The advisory panel did decide that they found the case for using experimental drugs in African populations ethical. While they did not say much about why they reached this conclusion it seems valid in that when facing a deadly plague the overwhelming majority of people infected would want a drug, even one that has barely been tested, to try to save themselves or a family member. In reaching this conclusion the committee puts to rest the argument that experimental drugs could not go to Africans at all or ought to go to Americans or Europeans first in order to avoid the charge of exploitation. In a plague that kills 90% of its African victims complaints about unwarranted exploitative research seem a bit ridiculous even against a long history of misuse and abuse of poor desperate persons in poor African nations.
The committee did not say a good deal more other than that informed consent and choice ought to be respected. This is far less helpful.
Informed consent and choice are wonderful values but they need spelling out in the context of a deadly plague impacting desperately poor and often uneducated populations with little access to health care. Who is to get the consent. What help will be given to potential subjects to insure their comprehension? If those who get a new drug or vaccine are injured by it do they have any redress? Who will pay the costs of getting the treatment and of travel, food and housing that associate with experimentation? And who will consent for children, prisoners, the mentally ill or those rendered incompetent by Ebola? Can a government or tribal leader consent for a community. Must an IRB or research ethics committee review all scripts be they written or oral that will be used to get consent?
The committee also had nothing to say about the obligation of companies to make experimental drugs available. Consent does not matter if a company will not release an experimental drug for reasons of money, fear of adverse events or worries that they cannot manage a large scale release.
And even if a company is willing to release its drug shouldn’t some independent scientific body vouch for its reasonableness. There are quacks, charlatans, fast buck artists and crooks more than willing to say their remedy, potion, nostrum and gris gris stick is the answer to Ebola. Who is to stop them or at least restrain them when the infected are looking for any life-preserver?
Lastly, the committee gave no advice about who ought to go first when supplies of experimental (or for that matter proven) therapies are scarce. Should children get priority? Only those who can be monitored over time to assess the outcome of an intervention. What about health care workers, funeral directors, cleaning personnel and food providers who go in harms way—ought they get priority over others?
Ethical choices are hard. Ebola has left us with many more than the WHO committee addressed.