Bioethicists: With Limited Supply of Ebola Drugs, Strengthening Health Systems Should Be a Priority

Doctors say experimental Ebola drugs should not be limited to well-off patients.

If experimental drugs are used to fight the Ebola outbreak, ethical principles must be adhered to, noted leading bioethicists in a commentary published today in The Lancet.

In their commentary, Ezekiel Emanuel, MD, PhD, of the University of Pennsylvania and Annette Rid, MD, of King's College London stated that, with the limited supply of experimental drugs, which carry a low probability of success, containing the Ebola outbreak by strengthening health systems in affected regions should be a priority. They also noted that the drugs must not be limited to wealthy or well-connected patients.

"Less than 10% of candidate drugs make it from pre-clinical selection to commercial launch,” Dr. Rid said in a press release. “Although promising in nonhuman 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 symptoms for patients, and might even weaken them as they battle a life-threatening disease.”

Consequently, Dr. Rid said, “experimental Ebola treatments or vaccines should only be deployed in clinical trials, and if trials are done, they must meet ethical principles for research."

The commentary authors also stated that experimental drugs should only be provided to patients through randomized controlled trials in collaboration with local communities and other stakeholders. Likewise, communities that participate in the trials should receive access to successful treatments, the bioethicists said.

In a study published Wednesday in Science Transitional Medicine, an experimental treatment from Tekmira Pharmaceuticals Corp was found to be highly effective in protecting monkeys from a virus related to Ebola hemorrhagic fever. Tekmira is also developing a separate Ebola treatment that uses lipid nanoparticle technology with RNA interference.

In addition to those promising treatments, significant attention has been paid to the drug ZMapp from Mapp Biopharmaceutical, Inc, which may have played a role in saving the lives of 2 American relief workers who became infected while working with patients in Liberia. The stricken relief workers have since recovered and were discharged from Emory University Hospital in Atlanta yesterday.

"With all due respect, we don't have any idea whether this helped them get better, had no impact or even, unlikely, made their recovery delayed," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said in a report published in the New York Daily News.

With limited information available regarding even the most promising treatments, the bioethicists said the key questions concerning the outbreak response include “how much emphasis should the international community place on experimental interventions in response to the Ebola epidemic; what are the ethical considerations if experimental treatments or vaccines are deployed; and if any interventions prove safe and effective, how can they be made more widely available?”

They also noted that containment measures have a proven track record of success against infectious diseases. Such measures involve isolating suspected Ebola cases, implementing universal infection precautions, monitoring and tracing potential contacts, and raising awareness in any region affected.

"Now that the global response to the Ebola outbreak is picking up, the international community needs more focus on strengthening of health systems and infrastructure and less on experimental treatments,” Dr. Emanuel said. “Adoption of infection containment measures with a view to strengthening health systems and infrastructure is the most effective way to curb this epidemic and prevent future ones, and the international community now needs to show that it can meet the challenge of this public health emergency, while learning the lessons for future Ebola and other epidemics."