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TORONTO -- On Monday experts from around the world will converge, by telephone, to try to chart a path through a mine field of ethical issues related to the expanding Ebola outbreak in West Africa.
The experts -- ethicists and representatives of the affected countries and other players involved in the outbreak -- are having a discussion at the request of the World Health Organization to debate whether it is ethical to use experimental Ebola therapies in this epidemic.
Most of the treatment options, including the one given recently to two American aid workers, have never been tested in humans. Studies in Ebola-infected primates provide the strongest clues of whether these potential drugs and candidate vaccines might work on people and whether they are safe for people to use.
The ethical questions are thorny, especially given the number of available doses or treatment courses is vanishingly small -- nowhere near enough to make a dent in an outbreak that has already claimed close to 1,000 lives. Nearly 40 per cent of all known Ebola deaths ever have occurred in this outbreak, which is far from over.
"You have experimental products which have never even been used in humans, in healthy volunteers. And in addition, there is very, very little of it. So what do you do with it?" Dr. Marie-Paule Kieny, the WHO's assistant director general for health systems and innovation, says in describing the dilemmas the ethics panel will be asked to help the WHO work through.
"Of course it should be used but for whom and how? I think you could make a case that if they are to be used, they should be used also in a condition where it is possible to learn as much as possible from their use."
Using a new vaccine or drug in an outbreak
Researchers have been trying to develop Ebola drugs and vaccines for years. But even the most promising projects eventually run up against what has been an intractable problem: The only way to know if a vaccine prevents Ebola infection or a drug cures it is to use it in an outbreak. The idea of using in Africa drugs for which there is little or no human safety data makes many people shudder.
"You need to reassure the governments and the regulators in these countries that you are not just taking their citizens and using them to do research," Kieny insists.
Dr. Ross Upshur, former director of the University of Toronto's Joint Centre for Bioethics, says the idea of using experimental drugs needs sober reflection.
"Trust me, I am no friend of Ebola," says Upshur, now a professor at the University of Toronto's Dalla Lana School of Public Health. "But taking whatever might be out in however many labs around the world and starting to stick them into people without a good clear (study) protocol, without informed consent, without regulatory oversight would be foolish."
"We need to à be really clearheaded about this, because it will also be precedent setting."
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