Skip to main content

Make more Ebola drug and give it to Africans

By Harriet A. Washington
August 6, 2014 -- Updated 2021 GMT (0421 HKT)
STORY HIGHLIGHTS
  • Americans with Ebola received an experimental medicine that seemed to help
  • Harriet Washington: Poor Africans don't have access to lifesaving medicines
  • She says access to drugs often based on how much money you have and if you're a Westerner
  • She urges this drug be made in quantity and given to infected West Africans in a trial

Editor's note: Harriet A. Washington, a fellow at the Black Mountain Institute at the University of Nevada, Las Vegas, is the author of "Medical Apartheid: The Dark History of Experimentation from Colonial Times to the Present" and "Deadly Monopolies: The Shocking Corporate Takeover of Life Itself -- and the Consequences for Your Health and Our Medical Future." The opinions expressed in this commentary are solely those of the writer.

(CNN) -- One of the many questions surrounding the revelation that Americans Kent Brantly and Nancy Writebol received a little-known, experimental serum for their Ebola infection is: "Why did we hear nothing about it earlier, and how did they gain access to it?"

Ebola has no cure, although potential medications and vaccines are in various states of development. The serum ZMapp, an experimental product of Mapp Biopharmaceutical, hasn't been tested in humans, which means it doesn't meet a primary requirement for FDA approval -- so its obscurity is no surprise.

The Americans managed to gain access to what more than 1,660 infected people in Guinea, Sierra Leone, Liberia and now Nigeria did not: medicine that seems to work -- although, of course, we don't know for sure yet. Some reports indicate they received ZMapp under the FDA's "compassionate use" rule, which permits untested drugs to be given to consenting patients who might otherwise die. This is a triumph of common sense and compassion over bureaucratic red tape.

Harriet A. Washington
Harriet A. Washington

One of the chief concerns about using unapproved medications is that we don't know what the risks are: The drug may not work, it may work with serious adverse effects, or it may prove as deadly as the disease. But as a doctor, Brantly understood the risks, and like him, Writebol had no other options. Most people with Ebola die.

Compassionate use is certainly ethically defensible. But apparently only three doses were available, and they were given to Westerners. The lack of broader access to ZMapp highlights what is often a very serious ethical failing.

9 questions about this new Ebola drug

Health workers in Monrovia, Liberia, move the body of a person who they suspect died from the Ebola virus on Tuesday, September 16. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 4,700 cases have been reported since December, with more than 2,400 of them ending in fatalities, according to the World Health Organization. Health workers in Monrovia, Liberia, move the body of a person who they suspect died from the Ebola virus on Tuesday, September 16. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 4,700 cases have been reported since December, with more than 2,400 of them ending in fatalities, according to the World Health Organization.
Ebola outbreak in West Africa
HIDE CAPTION
<<
<
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>
>>
Photos: Ebola outbreak in West Africa Photos: Ebola outbreak in West Africa

Why didn't Dr. Sheik Umar Khan, the chief Sierra Leone physician who died while treating Ebola patients, receive this medication? Because another method of determining who gets medications is at work here -- the drearily familiar stratification of access to a drug based on economic resources and being a Westerner rather than a resident of the global South.

Ebola vaccine delayed for business reasons?
How the experimental Ebola serum works
Fight against Ebola given new momentum

No health worker wants to intentionally deprive Africans of a needed drug. But informal medical networks, which Africans lack, connect well-to-do Westerners with information and drugs. In addition, the pharmaceutical industry has a history of declining to test medications for diseases of the tropical world, most of whose inhabitants cannot afford high prices.

We don't know how quickly ZMapp could be made in large quantities. If it were to be made available, who should receive it? Some think Ebola doctors and caregivers should, because their survival is essential to treating and quelling the epidemic. This makes sense, but it's not that simple.

First, it violates the principle of distributive justice: The benefits of the drug are being inequitably distributed, with skilled, economically secure professionals more likely to benefit.

Also, by what reckoning do we decide that the doctors' role increases their value and dictates they should be given a preferential chance to survive? Distributing the drug through a clinical trial would allow us to know whether and how well the medication works and what caveats might apply.

Africans must participate in any clinical trial, which would benefit the pharmaceutical company as well as, it's hoped, Ebola victims. This would mean their lives have irreplaceable value, too, in the equation of who should get the drug.

So, will Africans receive this potentially lifesaving medication?

A U.N. official suggested that drugs cannot be tested in the middle of an epidemic -- but he is wrong. Such tests are conducted all the time.

Dr. David Ho tested AIDS drugs in Uganda in the midst of the pandemic, and the meningitis drug Trovan was tested in Kano, Nigeria, in the midst of an epidemic. One of every three industry trials is conducted in developing countries; scientists often point to high disease rates, including epidemics, as a rationale for conducting them there.

The problem is not testing the drug amid an epidemic. The question is how ethically such trials are conducted.

Only small amounts of ZMapp are available now, but as soon as it can be made in quantity, the drug for Ebola should be made available to Africans in all the regions that are threatened by the epidemic, regardless of ability to pay.

If possible, it should be distributed within clinical trials to determine the safety and efficiency of the medications. Many people assume this requires withholding medications in a control group, but this is not necessarily the case. Experts should and can mount a well-designed study that permits early access to the medication to all who need it.

But if they cannot ensure that sick people get the drug early, then a clinical trial should not be any more of a requirement for poor Africans than it was for Kent Brantly.

It's also natural to wonder whether the threat of Ebola to the Western world, not to Africans, drives this initiative because so few such drugs are devised for Africans.

This simply highlights another reason why we should so our utmost to protect people from Ebola: our medical interdependence. If Ebola makes landfall in the United States, we will need drugs like ZMapp, just as Africans need them today.

Read CNNOpinion's new Flipboard magazine.

Follow us on Twitter @CNNOpinion.

Join us on Facebook.com/CNNOpinion.

Part of complete coverage on
September 16, 2014 -- Updated 1305 GMT (2105 HKT)
LZ Granderson says Congress has rebuked the NFL on domestic violence issue, but why not a federal judge?
September 16, 2014 -- Updated 1149 GMT (1949 HKT)
Mel Robbins says the only person you can legally hit in the United States is a child. That's wrong.
September 15, 2014 -- Updated 1723 GMT (0123 HKT)
Eric Liu says seeing many friends fight so hard for same-sex marriage rights made him appreciate marriage.
September 15, 2014 -- Updated 1938 GMT (0338 HKT)
SEATTLE, WA - SEPTEMBER 04: NFL commissioner Roger Goodell walks the sidelines prior to the game between the Seattle Seahawks and the Green Bay Packers at CenturyLink Field on September 4, 2014 in Seattle, Washington. (Photo by Otto Greule Jr/Getty Images)
Martha Pease says the NFL commissioner shouldn't be judge and jury on player wrongdoing.
September 16, 2014 -- Updated 1315 GMT (2115 HKT)
It's time for a much needed public reckoning over U.S. use of torture, argues Donald P. Gregg.
September 16, 2014 -- Updated 1225 GMT (2025 HKT)
Peter Bergen says UK officials know the identity of the man who killed U.S. journalists and a British aid worker.
September 16, 2014 -- Updated 1128 GMT (1928 HKT)
Joe Torre and Esta Soler say much has been achieved since a landmark anti-violence law was passed.
September 12, 2014 -- Updated 2055 GMT (0455 HKT)
David Wheeler wonders: If Scotland votes to secede, can America take its place and rejoin England?
September 16, 2014 -- Updated 1241 GMT (2041 HKT)
Jane Stoever: Society must grapple with a culture in which 1 in 3 teen girls and women suffer partner violence.
September 12, 2014 -- Updated 2036 GMT (0436 HKT)
World-famous physicist Stephen Hawking recently said the world as we know it could be obliterated instantaneously. Meg Urry says fear not.
September 12, 2014 -- Updated 2211 GMT (0611 HKT)
Bill Clinton's speech accepting the Democratic nomination for president in 1992 went through 22 drafts. But he always insisted on including a call to service.
September 12, 2014 -- Updated 2218 GMT (0618 HKT)
Joe Amon asks: What turns a few cases of disease into thousands?
September 11, 2014 -- Updated 1721 GMT (0121 HKT)
Sally Kohn says bombing ISIS will worsen instability in Iraq and strengthen radical ideology in terrorist groups.
September 16, 2014 -- Updated 2231 GMT (0631 HKT)
Analysts weigh in on the president's plans for addressing the threat posed by the Islamic State of Iraq and Syria.
September 11, 2014 -- Updated 1327 GMT (2127 HKT)
Artist Prune Nourry's project reinterprets the terracotta warriors in an exhibition about gender preference in China.
September 10, 2014 -- Updated 1336 GMT (2136 HKT)
The Apple Watch is on its way. Jeff Yang asks: Are we ready to embrace wearables technology at last?
ADVERTISEMENT