World Health Organization Endorses Use Of Experimental Ebola Drugs

By Nick Cumming Bruce and Alan Cowell

New York Times, August 13, 2014

GENEVA — The World Health Organization endorsed the use of untested drugs to combat the Ebola virus on Tuesday, hours after a Spanish priest who had been supplied with experimental medication became the first European to die in the world’s worst known outbreak of the disease.

No proven cure or vaccine exists for the Ebola virus, which the WHO says has killed 1,013 people in four West African countries — Guinea, Liberia, Nigeria, and Sierra Leone. Around half of the people infected in the outbreak, first reported in March, have died. Last week, the WHO declared the outbreak a global health emergency.

The Spanish priest, Miguel Pajares, 75, worked in a hospital in Liberia and was the first European to return home after being infected with Ebola. Citing medical confidentiality rules, hospital officials in Madrid declined to say whether the priest had ultimately been treated with the experimental drug, ZMapp, made in the United States, but the Spanish Health Ministry said Monday it had obtained the medication for him.

The provision of ZMapp, a previously untested drug in extremely limited supply, to foreign aid workers evacuated from West Africa has raised broad ethical questions about the disparities in treatment between white outsiders and the Africans who form the overwhelming majority of the victims. Two US aid workers, Dr. Kent Brantly and Nancy Writebol, who were evacuated to Emory University Hospital in Atlanta, received the drug as well, prompting questions from some African officials about why their nations had not received the medication.

On Tuesday, the government of Liberia announced it would receive ZMapp after a request to the United States by its president, Ellen Johnson Sirleaf. It said the drug would be used to treat two doctors battling for their lives against the Ebola virus.

That would be the first known use of the drug to treat Africans, but it also might be the last for a little while. The manufacturer, Mapp Biopharmaceutical, said that it had complied with a request received over the weekend from a West African nation, though it noted in a statement that the available supply of the drug was now “exhausted.”

In Geneva, the WHO convened an ethics panel Monday to debate the broader use of untested drugs. In a statement on its website Tuesday, it said that given “the particular circumstances of this outbreak,” the panel had reached a consensus that “it is ethical to offer unproven interventions with as yet-unknown efficacy and adverse effects, as potential treatment or prevention.”

The panel said the use of untested drugs should be guided by ethical criteria, including transparency about all aspects of the care provided, informed consent of the patient, freedom of choice, and patient confidentiality.

WHO officials said another meeting would be held at the end of the month to deal with another delicate and politically charged question: how to allocate scarce treatments.

Dr. Marie-Paule Kieny, assistant director-general of the WHO, said at a news conference in Geneva on Tuesday several drugs and vaccines have shown some promise in animal testing and might conceivably be deployed in the outbreak.

However, she said, none “is available in unlimited supplies right now.” She added, “I don’t think that there could be any fair distribution of something which is available in such a small quantity.”

Kieny said that intensifying public health measures to contain the outbreak was more important than drugs.

“It is very important to not give false hope to anybody that Ebola can be treated now,” she said.

The Spanish priest, Pajares, was flown back to Madrid on Aug. 7. A dozen doctors and nurses looked after Pajares, who died Tuesday morning. He will be incinerated in a sealed coffin, without carrying out any autopsy, to reduce the risk of further contagion.

Mapp and the US government, which has financed most of the company’s work, are making plans to increase supplies of ZMapp. But it is expected to take several months to increase supplies, and even then, there may be no more than a few hundred doses available, according to federal officials and corporate executives.