The Ebola debate

In the 2011 medical thriller movie Contagion, a super-contagious flu took over the world.

A pandemic ensued, causing the loss of social order and millions of people die, as the United States’ Centers for Disease Control (CDC) races against time to develop a vaccine against the lethal virus – which they did successfully.

But due to limited supplies of vaccine, survivors were inoculated through a random 'lottery' based on birth dates.

The plot is simple yet intriguing and unsettling because this fictional story presents a very real possibility – a global pandemic.

In a situation where millions of people are at risk of being infected with a deadly disease, who should be first in line to get the vaccine or cure?

Such a debate has been raised in the past week following an Ebola outbreak in West Africa that has so far infected 1,848 and killed more than 1,000 people.

Early this month, two American aid workers contracted the deadly viral hemorrhagic fever in Liberia and were given an experimental Ebola treatment called the ZMapp, a cocktail of three monoclonal antibodies that functions by binding and inactivating the virus. They were then flown home to the US to receive intensive care and treatment. Both are reportedly doing better now.

Although well-intentioned, the decision to administer an unlicensed serum, which had only been tested previously on monkeys, raised serious ethical questions.

Firstly, there has yet to be any conclusive evidence whether ZMapp really saved the aid workers, despite the drug seemingly showed promising results.

Both hailing from developed nations with good sanitation could have contributed to a stronger immune system, as opposed to the large majority of Africans who lack access to clean water. A superior medical treatment in the US may have also made the difference in their improved condition.

Secondly, there has yet to be any evidence of the drug’s side effects – whether it will cause more harm in the long run, even if patients seemed to recover with the treatment now.

What we know for certain is, the highly-contagious Ebola kills within two to three days. The virus has a mortality rate of up to 90 percent, with patients in remote areas being more vulnerable due to lack of medical care and facilities.

So, what is best now? Withholding a potential cure to a disease with almost certain fatality? Or giving an untested drug to humans?

And, who bears the responsibility of administering a drug that has yet to be proven safe?

The World Health Organization (WHO) has since authorised the use of the experimental drugs to fight Ebola on the grounds that it is “ethical to offer unregistered interventions as potential treatments or prevention."

The measures came following outcries of a slow international response to the outbreak and the use of ZMapp on foreign aid workers only, sparking fierce debates on why Africans are not getting the promising 'life-saving' drug.

So far, WHO revealed, only three doses of the experimental drug were sent to Liberia. Mapp Biopharmaceutical also said resources have depleted and it could take many months until more is available.

This brings up the issue of cost. The process of researching and developing a drug, putting it through clinical trials and then to market them can cost millions of dollars.

The majority of biotech and medical research and development are undertaken by private firms with the main purpose of selling its patented product for a profit.

As WHO assistant director general Marie-Paule Kieny so aptly puts it, the lack of treatment for Ebola represents a 'market failure'.

She pointed out that plenty of drugs have been developed to a certain point, but companies had not footed the bill for more expensive clinical trial processes, mainly because diseases such as Ebola was "typically a disease of poor people in poor countries where there is no market."

For now, the focus taken by governments and health organisations is in containing the virus, which is rightly so. The World Bank announced it has pledged USD200 million to strengthening medical supplies and protection of health workers on the frontline.

There is nothing more important than to keep emergency response systems running so that identifying and isolating the sick can be most effective – the crucial step to containing any infectious disease.