

With the price of oil now less than $80 a barrel, motorists throughout the United States are benefiting from gas prices below $3 a gallon. But as VOA’s Kane Farabaugh reports, the decreasing price of petroleum has a downside for the hydraulic fracturing industry in the United States.
Video

Video Tensions Build on Korean Peninsula Amid Military Drills

It has been another tense week on the Korean peninsula as Pyongyang threatened to again test nuclear weapons while the U.S. and South Korean forces held joint military exercises in a show of force. VOA’s Brian Padden reports from the Kunsan Air Base in South Korea.
Video

Video Mama Sarah Obama Honored at UN Women’s Entrepreneurship Day

President Barack Obama's step-grandmother is in the United States to raise money to build a $12 million school and hospital center in Kogelo, Kenya, the birthplace of the president's father, Barack Obama, Sr. She was honored for her decades of work to aid poor Kenyans at a Women's Entrepreneurship Day at the United Nations.
Video

Video Gay Evangelicals Argue That Bible Does Not Condemn Homosexuality

More than 30 U.S. states now recognize same-sex marriages, and an increasing number of mainline American churches are blessing them. But evangelical church members- which account for around 30 percent of the U.S. adult population - believe the Bible unequivocally condemns homosexuality. VOA's Jerome Socolovsky reports that gay, lesbian, bisexual and transgender evangelicals are coming out. Backed by a prominent evangelical scholar, they argue that the traditional reading of the bible is wrong.
Video

Video Ebola Economic Toll Stirs W. Africa Food Security Concerns

The World Bank said Wednesday that it expects the economic impact of the Ebola outbreak on the sub-Saharan economy to cost somewhere betweenf $3 billion to $4 billion - well below a previously-outlined worst-case scenario of $32 billion. Some economists, however, paint a gloomier picture - warning that the disruption to regional markets and trading is considerable. Henry Ridgwell reports from London.
Video

Video Mexico Protests Escalate Over Disappearances

Protests in Mexico over 43 students missing since September continue to escalate, reflecting growing anger among Mexicans about a political system they view as corrupt, and increasingly tainted by the drug trade. Mounting outrage over the disappearances is now focused on the government of President Enrique Pena Nieto, accused of not doing enough to end insecurity in the country. More from VOA's Victoria Macchi.
Video

Video US Senate Votes Down Controversial Oil Pipeline - For Now

The U.S. Senate has rejected construction of a controversial pipeline to transport Canadian oil to American refineries. The $5 billion project still could be approved next year, but it faces a possible veto by President Barack Obama. As VOA’s Michael Bowman reports, the pipeline has exposed deep divisions in Congress about America’s energy future.
Video

Video Can Minsk Cease-fire Agreement Hold?

Growing tensions between government troops and separatists in eastern Ukraine further threaten a cease-fire agreement reached two months ago in the Belarusian capital of Minsk. Critics of U.S. policy in Ukraine say it is time the Obama administration gives up on that much-violated cease-fire and moves toward a new deal with Russia. VOA's Scott Stearns has more.
Video

Video Chaos, Abuse Defy Solution in Libya

The political and security crisis in Libya is deepening, with competing governments and, according to Amnesty International, widespread human rights violations committed with impunity. VOA’s Al Pessin reports from London.
Video

Video US Hosts Record 866,000 Foreign Students

Close to 900,000 international students are studying at American universities and colleges, more than ever before. About half of them come from Asia, mostly China. The United States hosts more foreign students than any other country in the world, and its foreign student population is steadily growing. Zlatica Hoke reports.
Video

Video Ferguson Church Grapples with Race Relations

Many white residents of Ferguson, Missouri, say they chose to live there because of the American Midwest community's diversity. So, they were shocked when a white police officer killed an unarmed black teenager in August – and shaken by the resulting protests and violence. Some local churches are leading conversations on how to go forward. VOA’s Ayesha Tanzeem reports.

All About America

AppleAndroid