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Mon August 11, 2014
Use Of Experimental Ebola Serum Raises Ethical Questions
Originally published on Mon August 11, 2014 1:03 pm
DAVID GREENE, HOST:
Now two other American missionaries returned home earlier with Ebola. They're being treated right now in Atlanta. And as part of their treatment they had been given an experimental serum, which raises questions about who gets experimental drugs in a crisis like this. The World Health Organization is holding a meeting of medical ethicists today and they'll be discussing questions just like this. We called Alta Charo, she's a bioethicist at the University of Wisconsin and also a former advisor to the Food and Drug Administration. And one question we asked her was why that serum was given to the Americans but not to any Africans.
ALTA CHARO: No one can say that the optics here are not troubling. That is you have a very small amount of a drug that might work and the only people who get it are the Americans. But you need to also remember that if we had given it to non-Americans first there would be equally bad optics of testing drugs on people from developing countries before we're willing to test it on ourselves, which has usually been the complaint in the past.
GREENE: I wonder when these drugs are produced in larger numbers, who will then make the decisions? I mean, is it governments where people live? Is it governments where drugs are being produced?
CHARO: Well, it'll probably be a combination of those things. First it won't be just one drug. The Food and Drug Administration has now already taken action on several things besides ZMapp .
GREENE: And that was the drug these missionaries got, we should say.
CHARO: That's correct. The FDA had already been overseeing human clinical trials with another drug from a different company and they had stopped the trials when there were bad side effects they wanted to look at. They've now allowed that to move forward. There are other kinds of vaccines and drugs that have been in development and even a diagnostic test that the Department of Defense was developing. And all of these are now moving forward in a much faster fashion. Now, that's the American government. Once you get to let's say Liberia or Sierra Leone and Nigeria you must allow those governments to decide whether they want these drugs available to their own populations.
GREENE: Well, I know that it's difficult because each country might handle this differently. But in general, I mean, what are some of the issues that these officials in countries will be grappling with? I mean, is it a matter of where the crisis is greater, is it a matter of getting the drugs first to police, healthcare workers? How do you even get started thinking about this?
CHARO: Well, here's some of the considerations. No government will balance them all the same way. First of all, who's got the most urgent need, who's the closest to dying without some attempt to treatment? Who has the best chance of recovery? That might not be the person closest to dying, it might be the person who's the least sick. Where are you physically, logistically, capable of delivering it in an organized fashion where you know who needs it, how many doses they got, how many doses they need and where you can monitor what's going on in the hope of learning a little bit. So that when you use it again next week or next month you use it better. Where can it actually be delivered effectively. There are parts of some of these countries that are far from the cities, where simple things like lack of refrigeration can get in the way of being able to provide drugs in an effective way.
GREENE: So you could actually be in places where the outbreak is the worst. I mean, if it's poorer, less developed areas, those would be the places that would not receive the drugs.
CHARO: It's possible but again this is exactly the kind of very local assessment that requires local knowledge. If an area is in such chaos, where either there's finding or there's lack of clean water or refrigeration or medical facilities or medical providers it may be pointless to try to bring the drug into that area. And you might not be able to save people's lives.
GREENE: So the World Health Organization is convening a meeting this week, do they have the authority to set some standards and protocol for governments to follow?
CHARO: The WHO doesn't directly regulate the use of drugs in these individual countries but it can be incredibly influential. By convening this group I think the goal is to try and get some common understanding of which degrees of uncertainty will be tolerated. You know, what stage of development the drug is at will be considered sufficient in light of the risk of death that these countries are now looking at. But even more to the point - I think it's also an opportunity to focus everybody's attention on the greater potential of prevention methods for curbing this epidemic because this is not an easy disease to transmit. You need real close contact. So good measures that enforce isolation and quarantine, proper burial practices, proper precautions before touching somebody in a medical context will do more to stop somebody else from getting this and to reduce the number of victims than any number of doses of these experimental drugs could possibly hope to save.
GREENE: All right, Dr. Charo thank you so much for your time, we appreciate it.
CHARO: Thank you. Appreciate it too.
GREENE: That's Alta Charo, she is a bioethicist at the University of Wisconsin. Transcript provided by NPR, Copyright NPR.