West Africa is currently experiencing the largest Ebola virus disease (EVD) outbreak in history. As of August 1, there have been 1603 cases and 887 deaths. Treatment options for EVD are fairly limited, and center around palliative care of the patient. Maintaining hydration and reducing fever are two of the biggest challenges for patients, but can be lifesaving. No vaccination options are currently available and antiviral medications have been slow to develop. However, a pair of Americans who had been providing healthcare to EVD patients in Liberia have exclusively received an experimental treatment after they also fell ill. Dr. Kent Brantly and Nancy Writebol are being brought to Atlanta to receive treatment.
The FDA will sometimes allow expanded access for unapproved/experimental drugs in the face of life-or-death illnesses. This is dependent on the pharmaceutical company and the attending physician making their own plans to transport the medicine and is also contingent on FDA approval.
The experimental medication is called ZMapp and is created from monoclonal antibodies, which are the proteins created by the immune system of an organism that has previously been infected with the virus. The serum has been through rodent and primate testing, but is not ready for human trials. Animal models were given the medication 24 or 48 hours after the onset of symptoms, while the two Americans received treatment much later. However, they seem to be doing well
Writebol did not respond to the first dose of the serum. Brantly, on the other hand, showed signs of improvement within an hour of treatment. The next day, he was able to bathe himself and board the plane for Atlanta. Writebol received a second dose (the last of the serum available) and has been faring better. She is due to return to the US tomorrow (Tuesday).
There are currently no plans to give the serum to Africans, but there are important cultural barriers in play. Many of the people who have become ill distrust Western medicine. Rather than see quarantined treatment facilities as a place to receive help, the high fatality rate (roughly 55%) has many convinced that those locations are where people being made sick and killed. There is an unfortunate history of unethical medical experiments being performed in Africa, increasing their fears. There are also many legal and ethical barriers to administering experimental treatments to large populations, particularly those in a foreign, less developed country. It could be viewed as opportunistic and unethical medical experimentation.
Many Africans are preferring to hide their illness and receive treatment at home, which contributes to the spread of disease. The health care workers currently in West Africa are having a hard enough time trying to help people at the basic level of providing fluids and monitoring fevers; administering an untested medication could potentially hurt efforts more than it would help.
When news broke that Brantly and Writebol were being transferred to the US, many people immediately jumped on the outrage bandwagon, claiming what happened in West Africa could happen here. Believe it or not, the plan actually was thought through and the US will not experience a similar outbreak. Click here for more info on why you don’t need to freak out about Ebola if you live in a developed country.
[Hat tip: Popular Science]
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