Who gets access to experimental Ebola drug?
The use of an experimental drug to treat two Americans and a Spaniard diagnosed with Ebola is raising ethical questions about who gets first access to unproven new therapies.PT0M51S http://www.canberratimes.com.au/action/externalEmbeddedPlayer?id=d-3djvd 620 349 August 12, 2014
Madrid: An elderly Spanish priest infected with Ebola has died in a Madrid hospital, five days after being evacuated from Liberia.
The 75-year-old Roman Catholic priest, Miguel Pajares, was being treated in Spain with an experimental US serum, ZMapp, after being flown to Madrid on August 7.
He contracted Ebola at the Saint Joseph Hospital in the Liberian capital Monrovia where he worked with patients suffering from the disease.
Roman Catholic priest Miguel Pajares, who contracted the deadly Ebola virus, being transported from Madrid's Torrejon air base to the Carlos III hospital upon his arrival in Spain. Photo: AFP
"It is confirmed. He died at 9:28 am," said a spokeswoman for Spain's La Paz-Carlos III hospital. The priest had been treated with ZMapp, she said.
The medicine arrived at Madrid's La Paz-Carlos III hospital on Saturday after Spain's drug safety agency exceptionally cleared its import to treat the deadly disease.
Ebola has now claimed four lives in 10 days among the staff of the same Saint Joseph Hospital in Monrovia, which has since been shut down.
Spanish priest Miguel Pajares in 2011. Photo: Juan Ciudad ONGD
The hospital is run by the Juan Ciudad ONGD charity, which was established by a Spanish Roman Catholic order, the Hospitaller Brothers of St John of God.
The religious order issued a statement confirming the priest's death. It thanked the government and people for their support, highlighting the "good work" by hospital staff who treated the priest.
The use of the experimental drug has raised a host of ethical issues.
So far ZMapp has been used to treat two infected Americans and the Spanish priest but no Africans for the disease that has been ravaging West Africa for months and has killed about 50 per cent of those it infects.
A panel of medical experts on Tuesday determined it was ethical to provide experimental treatments to patients infected with the deadly virus, the World Health Organisation said.
Medical experts from around the world took part in the WHO-hosted discussions on Monday to draft guidelines for using non-authorised medicines in emergencies such as Ebola.
There is no known cure or licensed treatment for Ebola, which has killed over 1000 people in the current outbreak in West Africa. The World Health Organisation 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 of San Diego, said on Monday that "the available supply of ZMapp is exhausted", adding that it provided the drug at no cost and recipients "include medical doctors in two West African countries".
Nigerian officials say they had asked US 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 Centre. He said the pharmaceutical maker 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, Mr 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 Organisation 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 Father Pajares.
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 Dr Brantly said the same thing.
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. Dr 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 unauthorised medication for patients with a life-threatening illness who cannot be treated satisfactorily by authorised 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 US health officials about access to it but was told the manufacturer would have to agree. Guinea also said on 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 recognise 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.
AFP, AP, Washington Post