EpidemicsDisagreement over use of experimental drugs in desperate effort to contain Ebola outbreak

The efforts to contain the largest Ebola outbreak in history have so far failed. International response teams, desperate to limit the toll of the fast-spreading epidemic in three West African countries, have been calling for the use experimental drugs or vaccines to try to stop the deadly virus.

Many experts, however, including the scientist who led the work on a Canadian-made Ebola vaccine, say that using untested medications in the current West African outbreak could be disastrous.

The Vancouver Sun reports that using untested drugs, which may not work, would further erode local trust in the response teams, undermine these teams’ efforts, and even endanger them. If patients were to have a bad reaction to one of the experimental therapies, years of expensive and painstaking work on developing tools with which to fight Ebola and its cousin, the Marburg virus, could be jeopardized.

“I get e-mails basically every second day from someone either asking ‘Is there something that you’re planning?’ or ‘Shouldn’t you?’ And I know I’m not the only one getting those emails,” Dr. Heinz Feldmann, an Ebola expert who heads the laboratory of virology at the U.S. National Institute of Allergy and Infectious Diseases’ Rocky Mountain Laboratories in Hamilton, Montana, told the Sun.

Most of the debate about the experimental drugs takes place within scientific circles, but the director of Britain’s Wellcome Trust recently made the debate public. Dr. Jeremy Farrar, an infectious diseases expert, has questioned why the therapies which are furthest along in the developmental pipeline are not being deployed to West Africa to help fight the spread of Ebola there, saying that if the outbreak were to occur in the developed world, there would be no debate about using the experimental drugs.

“Imagine if you take a region of Canada, America, Europe and you had 450 people dying of a viral hemorrhagic fever. It would just be unacceptable — and it’s unacceptable in West Africa,” Farrar says.

He added that the Canadian-made Ebola vaccine — a project Feldmann led a decade ago when he worked at the National Microbiology Laboratory in Winnipeg — was released under emergency use provisions in 2009 when a German researcher pricked herself with a needle containing Ebola virus. She survived, but it was never clear if it was because of the vaccine or because she was not infected (see “Ebola lab accident tests experimental vaccine,” HSNW, 8 April 2009).

“We moved heaven and earth to help a German lab technician. Why is it different because this is West Africa?” Farrar asks.

The Ebola and Marburg viruses are among the deadliest known to mankind. The viruses are transmitted through contact with bodily fluids, with people caring for the dying, or preparing their bodies for burial, are often infected.

Since there is no treatment, the most important task of response teams is to break the chains of transmission and infection by figuring out who is infected and isolating them. These identification and isolation efforts often clash with local traditions and are met with distrust and hostility. In West Africa, persistent rumours have emerged that the Western doctors are there to harvest organs for sale, leading infected people hide and flee, thus extending the range of the epidemic.

The World Health Organization reports that the current outbreak, which is the first in West Africa, has so far infected 844 people, causing the death of 518 of them. This is double the size of the next largest outbreak, in Uganda in 2000, and this outbreak has just begun.