Although the outbreak is bursting beyond efforts to contain it, and daily finds ways to reach whole new levels of scary (for example, there have been a handful of cases in Lagos, a city the size of New York), hope is on the way. We’ve been hearing about experimental drugs and vaccines for the past few weeks, some being tried in humans and others yielding results from animal trials. But so far, they haven’t reached the places in West Africa where they are most needed.
Take ZMapp, the famous “experimental treatment” that Americans Kent Brantly and Nancy Writebol received. Both survived, although there’s no way to know if it’s because of ZMapp, because of other care they received, or because they were among the roughly 50% who would survive anyway.
ZMapp is a collection of human antibodies produced (in a feat of genetic engineering) by tobacco plants. There is none of it left; the company that makes it only had a small amount on hand for testing, and says it shipped out all the doses it could spare, at no cost, filling every request it got, first come first served.
Only a handful of doses were ever available. As far as we know, Brantly and Writebol’s employer, Samaritan’s Purse, requested two. Around that time, they were treating about 17 other Ebola patients in their center in Liberia, who presumably did not get the drug.
The Wikipedia article on ZMapp catalogues seven people who are known to have received the drug. Only three are African. A pharmacist in Guinea, in an AP interview, said what we’re all thinking:
“There’s no reason to try this medicine on sick white people and to ignore blacks. We understand that it’s a drug that’s being tested for the first time and that could have negative side effects. But we have to try it in blacks, too.”
“It would have been the front-page screaming headline: ‘Africans used as guinea pigs for American drug company’s medicine.’ ”
NPR reported that foreign leadership of Ebola treatment may be contributing to distrust., so fear of being a guinea pig may not seem farfetched. But as the situation grows more desperate, untested drugs and vaccines are looking better and better.
Still 50 white people away?
The Onion’s take on this issue is harsh: Experts: Ebola vaccine is at least 50 white people away. (“[W]hile progress has been made over the course of the last two or three white people, a potential Ebola vaccination is still many more white people off.”)
Life nearly imitates the Onion, as the fast-tracked safety trials enroll 60 people in the UK and 20 Americans (race unspecified). If the vaccines prove safe, though, larger quantities will be sent to Africa in November, where they will be offered first to health care workers.
That will leave us with further dilemmas about how to distribute the vaccine (who gets it first when there are limited supplies?) and the possibility that, if the vaccine doesn’t provide the promised protection, people may behave as if it does, perhaps touching and taking care of loved ones with the disease, believing they are protected when they aren’t. While we can assume workers will do their best to explain that the vaccine’s efficacy is untested and its safety only somewhat known, will everyone understand? Will they feel coerced to try it? If the vaccine doesn’t work after all, a large scale vaccination program would amount to a waste of time and resources at a time when clinics are already under-staffed and over-worked.
A treatment we already have
Last week’s WHO meeting on Ebola treatments discussed vaccines and experimental drugs, but the biggest action item they recommended was using a raw material already in abundant supply in Ebola-stricken regions: the blood of Ebola survivors.
Survivors’ blood should contain plenty of antibodies against the virus; in this sense, ZMapp is essentially an imitation of it. There are downsides here, too, including the possibility for transmitting other diseases such as HIV. While it may not sound as snazzy as a newly developed drug, blood is probably the most practical treatment to roll out on a large scale.
Even with effective drugs and vaccines, Ebola treatment in this outbreak will still depend heavily on basic medical care, since so many people are sick and, with or without drugs, isolation and supportive care are essential for patients.
But maybe, with luck, this will be the last big Ebola outbreak.