On August 11, a World Health Organization panel found that, in order to combat the current Ebola crisis in West Africa, it may be ethical for doctors to use “unproven interventions with as yet unknown efficacy and adverse effects.” This decision comes in the midst of the most deadly Ebola outbreak since the disease’s discovery; at least 1900 people have died in the past six months, according to Doctors Without Borders. The controversy surrounding the administration of the experimental drug ZMapp to seven patients, two of whom have since died of Ebola, spurred the WHO to provide ethical guidance. Do you agree with the WHO’s decision that it is ethical under certain circumstances to use experimental drugs on Ebola patients?

Prof. Alice Noble (HSSP)

This is a departure from traditional and well-established ethical requirements for experimental interventions. Note that the WHO report does not provide the final word on this issue, but charts a course for further discussion to determine more specifically: (1) ethical ways to gather data while providing care under prevailing conditions; (2) what ethical criteria should be used to prioritize use of unregistered experimental therapies; and (3) how to prioritize distribution among the many communities affected. To the extent that expectations are realistic, patient and community rights are protected, and a longer-term public good can be anticipated, the experimental deployment appears just and humane. But is it ethical to engage such scarce resources in what well may be a “Hail Mary pass” of untested therapies, while the public health and medical infrastructures are absent entirely or in disarray? Budget cuts, bare-bones staffing in key sections, and changing priorities have left the WHO ill-equipped to face the challenges of the present crisis. Diverting basic funding from personnel and public health measures needed to contain the outbreak poses an ethical challenge that cannot be overlooked. 

 Prof. Alice Noble (HSSP) is a Senior lecturer in Health: Science and Social Policy.

Jennie Bromberg ’15

While I do agree that for the case of Ebola the administration of unproven interventions is ethical and makes sense when there is no other treatment option in countries like the United States as long as some preliminary testing has been done, I don’t think they are an effective solution to the epidemic in West Africa. Even if treatments were shipped off to Liberia or Sierra Leone tomorrow, these countries lack a systematic ability to effectively administer the treatment. There are so many political and public health issues tied to the Ebola outbreak that administrating an unproven intervention in West Africa would be a waste of time and money. In developed countries there are so few cases of Ebola it would take a long time to really test the unproven interventions, and doing something in this case is probably better than doing nothing. 

Jennie Bromberg '15 is a Justice Forum staff writer and a Health: Science and Social Policy and International and Global Studies double major.

Danielle Nurick ’16

In many cases when companies look to test disease interventions, vulnerable populations seem easy targets for trials, and drugs that are in developmental stages that may not seem ethical in the United States are tested on people in developing nations.  Many of these people are more likely to want to be in these trials because they offer a cheaper alternative to medical care that many are not likely to receive, and companies are likely to use these populations because there are less legal issues involved. Ordinarily I might be opposed to these trials, but in the case of a disease like ebola that can be fatal up to 90% of the time, there may not be other options for care. Currently there are no effective treatments available for Ebola victims, so it may be better to offer a treatment that has a chance of working than to just allow so many to die untreated. Hopefully these experimental treatments will be more effective than no treatment at all.

Danielle Nurick ’16 is an Undergraduate Department Representative for Health: Science and Social Policy. 

Jacob Abrams

In my personal opinion, I believe the WHO ethics panel made the correct decision in how to currently deal with the Ebola crisis. Ebola is one of the deadliest viruses in today's world and has an extremely high rate of infection. The number of Ebola infections in West Africa is increasing exponentially, which also increases the possibility of the virus spreading to more of the African continent, and possibly the world. At this point, I believe that any treatment that can have a chance of eliminating the virus should be used, even if it is experimental. There is a good possibility that there may be adverse side effects directly caused by the drug. At this point in time, however, modern medicine should be using every weapon in its arsenal to control this contagion and restore peace to this currently volatile region.

Jacob Abrams '17 is a member of the Brandeis International Committee.