July 2, 2022

Divergent approaches to treating Ebola

How to deal with the Ebola outbreak in West Africa seems to be splitting bioethicists.

How to deal with the Ebola outbreak in West Africa seems to be splitting bioethicists. Some applaud the World Health Organisation’s recent decision to allow experimental drugs to be released “for compassionate use”. For Arthur Caplan, of New York University Langone Medical Center, this seems to be the right decision:

“In a plague that kills 90% of its African victims complaints about unwarranted exploitative research seem a bit ridiculous even against a long history of misuse and abuse of poor desperate persons in poor African nations.”

However, bioethicists Ezekiel Emanuel, of the University of Pennsylvania, and Annette Rid, of King’s College London, want to be a bit more restrictive about “compassionate use” and believe that experimental drugs are not the main way to beat the disease. In an article in The Lancet, they write:

“Adoption of containment measures with a view to strengthen health systems and infrastructure is the most effective way to curb this epidemic and prevent future ones; it has positive externalities for health promotion and offers fair benefits to communities who engage in research in this outbreak. Experimental Ebola treatments or vaccines should only be deployed in clinical trials.”

One reason for being restrictive is that untested drugs could actually be dangerous. They say:

“irrespective of hope, we need to be realistic. The distance between preclinical promise and clinical use is vast and littered with failed compounds. Only 10% of new molecular entities succeed from the point of preclinical candidate selection to commercial launch. Although promising in non-human primates, there is no reason to believe that the experimental Ebola interventions will be more successful. In other words, it is more likely than not that the interventions will not improve or save patients, and might even weaken them as they battle a life-threatening disease.”

They also believe that lessons should be learned from the Ebola epidemic about how to strengthen health systems in these impoverished countries. In the long run, this is what will save lives:

“Although Ebola’s rapid spread and high rate of mortality capture our attention, the disease needs to be put into perspective. Cumulatively in the past four decades, Ebola has claimed less than 3000 lives. By contrast, the death toll in sub-Saharan Africa was 547 322 from diarrhoeal diseases and 222 767 from pneumococcal pneumonia in 2010 alone; many of these deaths could have been prevented through access to basic health care, including cheap vaccines, and improved sanitation. Thus, strengthening of health systems and infrastructure will have positive externalities for health promotion after this epidemic subsides.”

Creative commons
clinical trials
public health