Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, August 13, 2014

Battling Ebola

"Our government is committed to doing everything we can to support our international partners, including providing staff to assist with the outbreak response, funding and access to our experimental vaccine."
Rona Ambrose, Canadian Minister of Health

"My sense is that what's required from here to get the drugs into people's arms or mouths or however it's going to be delivered is a far more complex and daunting set of challenges than the rhetoric is leading people to believe."
"I think it's very likely that the promises are going to be empty. But I don't think it's any stronger a response ethically if we just wring our hands and say there is nothing we can do. I think that sends an even more dire message."
"You're damned if you do and damned if you don't, at this stage."
Dr. Jim Lavery, managing director, Ethical, Social & Cultural Program for Global Health, St. Michael's Hospital, Toronto
A health care worker helps a colleague as she prepares his Ebola personal protective equipment before entering the the Ebola isolation ward at Kenema Government Hospital in Sierra Leone, August 12, 2014.  Photo, Michael Duff -- AP

The UN's World Health Organization called a special meeting to discuss the health emergency that this outbreak of Ebola virus in West Africa now represents, causing the death of one thousand people thus far, and as yet showing no sign of slowing down, as it is transmitted by people fearing isolation, preferring to remain with their families, unaware that they are risking the lives of those they love, as well as their own. And convinced that the virus has been brought to harm them by the very foreign aid workers who risk their lives to help them.

The disease has an astonishing mortality rate, between 60% and 80%, with no cure yet in sight, nor vaccine yet available to prevent its onset. Pharmaceutical companies have experimented with drugs to combat the disease, but none has undergone clinical trials. Despite which, given the outbreak and the fearful nature of the virus, along with superstitious reactions of the uneducated seeking to hide its presence rather than seeking out medical help, the WHO expert panel has decided that under these circumstances, it will be considered ethical to use the unproven drugs to attempt to save lives.

"It makes sense to try new things when you're in a desperate epidemic that is lethal", stated bioethicist Arthur Caplan, director of the division of medical ethics at Langone Medical Centre, New York University. Even with the decision to use the experimental treatments, such drugs are in short supply, there simply is not enough of the drug to go the rounds to treat everyone who has been caught up in the dread net of Ebola.

To date, a U.S.-produced drug called ZMapp has been used on two, perhaps three people; two Americans, one a doctor, the other a humanitarian aid worker, and a Spanish priest, Miguel Parajes, who though no confirmation is available that he was indeed treated with the experimental drug, died anyway. The two American aid workers were flown to Atlanta for isolated hospitalization and medical care, and appear to be recovering.

And then there's the issue of experimental vaccines and drugs being used on poor Africans. Such an event has, in the past, raised suspicion and accusations that the poor and the ignorant, the backward and the impoverished are treated differently than those in wealthy countries. That they are expendable, and although it is generally recognized as unethical for clinical trials of drugs to be tested on humans until they have passed animal-model trials, the decision to make the drug available in the theatre of the world where it now threatens the general population is yet another indication of how poor Africans are held in contempt by the white world.

Therapies to try to combat the deadly Ebola virus range from using blood from the disease survivors containing antibodies in the hope that they will work against the virus. Antivirals, vaccines and drugs such as ZMapp, and another compound drug developed in collaboration with scientists at the Public Health Agency of Canada's National Microbiology Laboratory in Winnipeg, comprised of three "humanized" monoclonal antibodies that bind to the protein contained in the Ebola virus appear to hold out hope.

ZMapp appears to have resulted in a "dramatic and very rapid effect on their state" [the two American aid workers], explained Dr. Marie-Paule Kieny, assistant-director of the WHO. And now another issue surfaces, where survivors of Ebola find themselves socially ostracized. Having survived the dread effects of the disease, people lose their employment, are refused entry to schools, their contact with friends, and even family will not approach them for fear they are contagious and will infect others.

Leaving those poor souls with their recovering health intact physically but bereft psychically, outcast and bleakly on their own, without the company of those who normally complemented their lives.

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