The fact that there is no approved treatment for Ebola does not justify trying out whatever we have that might work because there is an epidemic of convenience. On the other hand, if the drugs we are currently working on have been shown to be reasonably safe, and if there is realistic and robust African review and the recipients’ informed, voluntary consent, use of American-developed drugs in Africa could be justified. They could be made available as treatment under some form of expanded access/compassionate use program. Nonetheless, it would be critical to keep detailed records on all people who got the drugs so that we could learn from this experience. We have already failed to adequately respond to the current epidemic; what we are doing now is, in many ways, preparing to handle the next one better.
Does the situation have any parallels in history?
Yes, at the beginning of the HIV/AIDS epidemic, for example, ACT-UP demanded access to all sorts of investigational drugs, as well as the use of existing drugs for new purposes. One infamous drug that did not work was the French drug HPA-23, which Rock Hudson flew to Paris to obtain in 1984. Another was Suranim, which had been widely used to treat African sleeping sickness and was touted as “promising” for treating HIV infection. Still other researchers announced that they had cured AIDS using cyclosporine. Perhaps the closest parallel was when a Zairian scientist announced at a press conference that he had a “possible” cure for AIDS. Following that, the number of men in Zaire who believed AIDS could be cured doubled, and educational efforts aimed at prevention were set back.
The same could happen here—unrealistic beliefs in a “cure” for Ebola could set back the absolutely essential public health messages of disease containment and control. I also think that any strategy we in the US adopt that is centered on a new or miracle drug cure for Ebola will do little or nothing for those suffering from the disease in Africa, but could provide us with a comforting illusion that we are doing something to help.
How different would the government response to Ebola be, in your view, if the outbreak was in Europe instead of Africa?
You have to ask? Night and day. The very first patients would have been isolated immediately, their contacts monitored closely, and the disease effectively dealt with before it could spread.