Ebola outbreak: Experimental treatment sparks who-you-know debate
American aid workers get access to experimental serums that Africans don't
Getting access to an experimental treatment for the deadly Ebola virus seems to depend entirely on who you know.
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If you work for a charity run by the son of a famous U.S. evangelist, with the resources to fly a few precious vials of experimental vaccine to your bedside, you can get it.
But a few weeks ago, back when it was mostly African villagers who were dying of Ebola, the question was asked in several thoughtful medical articles: "Is it time to consider using experimental treatments not yet tested on humans?"
The consensus then was no, it's too risky and not ethical.
But then two Americans, Dr. Kent Brantly and Nancy Writebol, became infected, and the theoretical concerns were swept aside as an "experimental serum" was secured in a sequence of events that unfolded like a Hollywood movie.
Writebol is a Christian missionary working in Liberia and Brantly is a doctor with the American charity, Samaritan's Purse, which is run by Franklin Graham (son of evangelist Billy Graham) and which is helping run an Ebola treatment centre in the country.
Both Writebol and Brantly became infected around July 22, and soon after someone from Samaritan's Purse began asking about experimental drugs.
According to a statement from the U.S. National Institutes of Health, which denied any official role in all of this, someone from the Centers for Disease Control, who happened to be on the ground in Liberia, told Samaritan's Purse to talk to a scientist from the NIH, who was also in Liberia.
The scientist, acting in unofficial capacity, gave the charity the name of a company in the U.S. that was making an anti-Ebola antibody cocktail in tobacco plants.
This is where the story gets murky. No one will confirm exactly what happened next.
What we do know is that, by the following Thursday, three vials of this cocktail were somehow secured.
Did Samaritan's Purse get FDA approval to fly it out of the country? The U.S. Food and Drugs Administration won't say.
Who flew it there? The charity won't provide any information. Did Samaritan's Purse officials get approval by Liberia to use it? No one seems to have asked the Liberian health officials, the Wall Street Journal reported
The first word about this "experimental serum" came in a single sentence in a short press release from Samaritan's Purse the day after it arrived:
"Yesterday, an experimental serum arrived in the country, but there was only enough for one person. Dr. Brantly asked that it be given to Nancy Writebol," said Franklin Graham, president of Samaritan's Purse.
What about everyone else?
This unconfirmed story about Dr. Brantly's selflessness was instantly and breathlessly repeated by dozens of major media outlets. But it was several days before reporters were given an answer to the question: "What experimental serum?"
When I called initially to ask, Samaritan's Purse refused to say more.
Days later, a CNN report suggested that the Samaritan's Purse press release wasn't quite true. There were three vials of this mystery serum, not one, according to CNN.
Dr. Brantly, the report said, offered the first dose to his sick colleague, but then, after taking a turn for the worse, asked for it back.
Again, this is CNN's version, also unconfirmed. The charity will only say "we can confirm he did get the serum over there."
This is not to question the actions or motivations of a man fighting for his life. Or even those of an organization with no apparent qualms about releasing a tiny shred of a misleading story and watching it spread.
But to point out that an enormous ethical fissure has now been opened.
A few vials of a precious experimental elixir was flown to Liberia and given to two Americans. What about everyone else?
Now Liberians — at the centre of an Ebola epidemic in central West Africa that has killed over 900 people — are reported to be begging their health ministry for the same access.
Three prominent British researchers have said Africans deserve the same privileged access to this kind of experimental drug. And the World Health Organization will meet next week to consider what to do now.
Though when it comes to this particular treatment, the question might be moot.
There were only a few handfuls of the serum. It's not clear how fast those that make it can produce more. The companies involved are not returning phone calls.
Another option
When it comes to this current epidemic, vaccines are another non-starter.
There is no way to quickly make the many thousands of doses that would be needed.
U.S. health officials have ordered that vaccine development be ramped up, but the doses won't be available until sometime next year.
Meanwhile, there are thousands of doses of another experimental drug sitting on a shelf, and the company is prepared to give it away but can't find any takers.
The Canadian scientist who developed it is waiting for an email from the president of Sierra Leone. It seems the ability even to offer an experimental serum also depends on who you know.
In Toronto, Eleanor Fish, an immunologist and senior scientist at the University Health Network, has been trying to find someone who will listen.
Finally she contacted the executive assistant to the president of Sierra Leone and, after asking for her credentials, he said they would get back to her.
What she's offering is a treatment that has been tried in humans, unlike the one given to Brantly and Writebol. It is just that it hasn't been used against the Ebola virus.
The drug is a synthetic version of interferon, a molecule the body makes to fight viruses.
Ebola is one of the viruses that has evolved a way to shut off the body's interferon production. SARS was another.
Late in the 2003 SARS outbreak, Canadian researchers scrambled to launch a clinical trial to use this synthetic interferon on people with SARS.
They published the results in the Journal of the American Medical Association, and the WHO circulated the protocol so it could be used in a future SARS outbreak.
Will it work against Ebola? Dr. Fish doesn't know. She says the drug might help reduce the amount of virus in a patient's system, which could help that person successfully fight off the infection.
No one knows if the other experimental treatment will work either.
The synthetic interferon has been tested against Ebola in guinea pigs and mice. And there is inventory, up to 50,000 expensive doses that will expire in March.
The company that now owns the inventory says it is prepared to give it to whichever African country can use it. That's if anyone answers Dr. Fish's email.
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