Ebola Outbreak: WHO Ponders Ethics Behind Experimental Treatment of American Victims

Boots and other personal protective equipment being disinfected, Liberia.

Boots and other personal protective equipment being disinfected, in Ebola-hit Liberia. (Photo: WHO)

World Health Organization said it will convene a panel of medical ethicists to explore the use of experimental treatment in the ongoing Ebola outbreak in West Africa as there is no registered medicine or vaccine against the virus.

There are mainly three experimental options underway currently. The recent treatment of two health workers from Samaritan’s Purse with experimental medicine has raised questions about whether medicine that has never been tested and shown to be safe in people should be used in the outbreak and, given the extremely limited amount of medicine available, if it is used, who should receive it.

“We are in an unusual situation in this outbreak. We have a disease with a high fatality rate without any proven treatment or vaccine,” said Marie-Paule Kieny, Assistant Director-General of WHO. “We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

The gold standard for assessing new medicine involves a series of trials in humans, starting small to make sure the medicine is safe to use. Then, the studies are expanded to more people to see how effective it is, and how best to use it. The guiding principle with use of any new medicine is ‘do no harm’. Safety is always the main concern.

In fact, the Director-General of WHO and presidents of west African nations met in Guinea to launch a new joint $100 million response plan as part of an intensified international, regional and national campaign to bring the outbreak under control recently.

“The scale of the Ebola outbreak, and the persistent threat it poses, requires WHO and Guinea, Liberia and Sierra Leone to take the response to a new level, and this will require increased resources, in-country medical expertise, regional preparedness and coordination,” says Dr Chan. “The countries have identified what they need, and WHO is reaching out to the international community to drive the response plan forward.”

Hundreds of global aid workers and 120 WHO staff are already there in regional response efforts but more doctors and nurses are urgently required, said the WHO. The plan also outlines the need to increase preparedness systems in neighbouring nations and strengthen global capacities.

Key elements of the new plan, which draws on lessons learnt from other outbreaks, include strategies to stop transmission of Ebola virus disease in the affected countries through scaling up effective, evidence-based outbreak control measures.

It seeks to prevent the spread of Ebola virus disease to the neighbouring at-risk countries through strengthening epidemic preparedness and response measures. The plan also emphasizes the importance of surveillance, particularly in border areas, of risk assessments and of laboratory-based diagnostic testing of suspected cases.

Also highlighted is the need to improve ways to protect health workers, a scarce resource in all three countries, from infection. Finally, reinforcing coordination of the overall health response is critical.

In particular, this includes strengthening capacities of the WHO-run Sub-regional Outbreak Coordination Centre, which was opened this month in Conakry, Guinea, to consolidate and streamline support to West African countries by all major partners and assist in resource mobilization.

The scale of the ongoing outbreak is unprecedented, with approximately 1,323 confirmed and suspected cases reported, and 729 deaths in Guinea, Liberia and Sierra Leone since March 2014.


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