Leading bioethicists Professor Ezekiel Emanuel, of the University of Pennsylvania, Philadelphia, USA, and Dr Annette Rid, of King's College London, UK, outline critical ethical principles which need to be adhered to if experimental drugs are to be deployed in the Ebola outbreak, stating that the patients selected to receive such drugs must not be limited to well-off or well-connected patients -- including health care professionals. They also point out that, given the limited supply of experimental drugs and their low probability of success, containment of the epidemic and strengthening health systems in affected regions should be a priority.
Moreover, it is vitally important that experimental drugs are provided to patients as part of randomized-controlled trials, in collaboration with local communities and other stakeholders, say the authors, and any communities who participate in research trials must receive fair benefits, such as access to any successful treatments.
According to Dr Rid, "Less than less than 10% of candidate drugs make it from pre-clinical selection to commercial launch. Although promising in non-human primates, there is no reason to believe that the experimental Ebola interventions will be more successful. In other words, it is more likely than not that the interventions will not improve symptoms for patients, and might even weaken them as they battle a life-threatening disease. Experimental Ebola treatments or vaccines should only be deployed in clinical trials, and if trials are done, they must meet ethical principles for research."
Professor Emanuel adds that, "Now that the global response to the Ebola outbreak is picking up, the international community needs more focus on strengthening of health systems and infrastructure and less on experimental treatments. Adoption of infection containment measures with a view to strengthening health systems and infrastructure is the most effective way to curb this epidemic and prevent future ones, and the international community now needs to show that it can meet the challenge of this public health emergency,while learning the lessons for future Ebola and other epidemics."
The Viewpoint is published at the same time as the Ebola resource centre goes live. This new online resource, hosted by The Lancet, brings together existing Ebola content from The Lancet journals and Cell Press, and will host the latest Ebola research as it is published. The resource centre is intended to be a comprehensive Ebola resource for clinicians, public health professionals, and anybody else who needs access to existing Ebola research and latest developments; all content on the site is free to access.
- Annette Rid, Ezekiel J Emanuel. Ethical considerations of experimental interventions in the Ebola outbreak. The Lancet, August 2014 DOI: 10.1016/S0140-6736(14)61315-5
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