The ethical debate over the use of an untested Ebola drug

It’s like a movie. A deadly plague hits part of the world. Two Americans there get infected. A scientist has an untested serum. Should it be used? And if so, who gets it?

But this is no movie.

The disease is Ebola. The outbreak is In West Africa. And the two infected Americans are Kent Brantly and Nancy Writebol. They’re the ones who got the drug, which is called ZMapp.

ZMapp is believed to be derived from the antibodies of Ebola survivors, primarily mice. It has shown some success in tests on primates. But it has not been rigorously tested; nor has it been tested at all on humans. It’s not clear if the serum is working on Brantly and Writebol, but both are still alive. The case mortality in Africa is currently 50 to 60 percent.

Kevin Fitzgerald is a medical ethicist at Georgetown University — and also a Jesuit priest. He says there are good reasons not to use untested drugs. “Once you move from one species to another, there’s always the possibility that there can be differences in how that particular species reacts to a treatment, rather than the animals it’s been tested on. It can go from not functioning well at all, to actually causing harm. And I think this was part of the risk.”

Fitzgerald says that in this situation there is an ethical approach, called "compassionate use."

He explains that this is when someone is believed to be dying imminently. “If the only other alternative is death, and the goal of the drug is to prevent death, then it might be worth the risk.”

He says that’s “one of the ethical reasoning processes we use” when deciding whether to make an untested drug available.

Then there’s the issue of race. No Africans have received ZMapp.

“This shows simply that white patients and black patients do not have the same value in the eyes of world medicine,'' Nouridine Sow, a sociology professor at the Universal Institute of Guinea, told the Associated Press.

Fitzgerald says that based on the limited of information that he has access to, then “it doesn’t seem to be so much a matter of race, but socio-economic background.”  

He points out that these were two people “who were not from that part of the world; who had volunteered to go there to help the people who are there to address this tragic health care crisis.”

“Part of the reason there is a crisis there,” says Fitzgerald, is that as far as he knows “they don’t have the infrastructure they need to fight this disease.”

“What we need to do as a species, as a global society, is to recognize the fact that the people there on the ground do not have the tools that they need,” says Fitzgerald. They need help.

He adds that “if one wants to ask the social justice question and the ethics question, [then that] is the one we really need to wrestle with.”

Nigeria says it has requested access to ZMapp, but a CDC spokesman told the AP on Wednesday that “there are virtually no doses available.''

Late on Thursday, an Obama administration official told the AP that the US is setting up a special working group to consider broad “principles of decision-making” for the potential use of experimental drugs to help those infected by Ebola in Africa.

It’s like a movie. A deadly plague hits part of the world. Two Americans there get infected. A scientist has an untested serum. Should it be used? And if so, who gets it?

But this is no movie.

The disease is Ebola. The outbreak is In West Africa. And the two infected Americans are Kent Brantly and Nancy Writebol. They’re the ones who got the drug, which is called ZMapp.

ZMapp is believed to be derived from the antibodies of Ebola survivors, primarily mice. It has shown some success in tests on primates. But it has not been rigorously tested; nor has it been tested at all on humans. It’s not clear if the serum is working on Brantly and Writebol, but both are still alive. The case mortality in Africa is currently 50 to 60 percent.

Kevin Fitzgerald is a medical ethicist at Georgetown University — and also a Jesuit priest. He says there are good reasons not to use untested drugs. “Once you move from one species to another, there’s always the possibility that there can be differences in how that particular species reacts to a treatment, rather than the animals it’s been tested on. It can go from not functioning well at all, to actually causing harm. And I think this was part of the risk.”

Fitzgerald says that in this situation there is an ethical approach, called "compassionate use."

He explains that this is when someone is believed to be dying imminently. “If the only other alternative is death, and the goal of the drug is to prevent death, then it might be worth the risk.”

He says that’s “one of the ethical reasoning processes we use” when deciding whether to make an untested drug available.

Then there’s the issue of race. No Africans have received ZMapp.

“This shows simply that white patients and black patients do not have the same value in the eyes of world medicine,'' Nouridine Sow, a sociology professor at the Universal Institute of Guinea, told the Associated Press.

Fitzgerald says that based on the limited of information that he has access to, then “it doesn’t seem to be so much a matter of race, but socio-economic background.”  

He points out that these were two people “who were not from that part of the world; who had volunteered to go there to help the people who are there to address this tragic health care crisis.”

“Part of the reason there is a crisis there,” says Fitzgerald, is that as far as he knows “they don’t have the infrastructure they need to fight this disease.”

“What we need to do as a species, as a global society, is to recognize the fact that the people there on the ground do not have the tools that they need,” says Fitzgerald. They need help.

He adds that “if one wants to ask the social justice question and the ethics question, [then that] is the one we really need to wrestle with.”

Nigeria says it has requested access to ZMapp, but a CDC spokesman told the AP on Wednesday that “there are virtually no doses available.''

Late on Thursday, an Obama administration official told the AP that the US is setting up a special working group to consider broad “principles of decision-making” for the potential use of experimental drugs to help those infected by Ebola in Africa.