As the Ebola virus grips an unprecedentedly wide swath of Africa, many are asking whether it is time to begin administering untested drugs and vaccines. Given that the disease can kill up to 90 percent of its victims — higher than the mortality rate from the bubonic plague — there seems to be little to lose from relaxing clinical norms. However, the suggestion raises difficult ethical questions — and the urgency of the situation does not leave much time for deliberation.
One reason that there is no proven cure or vaccine for Ebola hemorrhagic fever is the wiliness of crossover diseases. These viruses are transmitted from animal populations, which can act as reservoirs where the pathogens can develop and mutate, making it difficult for researchers to keep pace with the diseases’ variations.
However, another reason is pharmaceutical companies’ declining interest in manufacturing vaccines. Indeed, only four companies today make vaccines, compared with 26 companies 50 years ago. These firms know that the return on their investment will be relatively low, owing to the long lead-in time that results from slow manufacturing processes (though new, faster methods offer some hope).
Illustration: Kevin Sheu
Public distrust of vaccines has also played a major role in this decline. In the late 1990s, anti-vaccine sentiment manifested itself in a backlash against the measles, mumps and rubella vaccine.
Similarly, a 2004 New York Academy of Medicine survey indicated that twice as many people were worried about the side effects of the well-established smallpox vaccine as were concerned about the disease itself.
The comparative docility of infectious diseases like smallpox has contributed to a degree of complacency about the magnitude of the risks of refusing vaccination. When an epidemic actually begins, people quickly change their minds, and demand the rapid production and distribution of vaccines. That is probably a good thing, but it is also unrealistic.
The British pharmaceutical company GlaxoSmithKline recently announced that, together with the US National Institute of Allergy and Infectious Diseases, it is developing an experimental vaccine for Ebola. However, it is just entering phase one clinical trials to test toxicity. With two more trial stages to go, the vaccine would not be ready for deployment before next year.
The duration of the trial process has provoked complaints of excessive red tape. However, such criticism is unfounded, given the potential of proposed drugs to cause serious illness or even death. Indeed, phase one trials — also called “first-in-man studies” — are extremely risky and ethically knotty, meaning that they must be handled with the utmost care.
In 2006, phase one trials of the drug TGN1412 had to be suspended when previously healthy volunteers developed multiple organ failure, with some barely escaping death. University College London pharmacologist Trevor Smart believes that they may never fully recover.
However, what about when a population is already ill? In 1996, during a major meningitis epidemic in northern Nigeria, the drug company Pfizer supplied doctors with the oral antibiotic Trovan, which was being tested against another drug, ceftriaxone.
Eleven children died during the Trovan trial, and others were left permanently disabled. Still, the death rate in the Trovan trial was much lower than the rate from untreated meningitis, bolstering the case for administering untested Ebola drugs today.
In fact, the WHO has already pronounced the use of the experimental serum ZMapp — a mixture of genetically engineered antibodies intended to help patients fight the disease — ethical. ZMapp never made it to human trials and is not yet licensed by the US Food and Drug Administration.
As it stands, only a few doses of ZMapp exist, and it will take months to produce even a modest supply. This raises another ethical dilemma: Who should receive such a scarce resource?
The first three doses of ZMapp were administered to the US medical missionaries Kent Brantly and Nancy Whitebol, who have recovered, and the Spanish priest Miguel Pajares, who has since died. Some offered a practical justification for the widely criticized selection of Brantly and Whitebol: It makes sense to treat health workers first, so that they can continue to help others. However, this argument largely fell apart with the selection of the 75-year-old Pajares.
The credibility of claims that practicality drove the selection was, to some extent, revived by the decision to provide doses to three African doctors. In any case, the available supply of ZMapp has been exhausted.
It is important to note that even pragmatic arguments about rationing scarce medical resources can be highly controversial. During World War II, when army doctors were forced to ration doses of penicillin, they decided to give first priority to men with sexually transmitted diseases, who would be ready to return to the battlefield more quickly. However, many contended that men who had been wounded in battle were more deserving.
Putting such a moral spin on the allocation of Ebola treatments, it could be argued that Africans should be selected over Westerners, because Africa’s healthcare systems are less able to combat the disease. However, one might also contend that Western medical workers deserve higher priority because they volunteered to expose themselves to the disease to help those who had no choice.
Such arguments make reaching agreement virtually impossible. Worse, using social, rather than medical, criteria for rationing treatments is a slippery slope. One need only recall Seattle’s notorious “God” committee, which in the early 1960s allocated then-scarce kidney dialysis on the basis of criteria like earnings, church involvement and even Scout membership. The use of social criteria for treatment allocation has had a bad name ever since — and rightly so.
Donna Dickenson is emeritus professor of medical ethics at the University of London.
Copyright: Project Syndicate/Institute for Human Sciences
Two sets of economic data released last week by the Directorate-General of Budget, Accounting and Statistics (DGBAS) have drawn mixed reactions from the public: One on the nation’s economic performance in the first quarter of the year and the other on Taiwan’s household wealth distribution in 2021. GDP growth for the first quarter was faster than expected, at 6.51 percent year-on-year, an acceleration from the previous quarter’s 4.93 percent and higher than the agency’s February estimate of 5.92 percent. It was also the highest growth since the second quarter of 2021, when the economy expanded 8.07 percent, DGBAS data showed. The growth
In the intricate ballet of geopolitics, names signify more than mere identification: They embody history, culture and sovereignty. The recent decision by China to refer to Arunachal Pradesh as “Tsang Nan” or South Tibet, and to rename Tibet as “Xizang,” is a strategic move that extends beyond cartography into the realm of diplomatic signaling. This op-ed explores the implications of these actions and India’s potential response. Names are potent symbols in international relations, encapsulating the essence of a nation’s stance on territorial disputes. China’s choice to rename regions within Indian territory is not merely a linguistic exercise, but a symbolic assertion
More than seven months into the armed conflict in Gaza, the International Court of Justice ordered Israel to take “immediate and effective measures” to protect Palestinians in Gaza from the risk of genocide following a case brought by South Africa regarding Israel’s breaches of the 1948 Genocide Convention. The international community, including Amnesty International, called for an immediate ceasefire by all parties to prevent further loss of civilian lives and to ensure access to life-saving aid. Several protests have been organized around the world, including at the University of California Los Angeles (UCLA) and many other universities in the US.
Every day since Oct. 7 last year, the world has watched an unprecedented wave of violence rain down on Israel and the occupied Palestinian Territories — more than 200 days of constant suffering and death in Gaza with just a seven-day pause. Many of us in the American expatriate community in Taiwan have been watching this tragedy unfold in horror. We know we are implicated with every US-made “dumb” bomb dropped on a civilian target and by the diplomatic cover our government gives to the Israeli government, which has only gotten more extreme with such impunity. Meantime, multicultural coalitions of US