Who Are Ebola's Guinea Pigs?
It's a controversial image, to be sure: two white, U.S. health workers receive doses of a serum that appears to save their lives, while hundreds of other Ebola sufferers, almost all of them black Africans, go without. The image has sparked outrage and calls to reform the way experimental treatments are dispersed.
Before tinkering with a system designed to protect people from unsafe and ineffective drugs, it's valuable to examine the grounds for the outrage. How was it, after all, that Kent Brantly and Nancy Whitebol, U.S. volunteers for the charity Samaritan's Purse, having contracted Ebola while working in Liberia, became the only patients to receive ZMapp, an unapproved drug that had been tested only in animals?
Resentment of their treatment is based on the notion that as Americans, they were privileged over Africans. This is true in the sense that they had the good fortune to work for a U.S.-based employer that took the initiative to inquire about experimental treatments with U.S. health authorities, who referred the charity to ZMapp's maker. The charity had the wherewithal to either pay for the drugs, which may have cost as much as $10,000 a dose, or negotiate a deal.
On the other hand, Americans ordinarily are at a disadvantage when it comes to access to experimental drugs. Compared with most national drug regulators, the U.S. Food and Drug Administration more strictly controls such substances. Samaritan's Purse avoided FDA constraints by providing Brantly and Whitebol with ZMapp while they were still in Liberia.
Some commentators have said it's unfair that the U.S. medical workers received ZMapp while Sheik Umar Khan, Sierra Leone's leading Ebola expert, who died last month of the disease, did not. It might seem like a valid point in light of the improvement the Americans made after receiving the treatment.
But their progress was hardly preordained. No human had ever taken ZMapp before. If Khan had been the first and ZMapp had killed him instantly, those same commentators would have complained that a U.S. drugmaker used an African as a guinea pig.
In fact, Brantly and Whitebol were guinea pigs. As medical workers, they were capable of giving their informed consent to an experiment that might have gone very badly. It appears not to have. Nevertheless, with only two subjects, the experiment provides very little information about the safety or efficacy of ZMapp in humans. In the current outbreak, about 45 percent of Ebola sufferers have survived, so the two Americans might have improved even without the drug.
Does the experience of Brantly and Whitebol provide enough information to rationalize making ZMapp and other experimental Ebola drugs available to patients? A panel of medical ethicists convened by the World Health Organization will consider that next week. Their deliberations should be dominated by the costs and benefits of suspending the normal process for drug approval, rather than by the emotions generated by the nationality of the two volunteers.
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