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Serum for Ebola a benefit of privilege

NEW YORK – What should happen if a massive viral outbreak appears out of nowhere and the only possible treatment is an untested drug? And who should receive it?

The two American missionaries who contracted the almost-always-fatal virus in West Africa were given access to an experimental drug cocktail called ZMapp. It consists of immune-boosting monoclonal antibodies that were extracted from mice exposed to bits of Ebola DNA. Now in isolation at an Atlanta hospital, they appear to be doing well.

It's an opportunity the 900 Africans who've died so far never had.

ZMapp requires a lot of refrigeration and careful handling, plus close monitoring by experienced doctors and scientists – better to try it at a big urban hospital than in rural West Africa, where no such infrastructure exists.

But it's about more than logistics. Drugs based on monoclonal antibodies usually cost a lot – at least tens of thousands of dollars. A tiny company like Mapp, the San Diego-based maker of ZMapp, won't enthusiastically give away its small supply of drug for free. It is likely that if they were going to donate drugs, it would be to people who would command a lot of press attention and, thus, investors and government money for further research – which is to say, not to poor Liberians, Nigerians or Guineans.

The medical missionaries got the experimental drug because the evangelical Christian international relief organization they work for, Samaritan's Purse, reached out to the CDC and the NIH to find out whether there was any drug to give to them. They were referred to Mapp Pharmaceuticals and evidently struck some kind of deal to get the drug to their employees who were in Africa at the time.

Even if logistical and economic obstacles could be surmounted, is there a case for giving Zmapp to Africans still dying from Ebola? Many Africans were infected more recently than the Americans now being treated in Atlanta, so they better fit the conditions in which the drug was tested. But there is no accepted set of rules for a sick person to request compassionate access to drug that is experimental, expensive and in short supply.

An ethical case can surely be made for an organization that puts health care workers in harm's way to acquire access to experimental drugs and bring staff home to get the best possible care. But that is neither a fair nor just policy for deciding what to do when an emergency arises and rationing is the only option.

This Ebola outbreak has taught us two things: that we need to act quickly to shut down emerging epidemics wherever they occur, and it is long past time to have a transparent public policy about what to do when not everyone gets a chance to live.

Arthur L. Caplan is the director of the Division of Medical Ethics at NYU Langone Medical Center's Department of Population Health. He wrote this for the Washington Post.