Tech + Health

08.08.14

Why the White Americans Got the ‘Secret’ Ebola Serum

After two missionaries were given an experimental treatment for Ebola, questions have swirled about why the hundreds of Africans infected aren’t getting it. For good reasons, it turns out.

A Washington Post blog asks: “Why do two white Americans get the Ebola serum while hundreds of Africans die?”

The New Republic demands: “Why did two U.S. missionaries get an Ebola serum while Africans are left to die?”

That was just media yammering, but it was echoed on streets and in subways by otherwise reasonable people.

Never mind that there seem to have been no more than eight doses of the serum in existence. 

Never mind that the white people in question—Dr. Kent Brantly and Nancy Writebol—who received three of those doses before they were flown home to the U.S. got perilously ill in the first place because they risked their lives helping Ebola victims in Liberia who happened to be black.

And never mind that Samaritan’s Purse would not have established the Ebola clinic in Monrovia and asked Brantly serve as medical director had it thought the life of a white American was worth more than the life of a black African.

If nationality and race did influence the organization’s decision to seek an untested serum for Brantly and Writebol, it was likely only because any Western organization that administers an untested serum to the African population runs the risk of being accused of using blacks as guinea pigs in the way of the long-ago Tuskegee syphilis tests and the 1996 meningitis tests in Nigeria.

That was not a worry with the two white Americans.

Of course, Samantha’s Purse may not have been immune from the sense of urgency that can seize even the most altruistic organizations when one of its own is in mortal danger. The same is true with a fire department when a firefighter is critically injured.

Watch what happens at the scene of a blaze when a radio call of “Mayday!” signals that a firefighter who went in to save others suddenly needs saving himself.  

This does not mean firefighters care any less about the people they are trying to save any more than it means Samaritan’s Purse was leaving Africans to die when it began asking U.S. scientists and health workers in the hot zone about experimental treatments described in various scientific papers in recent years.

Samaritan’s Purse ended up in contact with Mapp Biopharmaceutical in San Diego, the lead developer of a drug called ZMapp.

The scandal is not that two white people got an untested serum, but that the deaths of so many black people were ignored until two white people got sick.

ZMapp is an enhanced version of MB-003, which was developed in conjunction with the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID). MB-003 consists of three monoclonal—artificially produced—antibodies that proved capable of both deactivating the Ebola virus and tagging it for attack by the victim’s immune system.

A year ago this month, USAMRIID and Mapp announced the results of a study involving Rhesus monkeys that would have caused a sensation had we not been in a long lull between Ebola outbreaks. MB-003 protected 100 percent of the monkeys when administered an hour after exposure and two-thirds of those given the drug 48 hours after exposure.

“We were able to use MB-003 as a true therapeutic countermeasure,” USAMIID virologist Gene Olinger said when the results were announced.

James Pettitt, the study’s lead author, said he and his colleagues would be working with Canadian researchers who had devised a different antibody cocktail. The immediate aim would be to devise the most effective mixture of MB-003 and the Canadian compound and test it in additional monkeys, along with the best dose.

The combination was called ZMAPP. The ultimate results are said to have been even more promising than with MB-003 alone. But Ebola did not seem an imminent threat, and there was no scramble to produce more of the stuff than would be needed for animal toxicity testing and eventually the first human trials, which USAMIID expected to take between five to 10 years.

The federal Centers for Disease Control estimates that there were no more than eight doses of ZMapp in existence when Samaritan's Purse sought some. Three doses were flown to Liberia. Two were given to Writebol and one to Brantly, who was repeatedly also given a transfusion of blood from a 14-year-old survivor he had treated.

The two stricken Americans were flown to Atlanta, and Brantly in particular seemed to be on the mend. Governments of the affected countries in West African began inquiring about Zmapp. U.S. scientists cautioned that the drug had not yet proven to be as beneficial to humans as it apparently was to monkeys.

“We don’t know if it is effective,” Dr. Heinz Feldmann  of the U.S. National Institute of Allergy and Infectious Disease told The Daily Beast. “We don’t have enough even if it was effective.”

ZMapp is made by inserting modified genes into the cells of tobacco plants whose cells then become mini-factories of the antibodies. The facility where this happens is owned by R.J. Reynolds, which also makes cigarettes that kill by the hundreds of thousands.

Reynolds is now said to be accelerating its effort to do good as well as evil, but tobacco plants grow only so fast, and extracting and purifying antibodies is considerably more complicated than producing cancer sticks. Any significant quantity of ZMapp appears to be months away even if another company with a larger facility joins in the effort.

The question of the serum came up at the press conference President Obama held at the end of this week’s Africa Summit at the White House. He said it would be premature to rush ZMapp to the hot zone. 

“Let the science guide us,” he went on to say. “I don't think all the information is in on whether this drug is helpful.”

He observed that previous epidemics had been brought under control by effective public health programs.

“We’re focusing on the public health approach right now, but I will continue to seek information about what we’re learning about these drugs going forward,” he said.

Obama did authorize sending kits for a diagnostic Ebola test called the EZ1 Real-Time RT-PCR Assay. His view that the primary focus should be on containment was echoed by the head of the Centers for Disease Control at an emergency congressional hearing held on Thursday even though lawmakers are in recess.

“In terms of the promising drugs, I can assure you that the U.S. government is looking into this very carefully,” Dr. Thomas Frieden said. “But I don’t want there to be false hope out there. Right now, we don’t know if they work.”

The CDC is moving to assist the fight by going to a Level 1 alert and “surging” 50 experts to West Africa. Frieden emphasized that containment will require great care.

“It’s like fighting a forest fire: Leave behind one burning ember, one case undetected, and the epidemic could reignite,” he said.

When it came his turn to testify, Ken Isaacs of Samaritan’s Purse wondered why the forest fire had been allowed to rage for months with little notice beyond those who were being consumed by it. The scandal is not that two white people got an untested serum, but that the deaths of so many black people were ignored until two white people got sick.

“It took two Americans getting the disease in order for the international community and the United States to take serious notice of the largest outbreak of the disease in history,” he said. “The disease is uncontained and out of control in West Africa.”

Isaacs, who is a vice president of the organization, spoke as someone who has been watching the fire rage for months and believes it will be harder to contain than many anticipate. He said that too many people in Western Africa remain suspicious of Western medicine and tied to traditional practices that spread the virus, notably the washing and kissing of the dead. He noted that even now university students in Liberia “continue to mock and deny the existence of Ebola.”

“I think we are going to see the death toll in numbers we cannot imagine,” Ken Isaacs said.

He noted that the disease can travel anywhere “at the speed of an airplane.” He said the ultimate goal should be an effective vaccine.

“In the meantime it is a nasty, bloody disease that we must fight now,” he said.