Desperate times call for desperate measures, and the situation in West Africa unquestionably deserves to be put in that category. So far, more than 1,000 people have died as a result of the worst known outbreak of the Ebola virus. In response, the World Health Organisation (WHO) took the unprecedented step this week of announcing that experimental drugs and treatments, “with as-yet-unknown efficacy and side effects”, could be used on patients who have contracted the disease. A panel of medical experts in Geneva concluded that, with victims facing a 70 or 80 per cent mortality rate, the Hippocratic oath to “do no harm” was insufficient reason to prevent desperate men and women from taking advantage of risky but potentially life-saving medicines.
Their decision to overrule the central principles of Western drug safety – that nothing can be used on humans without a process of trials often lasting more than a decade – was clearly not taken lightly. Nor should the layman object to it in principle. Put crudely, when your other option is a likely death, there’s little to be lost in submitting to a regimen that medical researchers at least tentatively believe may do some good.
Nevertheless, the introduction of a small supply of drugs and vaccines into a situation as precarious as that in Western Africa, where several nations have already announced states of emergency, brings its own questions. There was uproar when two US aid workers who contracted the virus in Liberia were flown back to America and dosed with ZMapp, an experimental treatment never before taken by humans. Why did they receive special treatment when the overwhelming majority of the victims are African men and women?
There is a reasonable answer to that, at least in the short term: the drug was produced with the help of funds from the US Department of Defence, so it is to be expected that the first patients to use it fall within the citizenry of the United States. Furthermore, had the medication been a disastrous failure – using it first on, say, Liberian men and women – there would likely have been the accusation that this was a case of a rich nation being prepared to treat men and women from a poor one as human guinea pigs.
In the longer term, however, the inequalities behind the spread of this disease are glaring. That no vaccine or cure has so far been brought to market is related to its status as an African problem. More money goes into fighting baldness and erectile dysfunction than haemorrhagic fevers of the sort that rarely spread into the developed world. Private companies, which provide the majority of research funding, have little interest in ploughing funds into a disease that primarily affects poor communities. Many will recall the attempt by Western pharmaceutical companies to prevent Indian firms from producing a generic version of their antiretroviral treatments at the turn of this century, thereby putting profit above the lives of millions of African sufferers of Aids.
Today’s announcement that Canada will donate 1,000 doses of an experimental vaccine to the WHO further ramped up hopes of a medical solution to this crisis. In truth, the best way to ease the epidemic will not be found in Western laboratories: the quantities of available drugs are too small at this stage, and the pipeline too slow, even if safety regulations have been brushed aside. Better to concentrate on what can be done in the here and now: that is, isolate known patients, trace their contacts, and inform communities about how Ebola travels from person to person. A silver bullet will not take down the virus. Logistics have the ability to save many more lives.