Ebola drug test on Spanish priest highlights ethical questions

In a development that raises a host of ethical issues, Spain announced it had obtained a scarce U.S.-made experimental Ebola drug to treat a Spanish missionary priest infected with the killer virus.

So far the experimental drug ZMapp has been used to treat two infected Americans and a Spaniard but no Africans for a hemorrhagic disease that has been ravaging West Africa for months and has killed about 50 per cent of those it infects. That news came as medical experts debated the ethical questions surrounding experimental Ebola drugs and vaccines during a teleconference Monday organized by the U.N. health agency.

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There is no known cure or licensed treatment for Ebola, which has killed over 960 people in the current outbreak in West Africa. The World Health Organization has called the Ebola outbreak which emerged in Guinea in March and has since spread to Liberia, Sierra Leone and possibly Nigeria an international health emergency and urged nations worldwide to battle the disease.

The drug's maker, Mapp Pharmaceutical Inc. of San Diego, says on its website that "very little of the drug is currently available" and that it is co-operating with government agencies to increase production as quickly as possible.

Nigerian officials say they had asked U.S. health authorities about getting the Ebola drug last week.

"It certainly looks bad that only three Westerners have gotten the drug while most of the people with Ebola are African," said Art Caplan, director of bioethics at NYU Langone Medical Center. He said the drugmaker must make its policy for distributing its treatment clear. "I don't think this scarce resource should just be given to whoever is best connected."

Still, Caplan said there might be a reasonable explanation for why only Westerners were given the drug, including the need for a sophisticated medical centre to administer it and monitor the patient carefully since the drug hasn't been tested in humans.

But some Africans said giving the experimental drug only to Westerners was patently unfair.

"There's no reason to try this medicine on sick white people and to ignore blacks," said Marcel Guilavogui, a pharmacist in Conakry, Guinea. "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."

In Nigeria, which says it has 10 confirmed cases of Ebola, some people began demanding the serum on Twitter. The World Health Organization has not yet confirmed the Nigerian cases.

In a statement, the Spanish Health Ministry said the ZMapp drug was obtained in Geneva this weekend with permission from the company and brought to Madrid to treat Miguel Pajares. The 75-year-old priest was evacuated from Liberia and placed in isolation Thursday at Madrid's Carlos III Hospital.

Two Americans diagnosed with Ebola in Liberia and evacuated back to the United States have been treated with the drug. One of them, Dr. Kent Brantly, said last week that his condition was improving and the husband of the aid worker being treated with Brantly said the same thing.

Nigeria and Guinea interested in drug

The drug is made at Kentucky BioProcessing for Mapp Biopharmaceutical. A spokesman for Kentucky BioProcessing said last week that it complied with a request from the international relief group Samaritan's Purse and Emory University Hospital in Atlanta and provided a limited amount of the drug. Brantly works for Samaritan's Purse and both Americans are being cared for now at Emory.

It was not exactly clear how Spain got the drug and authorities refused to comment about any possible costs involved. Geneva University Hospital told The Associated Press it was involved in getting the drug to Spain but would not elaborate.

In its statement, Spain's Health Ministry said "the medicine was imported from Geneva where there was one dose available in the context of an accord between the laboratory that developed the medicine, WHO and (Doctors Without Borders)."

It said Spain sought the drug under a Spanish law that permits the use of unauthorized medication for patients with a life-threatening illness who cannot be treated satisfactorily by authorized drugs.

At least two countries in West Africa have expressed interest in the drug. Nigeria's health minister, Onyenbuchi Chukwu, said last week he had asked U.S. health officials about access to it but was told the manufacturer would have to agree. Guinea also said Monday it would like to have some of the drug.

"Guinean authorities would naturally be interested in having this medicine," said Alhoussein Makanera Kake, spokesman for the government committee fighting Ebola.

Because the ZMapp drug has never been tested in humans, scientists say there's no way to tell if it has made any difference to the two American aid workers who have received it.

The drug is a mixture of three antibodies engineered to recognize Ebola and bind to infected cells so the immune system can kill them. Scientists culled antibodies from laboratory mice and ZMapp's maker now grows the antibodies in tobacco plants and then purifies them. It takes several months to even produce a modest amount of the drug.

The U.N. health agency planned to hold a news conference Tuesday to discuss the ethics meeting.

In other Ebola developments:

• Nigerian health authorities confirmed another Ebola case Monday, a nurse who was treating Patrick Sawyer, the Liberian-American who flew into Nigeria with the disease and died of it last month. That brings the locally confirmed Ebola cases in Nigeria to 10, including two who have died, Sawyer and another nurse. Nigerian authorities now have 177 contacts of Sawyer under surveillance. WHO has not yet confirmed the Ebola cases in Nigeria.
• The hemorrhagic disease is ravaging some of the world's poorest countries, and their ill-equipped health systems have struggled to keep up. Liberia announced that a donation of protective gear from China was arriving Monday. A shortage of full-body suits and even clean surgical gloves has left health workers exposed to the virus and prompted some to refuse to treat Ebola patients.
• Three Liberia-based missionaries, including the husband of a missionary being treated for Ebola in Atlanta, have returned to the United States and will be quarantined to ensure they did not contract the deadly virus, their Christian group, SIM USA, said on Monday.
• Residents in central Liberia rioted over the weekend, claiming the government had left some highly infectious bodies of Ebola victims in the streets for days without picking them up.
• George Weah, a former FIFA world player of the year from Liberia, has joined the efforts to spread awareness about the disease and how to prevent it. He recording a song titled "Ebola is real," and proceeds are going to the Liberian Health Ministry.