Last month I attended the Global Health Symposium: Ethics of compassion: Lessons from the Ebola Epidemic in West Africa with Dr. Art Caplan who is the Director of the Division of Medical Ethics at NYU Langone. He spoke on the ethics of compassion in relation to the recent outbreak, especially considering the choices and implications around experimental medications in emergency contexts. It brought forward a lively conversation around who should receive experimental medications first (priority setting) and when they should be used at all (resource allocation).
One of the specific experimental medications was called ZMapp which was manufactured by Mapp Biopharmaceutical, Inc., and given first to infected Americans. It certainly looked bad that only three Westerners had gotten the drug while most of the people with Ebola are African, said Dr. Caplan. He felt strongly that a scarce resource shouldn’t be given to whoever is best connected and he added that the drugmaker should clarify its policy.
Mapp Biopharmaceutical Inc., said in a brief online statement it had complied with every request for the drug that had the necessary legal and regulatory authorization. The company said it provided the ZMapp at no cost in all cases. Although it didn’t name any countries that requested the drug and didn’t release additional details. Liberia’s president later said the U.S. planned to deliver sample doses of an “experimental serum” to Liberia later that week to treat Liberian doctors infected with Ebola.
How did the US Government and Mapp Biopharmaceuticals determine Liberia needed the sample doses instead of Guinea or Sierra Leone? Were the total number of deaths a factor? As of October 3, 2014, Liberia had 2069 deaths compared to Guinea with 739 and Sierra Leone with 623. Although, Sierra Leone has had far more laboratory confirmed cases (2179) compared to Liberia (931) and Guinea (739).
Wouldn’t it make sense to send the experimental vaccine to a country that had more confirmed cases with less deaths? Aren’t there more lives that could be saved in Sierra Leone? Maybe the reasoning was that the Liberian healthcare system suffered a greater loss compared to the other countries.
Maybe it was more of an economical determination. Liberia’s GDP ($2.898 billion in 2103 est.) put it at 184 in comparison to the rest of the world. Which is far behind number 155 in the world, Sierra Leone ($9.156 billion in 2013 est.), and even further behind number 151 in the world, Guinea (12.56 billion in 2013 est.). So maybe Liberia with the greatest number of deaths and the weakest GDP made the “powers that be” determine that it was a country closest to collapsing and therefore needed the vaccine.
Dr. Caplan made the comment that when we are in a dire global health situation, such as the one in West Africa, countries should be “giving the stuff out and hope it works”. In these types of situations, he related administering experimental medications to throwing spaghetti on the wall and hoping it sticks. Either way, the US and Liberian governments, along with Mapp Biopharmaceutical, and other decision makers should be more transparent in their decision making process. We have an opportunity to learn a great deal from this entire experience – an experience that is merely a warning of bigger events to come in the future.