Obama’s Ebola dilemma

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The Obama administration is grappling with ethical questions over its response to an increasingly dire outbreak of the Ebola virus in West Africa.

At the center of the debate is an experimental treatment given to two American Ebola patients that was facilitated in part by a U.S. government health worker.

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Calls are rising for health agencies to fast-track approval of the drug for use by African patients. But President Obama said that move would be “premature” given questions about the serum’s effectiveness.

At the same time, the government has indicated that it will clear the way for a separate drug to be used on Ebola victims and will speed the development of a potential vaccine.

It’s a tough set of choices for the United States, now leading the effort to contain Ebola on the ground alongside the United Nations.

Ebola has no cure, vaccine or proven course of treatment and kills up to 90 percent of its victims.

Its sheer lethality — nearly 1,000 people had died as of this week — is putting pressure on the Obama administration to hasten access to trial medicines.

But the government is also cautious about releasing drugs that have not been rigorously tested, citing potential side effects, and has distanced itself from the decision to use the serum on Americans.

This controversy has exploded in debate across the media.

Headlines demand to know why Americans, and not Africans, received the experimental treatment as the Ebola death toll mounts.

Obama outlined his view at a press conference Thursday, voicing concerns also stated by the World Health Organization (WHO).

“I don't think all the information is in on whether this drug is helpful,” Obama said.

“Let's help to bolster the [health] systems that they already have in place [in Africa]. Let's nip as early as possible any additional outbreaks of the disease,” he continued.

“During the course of that process, I think it's entirely appropriate for us to see if there are additional drugs or medical treatments that can [help].”

Leading Ebola experts, meanwhile, are calling on the United States and the WHO to go beyond what Obama called the “public health approach.”

In a widely cited statement, three of the world’s top experts in infectious disease said African governments should be able to make their own choice about potential treatments.

“The WHO and Western medical agencies should be helping countries weigh the risks and benefits of limited deployment of the best [drug and vaccine] candidates to those in the greatest need,” said the scientists, which included Peter Piot, a co-discoverer of Ebola.

“African government should be allowed to make informed decisions about whether or not to use these products.”

The debate pits patient advocates against health officials wary of repeating past episodes where developed countries have used first-world patients as guinea pigs.

In one example, 11 Nigerian children died and many others were disabled during a Pfizer drug trial in 1996. The company reached a settlement with families out of court in 2009.

Stories like this one make the government cautious about distributing medications too quickly, experts said, and both the United States and the WHO said they will convene working groups to debate the issue in the coming weeks.

In the meantime, agencies said supplies of potential treatments are short, dashing African leaders' hopes for procuring them quickly.

Centers for Disease Control Director Tom Frieden said Thursday that prevention is still the best way to stop more deaths.

“Stopping outbreaks where they occur is the most effective and least expensive way to protect people's health,” he told lawmakers at a House hearing.

 

 

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