Ethicizing the Ebola Epidemic

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It is the topic of almost every healthcare, political, and legal news article—Ebola. Last month, the World Health Organization stated that the 2014 outbreak, which originated in Western Africa, has killed more than 1,000 people. This year’s epidemic marks the largest and most dangerous Ebola outbreak ever documented. As the number of cases grows, another significant topic has surfaced—the ethical implications surrounding this public health nightmare. Although no current vaccine or treatment has been identified to cure this deadly disease, scientists are working relentlessly to find an effective treatment and a few experimental vaccines are already available in limited quantities. The possibility of an experimental cure poses many ethical questions, including allocation. However, before the ethical issue of drug or vaccine allocation can even be considered, another ethical dilemma must be addressed—is it ethical for experimental drugs and or vaccines to be distributed before proper research has deemed them safe? Conventionally, for drugs to be used in clinical care, they must be researched for many years and tested in vitro, on animals, and in systemized clinical trials before distributed to and implemented in the wider community. Yet, with the onset of a public health emergency, like the current Ebola crisis, the regular protocol for proper testing must be reevaluated. Global ethics comes into play as healthcare workers engaged in containing the spread of this fatal disease must weigh the risks of using experimental therapies whose effects are still unclear. In medical ethics, the fundamental code doctors must follow is “do no harm.” Nevertheless, regarding a disease like Ebola, with an approximate 90% mortality rate in some areas, the harm is already being done. The likelihood of survival is so slim that experimental therapies might be the only way to save a dying patient. In medical emergencies, such as this, I believe there should be guidelines allowing for exceptions to general rules regarding experimental testing. The FDA already has a reserve procedure allowing doctors to apply investigational drugs in cases for which there is no other alternative. Although disagreements inevitably arise over what constitutes an emergency, I think in this current situation the only option is to make exceptions. Moreover, as mentioned above, if experimental drugs or vaccines were to be allowed, and informed consent was obtained, the issue of allocation poses many more ethical questions, starting with—who should be treated first? In August, two American workers providing aid relief in Africa who contracted the virus were given an experimental drug, ZMapp. These patients were two of only three infected individuals with access to the drug. Both of the patients survived, and are doing well now. Although it has not been proven whether or not the drug played a part in curing the patients, this circumstance provokes the question of whether it was fair that these two individuals were administered the drug while hundreds of others, including doctors aiding in the cause, have no access to any experimental therapies. Ethics inevitably comes into play with regard to equality in distribution based on fundamental factors including race, religion and ethnicity. For now, while scientists work to discover a safe and effective treatment regimen, the most ethical thing health care providers can do is to provide basic care to those in need. At this point, the primary goal is to try and contain the disease. As demonstrated from the rapid spread of other diseases in our modern world, public health crises affect us globally. Even if there are drugs to help prevent or cure the virus, public health infrastructure is the fundamental key to prevent medical mayhem. Ethical issues will continue to arise and be debated, but what cannot be argued or ignored is the need for global cooperation to ensure that all nations can provide proper healthcare to their citizens and that each and every nation is armed with the necessary resources to prevent the further spread of this violent virus.