The government of Liberia announced Monday that it would soon receive doses of the experimental Ebola drug ZMapp to give to two sick doctors, making them the first Africans to receive the scarce treatment amid a spiraling outbreak.
The White House and Food and Drug Administration approved the Liberian request for the drug to be made available to them. Liberia identified itself as the recipient of the drug after the company that makes ZMapp said earlier that its supply was exhausted after fulfilling the request of a West African country, which it did not name.
The delivery of the ZMapp to Liberia follows a request made on Friday from Liberian President Ellen Johnson Sirleaf to President Barack Obama. The sample doses will be brought to Liberia by a U.S. government representative this week, the Liberian government said.
The news comes as anger is growing over the fact that the only people to receive the experimental treatment so far have been Westerners: two Americans and a Spaniard, all of whom were evacuated to their home countries from Liberia.
Late Monday, the World Health Organization said 1,013 people had died in the Ebola outbreak in West Africa. Authorities have recorded 1,848 suspected, probable or confirmed cases of the disease, the U.N. health agency said. The updated WHO tally includes figures from Aug. 7-9 when 52 more people died and 69 more were infected.
There is no Ebola vaccine or treatment available, but there are several in development besides ZMapp. That treatment is so new that it hasn’t been tested for safety or effectiveness in humans, and the company has said it would take months to produce even modest quantities.
It was unclear how much of the treatment would be sent to Liberia.
“The U.S. Government assisted in connecting the Government of Liberia with the manufacturer,” the U.S. Department of Health and Human Services said in a statement. “Since the drug was shipped for use outside the U.S., appropriate export procedures had to be followed.”
The Liberian statement, posted on the presidency’s website, said it was also receiving an experimental treatment from the World Health Organization. It was unclear if this was also referring to ZMapp or another treatment.
‘We can’t afford to be passive while many more die’
In the past few weeks, the experimental drug was given to two American aid workers diagnosed with the disease while working at a hospital in the capital city of Monrovia that treated Ebola patients. Both patients had to give consent to receive the drug, knowing it had never been tested in humans before. The two Americans are said to be improving, but there’s no way to know whether the drug helped, or if they are getting better on their own, as others have. Around 40 percent of those infected with Ebola are surviving the current outbreak.
On Monday, officials in Spain disclosed that the treatment was also given to a Spanish missionary priest who fell ill while working in Liberia. The drug was sent from Geneva, Switzerland, to Madrid, where the patient was being treated in a special isolation unit at Hospital Carlos III.
The patients’ treatment has raised questions about the use of unproven and unlicensed drugs to treat Ebola and why these three have received the serum when so many others in West Africa also have the virus. Many have called for the untested drug to be given to Africans, too, and some are using Twitter to demand that the drug be made available.
The use of an experimental Ebola drug among Western aid workers is raising ethical concerns, as only a limited supply of the drug is available. This week, the remaining supply will be sent to Liberia to treat two doctors stricken with the virus.
“We can’t afford to be passive while many more die,” said Aisha Dabo, a Senegalese-Gambian journalist who was tweeting using the hashtag “GiveUsTheSerum”on Monday. “That’s why we raise our voice for the world to hear us.”
The ethical dilemmas involved in using the experimental drug prompted the World Health Organization to consult Monday with ethicists, infectious disease experts, patient representatives, and the Doctors Without Borders group. Most participants in the closed teleconference were from developed countries, but Uganda and Senegal were represented. The World Health Organization said it would discuss the results of the meeting at a press conference on Tuesday.
Companies can provide experimental drugs on a “compassionate use” basis, usually after they have been through the initial stage of testing in humans. The Food and Drug Administration approves such uses in the U.S., but has no authority overseas. Ultimately, the companies alone decide whether or not to share their products.
Spain’s Health Ministry said it obtained ZMapp this weekend with company permission to treat Miguel Pajares, a 75-year-old priest evacuated from Liberia and placed in isolation Thursday at Madrid’s Carlos III Hospital. “The medicine was imported from Geneva where there was one dose available in the context of an accord between the laboratory that developed the medicine, WHO and (Doctors Without Borders),” the ministry said, invoking a Spanish law permitting unauthorized medication for patients with life-threatening illnesses.
The evacuated American aid workers, Dr. Kent Brantly and Nancy Writebol, have been improving at Atlanta’s Emory University Hospital. They got the treatment after their international relief group Samaritan’s Purse asked Kentucky BioProcessing, which produces it for Mapp Biopharmaceutical.
ZMapp, which is actually a cocktail of two different Ebola treatments, has been shown to prevent Ebola in monkeys when administered immediately after exposure to the virus. The drug also offered monkeys a 100 percent survival rate a full day after exposure and 50 percent after two days.
The treatment is aimed at boosting the immune system’s efforts to fight off Ebola. It’s a monoclonal antibody, a common disease-tackling approach that has been used by scientists for some time now. Monoclonal antibodies come about when scientists infect an organism with a disease, collect the antibodies the organism creates to fight the disease, and then administer those antibodies to a human. In this case, the antibodies were harvested from Ebola-infected mice.
Since the antibodies present in the serum were taken from mice exposed to Ebola, the drug is known as a three-mouse monoclonal antibody mixture, Forbes reports. Ideally, the body’s immune system can vigilantly fight off the virus once the antibodies from the serum are present in the blood system. The treatment offers an artificial immune response to the virus, and the lab-made antibodies then fight the infection by sticking to the Ebola virus.
Last week, health authorities in Liberia had questioned why the treatment was given to the two American health workers when it was unavailable to the thousands of Africans stricken by the virus. Liberia’s Assistant Health Minister, Tolbert Nyenswah, told the Wall St. Journal that patients and their relatives had been begging for the treatment.
Ebola is spread through direct contact with the blood or bodily fluids of a sick person. It begins with symptoms including fever and sore throat and can escalate to vomiting, diarrhea and internal and external bleeding.
The current outbreak was first identified in March in Guinea, but it likely started months earlier. It has since spread to neighboring Liberia and Sierra Leone, and possibly to Nigeria. The WHO has said the epidemic will likely continue for months as the region’s healthcare systems struggle to cope and has appealed urgently for funding and emergency medical staff.