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Should an experimental drug be used to treat Ebola in West Africa?

August 6, 2014 at 6:31 PM EST
The treatment of two Ebola-infected Americans with an experimental drug, Z-Mapp, raises the question of whether it has potential for widespread use in combating the outbreak in West Africa. Judy Woodruff gets perspective on the topic from two experts, Dr. Robert Garry of Tulane University School of Medicine and Laurie Garrett of the Council on Foreign Relations.
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TRANSCRIPT

JUDY WOODRUFF: And there is a late-breaking piece of information. President Obama was asked this afternoon as he met with the African leaders who are here meeting at a summit in Washington — he was asked about that drug made available to the two American health care workers. He said — quote — “All the information is not in yet on the new Ebola drug.” He said, we need to let the science guide us.

So, having said that, reports say there are only a handful of courses of treatment with that experimental drug right now. Its use is prompting questions over whom should get access and under what circumstances.

We have two experts who join us to discuss this.

Robert Garry is a virologist. And he’s a professor at the Tulane University School of Medicine. And Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations.

We welcome you both.

Laurie Garrett, you just heard what the president said about that. What is known about any drug available at this point to treat Ebola?

LAURIE GARRETT, Council on Foreign Relations: Almost nothing. We don’t know if they work. We don’t know if they are safe.

There have been not been clinical trials. What we know is, one individual, an American, received this ZMAb drug and seems to have had a recovery. Did he have a recovery because he was part of the lucky 30 percent of people who have contracted Ebola in this current outbreak who have indeed walked away and survived the disease, or did he make it through because the drug worked?

We don’t know. And until you have something more than an N of one person, you don’t have any clinical evidence.

JUDY WOODRUFF: Dr. Garry, what is your understanding of how much is known about this drug and what is your comfort level with its having been given to one or two of these American health care workers before anyone else?

DR. ROBERT F. GARRY, Tulane University School of Medicine: Well, let me answer the second question first.

I am very comfortable having those two Americans given this experimental treatment. They’re both health care workers. They knew about the risks of taking an experimental drug, so they were fully informed of the possible outcomes.

And so I think, as Americans, we need to do all that we can to protect people that go to countries where a very serious disease like this is occurring and do all we can to protect them if they should be unfortunate enough to get infected.

So this drug, ZMApp, has shown very good promise in experimental animals. These human — these monoclonal antibodies are very promising drugs. They’re at the very top of a list for possible treatments for hemorrhagic fevers like Ebola.

JUDY WOODRUFF: So, staying with you, Dr. Garry, does that mean it should be more widely distributed at this point?

DR. ROBERT F. GARRY: Well, when I came back from Sierra Leone about a month ago, I realized that this outbreak was — had the potential of being unlike any other, to spread wider and infect more people, because it was in West Africa instead of Central Africa.

And so people are living much closer together there. They are more mobile. And, unfortunately, that has come to pass. So, my first concern when I came was about some of my colleagues who I have been working with for about 10 years. And I thought, well, maybe we need to start to pull out some of the stops and think about getting them some of these either experimental treatments like the ZMApp, or perhaps, even better, some of the vaccines that have shown such great promise in monkeys and in other trials.

So, unfortunately, what I was faced with was resistance, saying, you can’t do experiments during an outbreak. And that didn’t come to pass. And, unfortunately, some of my dear colleagues lost their battle to Ebola virus.

JUDY WOODRUFF: Where was that resistance coming from, Dr. Garry?

DR. ROBERT F. GARRY: Many people say that you shouldn’t do research during an outbreak.

But I think that this outbreak is totally different. It’s not in Central Africa. It’s not so easy to get a ring around the small villages that are very isolated. It’s in West Africa. The population is much more dense. This outbreak is going to go on for a much longer period of time.

So we need to think outside the box of some of the thinking that we have had about can’t do a research, can’t do a trial, can’t do these things. We need to get the approvals in place and we need to think about doing some things that are going to be necessary to protect Americans and also to help the Africans.

JUDY WOODRUFF: Laurie Garrett, listening to all this, what are the considerations that should be part of this conversation as it’s decided how — when, how, what medications are made available and to whom?

LAURIE GARRETT: I think we’re in an unbelievably difficult mess here.

There’s no easy answer to your question, Judy. We will start with this. We have a population that has demonstrated that they don’t trust their government, they don’t trust police, they don’t even trust the folks at the next village or the local health care workers.

Health care workers have come under physical attack. People are — part of the reason we can’t control this epidemic is because people are not complying with quarantines, they are not complying with burial procedures meant to limit exposure to bodily fluids, and, in general, they are highly suspicious of everything that’s going on.

So, now, if you start to introduce a pill, an injection, whatever it may be and say, we’re not sure, but we think this might be helpful, you’re going to have to have an extraordinary effort to communicate that risk to make it understood what you’re talking about, or you could have a really violent reaction against either saying, you know, that those white doctors from someone else put a pill in my relative’s mouth, and that’s what killed them, or, conversely, saying they’re hoarding the pills, and the pills will save you, and our village isn’t getting them as fast as this other village.

This isn’t like rolling out an experimental procedure in Bethesda, Maryland, on the NIH campus. This is social chaos. And it’s potentially, if not thought through very carefully, you could be worsening the situation.

JUDY WOODRUFF: And you’re mainly talking about it obviously at the point of distribution, the difficulty of gaining the trust of people in these countries in West Africa and perhaps elsewhere on the African continent.

Let me come back to you, Dr. Garry, because you were speaking about difficulties about the point of origin. What needs to change?  And, again, we don’t even know if this drug ZMApp is what has led to the survival so far of the American health care workers. But even assuming it is making a difference, what needs to happen, do you believe, in the United States or in the places where these drugs are being created and manufactured?

DR. ROBERT F. GARRY: Well, first, let me address something that Ms. Garrett said.

There are always going to be some people in a population that are going to resist what the government says and what they’re doing. But the vast majority of people in Sierra Leone and West Africa are listening to their government. The government is stepping up, doing the right thing. And there is cooperation there.

So you’re going to get a small fraction that are going to say, no, that’s not the right thing to do. That’s, you know, white people coming in and causing a problem.

But it’s not the — it’s not the vast majority of people there. And so what we need to do, is we need to engage the governments. We need to get all the ethical approvals in place on both sides of the Atlantic, in Africa and in the United States. We need to get out of our own way.

If we can make these wonderful new drugs that may or may not have had an impact in the two Americans that are in Atlanta, let’s try some things. Let’s not be faced with the next outbreak and saying, oh, well, we can’t do something now because we don’t have the proper ethics approvals in place.

JUDY WOODRUFF: Well, these are tough questions. And we are going to continue to look at this, as I know the two of you are.

Dr. Robert Garry, Laurie Garrett, we thank you both.

LAURIE GARRETT: Thank you.