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Is talk of ‘magic bullet’ Ebola treatments distracting from more important measures?

August 12, 2014 at 6:09 PM EST
Judy Woodruff leads a conversation with Lawrence Gostin of Georgetown Law and Jonathan Moreno of the University of Pennsylvania on using untested drugs to fight the Ebola outbreak in West Africa, the possibility of a new experimental vaccine from Canada, as well as why the focus on experimental drugs is distracting from other vital measures.
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TRANSCRIPT

JUDY WOODRUFF: Given those problems with the health systems and a scarcity of drugs, what more can be done and what should be done?

We ask two people who are watching this all very closely. Lawrence Gostin is professor of global health law at Georgetown Law School, and he’s the director of the World Health Organization’s Center on Public Health Law. And Jonathan Moreno is professor of medical ethics and health policy at University of Pennsylvania’s Perelman School of Medicine.

And we welcome you both to the NewsHour.

There is some late-breaking information that’s come out this afternoon.

And I want to start with you, Dr. Gostin.

Some Canadian officials saying they have about 1,500 doses of a vaccine which they believe can be used on Ebola. What do we know about this and is it useful in this crisis?

LAWRENCE GOSTIN, Georgetown Law: Well, I don’t think we know very much.

We don’t know that it’s undergoing rigorous safety and efficacy testing. And we don’t know how quickly they can ramp it up. But I will say this, that a vaccine would be a blessing come true. Heretofore, most experts had not predicted a vaccine coming on board this quickly. All we can do is keep a very watchful eye on it.

JUDY WOODRUFF: Dr. Moreno, is it a surprise the Canadians have this?  It just came out. It just broke in the news this afternoon.

JONATHAN MORENO, University of Pennsylvania: It’s surprising to me. It’s a kind of hopeful sign that the international community is trying to respond in a humane way to the crisis.

What’s disheartening is that we have gotten to this point at all. The infrastructure for public health in West Africa and indeed the global infrastructure has been neglected. And so this was unfortunately predictable, though it’s a little more horrible than even those of us who were watching this would have thought.

JUDY WOODRUFF: Sure.

And what about a timeline for this Canadian vaccine?  Again, the vaccine different from the drug that was being used to treat it, treat a very few people, because that would be given to people to prevent them from getting Ebola in the first place. Do we know anything about a timeline about when it would be available?

JONATHAN MORENO: Well, as Professor Gostin said, the testing for safety is critical. It needs to be underlined.

A real clinical trial is going to take a year-and-a-half, in my estimation, roughly, if you really ramp things up. And that means that you need an infrastructure to do that in a number of patients with whom to do that.

JUDY WOODRUFF: You have as we reported a little — a few minutes ago, Dr. Gostin, the World Health Organization voting unanimously to make the drug available. Is that something that a vaccine could — could it also be made available without extensive testing?

LAWRENCE GOSTIN: Well, I do think that given the urgency of the situation that, as long as it had fairly good safety data and promising effectiveness, that we would want to have some kind of an investigational use of it.

And I would roll it out as quickly as we could, given those two preconditions, but continue to evaluate it, because both ZMapp, the drug to try to treat this, and this vaccine are still at very, very early stages, and we want to make sure it doesn’t do harm, and we want to make sure that it helps.

JUDY WOODRUFF: Sure. There are so many questions here that are being asked.

Dr. Moreno, part of what the World Health Organization is addressing is not only how quickly, but who gets this, and we know Liberian officials announced today that two doctors will be among the first recipients. Is it health officials who should be first in line?

JONATHAN MORENO: Well, there is certainly an argument to have a kind of multiplier effect, of the benefits to people who are on the front line to try to get them better again so they can work again.

There is also an argument about reassuring other health care workers to make sure that their morale stays up when they’re exposed to these very difficult conditions. So there are those arguments.

And also perhaps physicians might be able to have a better understanding of the informed consent issues involved in this highly investigational and I would say experimental serum.

So there are some arguments for doing doctors first, but still, how many doctors and how do you decide which doctors?  Other triage arguments could be, well, do you give it to the sickest or do you give it to somebody who you think is the most likely to benefit?  So there are these subcategories of micro-allocation questions that, so far as I can tell so far, the WHO hasn’t addressed.

LAWRENCE GOSTIN: I agree.

JUDY WOODRUFF: And you were going to add…

LAWRENCE GOSTIN: Yes.

One of the things that really troubles me and I think troubles people on the ground in West Africa is, is that the first three people who got this medication were white European foreign aid workers.

JUDY WOODRUFF: Two Americans, Spanish…

LAWRENCE GOSTIN: Two Americans and a Spanish priest.

And they weren’t involved in the decision-making process. The health care workers there are on the front line. It’s really dangerous to go to work in Sierra Leone and other places like that because you don’t have protective equipment, you don’t have infection control, and there’s a high rate of illness and death from Ebola.

JUDY WOODRUFF: Well, at this point, we know the manufacturer of ZMapp, the drug, the serum, is saying they have exhausted their supply.

Both of you have talked to us earlier today about what else needs to be done urgently, Dr. Moreno. What are the kinds of things that government, governments and health care organizations need to be doing right now?

JONATHAN MORENO: Well, 50 very courageous CDC people, I understand, are in the region now…

LAWRENCE GOSTIN: They are.

JONATHAN MORENO: … to try to bulk up the — to ramp up the infrastructure in those countries.

Isolation is something that’s going to have to be improved, from what we can tell. Obviously, you do worry about immigration. There are three major airports in Lagos alone. And when people come to other countries and present to their doctors with flu-like symptoms and the doctor can’t figure out exactly what’s going on, the straightforward first-year medical student question is, where have you been?

So there are very straightforward, non-rocket science measurers that need to be taken. And I’m afraid, by the way, that some of the conversation about the magic bullets, ZMapp, and the vaccines and so forth, are distracting from what really needs to be done now.

LAWRENCE GOSTIN: Totally agree.

JUDY WOODRUFF: Are distracting from — what needs to be done?

LAWRENCE GOSTIN: Let me begin by saying that this was a completely preventable tragedy.

We got surprised by it. There was no reason to be surprised, because Ebola pops up in Africa a lot. We have very fragile health systems. If it happened anywhere else, we would know. So, basically, you want to have protective equipment for the hospitals, you want to have safe, sterile isolation, and you want to find the contacts and put them in isolation, treating them in a dignified and humane way.

JUDY WOODRUFF: And you were telling us earlier today a lot of money, in fact tens of millions of dollars have been spent internationally in the developing world on other diseases.

LAWRENCE GOSTIN: Yes, I have been really calling for a dedicated fund at the World Health Organization, which would be peanuts compared to what we give for AIDS, T.B., malaria, that would be dedicated to building up this fragile health system and to do it in an endurable and sustainable way.

We can prevent the next one. Right now, I foresee that it would take at least six months for us to contain this.

JUDY WOODRUFF: Do you agree with the six months?

JONATHAN MORENO: I’m afraid I agree that that’s likely.

JUDY WOODRUFF: Well, on that sobering note, I know the two of you will continue to work very hard on this.

Dr. Lawrence Gostin, Dr. Jonathan Moreno, we thank you very much.

JONATHAN MORENO: Thank you, Judy.

LAWRENCE GOSTIN: Thank you.