To treat or not to treat: Zmapp and the Ebola outbreak

Opinion by Mina Shah
Sept. 23, 2014, 12:13 p.m.

The current Ebola outbreak in West Africa is the worst in world history. Over five thousand cases of Ebola have been reported, and the disease is currently projected to continue spreading exponentially, resulting in an estimated 15,600 cases by January 2015. Ebola can have up to a ninety percent mortality rate and has no known cure.

Well, almost.

“Zmapp” is an experimental treatment, currently in the midst of clinical trials. So far, it has been administered to a small number of Ebola patients, including two American aid workers, and has been largely effective.

At the time when the two Americans were initially treated, it was alleged that there were no doses of the drug left. However, about a week and a half after the patients recovered, the Liberian government confirmed that limited supplies would be sent to aid workers in treatment and outbreak control. It took far too long to begin disseminating this potential miracle-drug. And why was it initially administered only to Westerners and not made widely available for even the most affected areas in West Africa?

Slow dissemination might have to do with the fact that the drug is still comparatively new and has not yet completed clinical trials. There’s also the fact that supplies are indeed limited; they are not non-existent, but currently are not present in a volume anywhere near adequate to combat the magnitude of the outbreak.

Moreover, treatment of Africans has stalled, ironically as a result of ethical debates on the subject. Debaters and stallers probably have on their minds early research studies like the one at Tuskegee, in which black Americans participated in research without having been fully informed as to the potential ramifications of the study, and were thus unable to truly give consent to participate.

There’s a difference, though, between research conducted without informed consent and experimental treatment in seriously life-threatening situations. Ebola’s mortality rate is alarmingly high; death is almost certain for those who contract it. Even a risky, experimental treatment option would seem attractive to a patient whose prognosis is otherwise bleak. At least patients ought to have been given a choice. If Zmapp had been sent to West Africa a bit sooner, it’s possible that the outbreak would have been at least a bit more manageable by now, because an increase in the number of survivors would certainly help control the infection rate.

Furthermore, it’s unethical to provide contradicting bits of information: to first allege that there are no more doses of the drug available, and then a week later turn around and provide that which had existed all along. It is wholly unfair of Westerners to decide for West African governments through the control of information whether and when the drug should be made available. While it is true that pharmaceutical companies might have some right to agency over the drug’s delivery, to prevent governments from having the choice to engage in the market at all isn’t fair, and nor is it beneficial to the pharmaceutical companies if they truly want to maximize their profits. If that were the case, it would follow that companies should open their product sales to as many potential buyers as possible – particularly if a buyer has a need for the product.

In the recent U.S. response to the Ebola outbreak, President Obama has pledged to increase support to affected West African nations, which consists of facilitating the set-up of seventeen new Ebola treatment centers, promising to train 500 healthcare providers per week on prevention and treatment and sending military troops to manage international relief. By putting so much emphasis on sending troops while mostly neglecting the possibility of increasing Zmapp production, we are only addressing half of the problem. It is important to alleviate current suffering by providing more Ebola units and training for healthcare workers, but a more sustainable solution would have to include an effective treatment process as well. If we focused more on funding greater Zmapp production, not only would people currently suffering benefit, but we’d also be able to mitigate the disease’s spread in the future, hopefully making the projected 15,600 cases by January a gross overestimation.

Though the initial responses of foreign aid and pharmaceutical companies have been less than ideal for this particular outbreak, we must learn from this experience for the future. Foreign nations should use a two-pronged approach: They must address both the issues of limitations in affected areas and longer term solutions that would allow for more effective and more immediate treatment. Pharmaceutical companies would do well to be wholly transparent with product information and availability to all potential buyers so that they could better profit and consumers with the greatest needs could be served.

Contact Mina Shah at minashah ‘at’

Login or create an account