ZMapp is Not the Answer to This Ebola Outbreak

In 1976, the Ebola virus first emerged in Sudan and Zaire and was given its name by Dr. Peter Piot. According to the World Health Organization (WHO), there have been about 1,848 people infected and 1,013 people have died. Currently, Sierra Leone, Guinea, Liberia, and Nigeria are working to contain the Ebola virus. Controversy arose when two Americans, Dr. Kent Brantly and Nancy Writebol, were the first humans to be given an experimental drug known as ZMapp (a cocktail of three monoclonal antibodies) after contracting Ebola in Liberia. ZMapp was developed by San Diego based biotech firm, Mapp Biopharmaceutical Inc. and was never tested on humans before Brantly.

So far the patients are having positive results, which makes people question, “why weren’t two of the 1,700+ Africans suffering from Ebola, get the experimental drug?” According to Arthur L. Caplan, the director of medical ethics at the New York University Langone Medical Center’s department of population health, the drugs have not yet undergone clinical testing; therefore, it is still a “risky long shot” and shouldn’t be given to African patients just yet. WHO brought together a dozen participants around the world to discuss which drugs could be ethically offered even if the safety and efficacy of the drugs remain unknown. The panel unanimously decided to offer the treatments to West Africans despite lack of thorough clinical tests. Despite the decision of the panel, I still believe ZMapp should not be distributed to West Africans until there is thorough clinical testing and that more money should be used to create and improve medical infrastructures in the affected West African countries.

There are many people around the world who are criticizing the fact that white Americans were given “first priority” to ZMapp. These same people say that by giving the Americans the serum, the principle of distributive justice is being violated meaning that the benefits of the drug are being “inequitably distributed” with the economically secure professionals benefiting. Nourdine Sow, a sociology professor at the Universal Institute of Guinea stated, “This shows simply that white patients and black patients do not have the same value in the eyes of world medicine.” This is simply not the case. Some disadvantages of giving African patients ZMapp include, lack of thorough clinical testing, lack of “informed consent,” rate and cost of production, and America’s reputation of using Third World people for pharmaceutical experimentation. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, believes that new drugs are not the best answer for Ebola, and that the problem should rather be addressed by “setting up medical infrastructure in the affected countries to provide the sick people with basic medical support such as replacement fluids and blood.” He believes that, “that will have a more significant effect on health than a few batches of experimental medications.”

Before the emergency use of ZMapp, the drug had only been tested on a few monkeys. The scientists reported that 4 out of 4 monkeys who received the treatment within 24 hours of being infected survived. However, only 2 out of 4 of the monkeys that were given the serum within 48 hours survived. In trials that only involve a few number of animals, even if there is success among the few, there is a tendency for failure to occur when tested on humans. Although this drug was not tested on humans before Brantly and Writebol, it has already been prematurely nicknamed the “secret serum,” even though future side effects have yet to be tested for. We can’t assume that this drug will have the same effect on the Africans because the Americans grew up in a developed world with food and clean water that strengthened their immune systems.

Another disadvantage of distributing ZMapp is its slow rate of production. According Dr. Fauci, “ZMapp will take two to three months to get a real, very modest number of treatment courses,” adding that each patient would need about three doses of the drug. The reason for such slow production is because ZMapp is created from the antibodies that are grown inside of tobacco plants that are then extracted and purified. This is a very slow process. He also noted that even if there are current breakthroughs in Ebola “cures,” ZMapp cannot be made in large enough quantities to benefit current victims. Along with the slow production time, a lot of money is needed to develop a drug in general. For this recent Ebola outbreak, the National Institutes of Health (NIH) awarded a grant of $28 million for researchers from 15 different institutions to collaborate for the purpose of fighting Ebola, and the U.S. Department of Defense has a $140 million contract with Tekmira Pharmaceuticals to develop an Ebola drug. In my opinion, it would make more sense to invest in long-term infrastructures than to try to send out as much experimental vaccines as fast as possible. Experts say that the two main drivers of the outbreak are improper infection control during patient care and improper handling of dead bodies that are still infectious; these are two things that could be addressed and taken care of with proper facilities.

The next reason why ZMapp should not yet be brought in for African patients is lack of “informed consent,” which is defined as “the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment.” Experimental drugs that have not been clinically tested should not be given to Africans because they are not able to give “informed consent.” Researchers have to make sure that they thoroughly inform their subjects of the risks of participation and non-participation, as well as how the data will be used. There are some groups of people who are unable to give meaningful informed consent, such as children, the mentally ill, and uneducated people, because they may not be capable of understanding all of the implications. According to lawyer Esther Chang, “developing country participants in clinical trials often do not understand the concept of a placebo or may misunderstand informed consent forms.” The patient may not understand that the possible negative side effects of the drug may do more harm than good.

The reason it may not be ethical to give the drug to the West Africans because about 45% of those afflicted with this strain of Ebola have survived. Some don’t even actually have Ebola but are convinced that they have the symptoms due to paranoia. For people that already have a chance of survival, taking an untested drug could be more dangerous to them.

The United States already has a bad reputation of experimental testing on people who cannot give informed consent, such as illiterate people or people suffering from a mental disorder. In 1996, Pfizer (an American pharmaceutical company) had to do clinical testing on their drug, Trovan, before the FDA in America could give the drug certification. Pfizer scientists went to Nigeria during a meningitis outbreak and treated 200 sick children between the ages of 3 months and 18-years-old. A total of 11 children were killed during this experiment and dozens of other patients were left with paralysis, brain damage, or slurred speech. Even if we could manufacture an endless supply of ZMapp, if it were distributed to Africans without clinical testing and resulted in deaths, people would accuse America of more experimental testing in Third World countries. As Dr. Salim S. Abdool Karim, director of Caprisa (an AIDS research center in South Africa) stated, “It would have been the front-page screaming headline: Africans used as guinea pigs for American drug company’s medicine.” We mustn’t put more strain on our already fragile relationships with companies (like Nigeria) that we already have a complicated medical history with.

Although there are people who think it would be more ethical to make ZMapp available to Africans, in reality there is a big chance that it would do a lot more harm than good. Even though it is sad to see African countries battling this fatal disease, we need to consider the negative consequences that could happen if we were to give experimental drugs to them. Not only could it give them a higher chance of death, it could also make pharmaceutical companies (and their respective countries) that are currently trying to develop Ebola cures look bad if the usage of their drug doesn’t lower the mortality rate. Dr. Fauci stated that having proper medical infrastructures that give supportive therapy (such as quickly replacing the patient’s fluids), is much more effective than using drugs that are under experiment. If just a fraction of the money that is currently being used to develop these new drugs could be used to improve medical infrastructures by providing clean facilities and Ebola prevention education, West Africa could be one-step closer to slowing this outbreak.

Kaitlyn Fujihara

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