Media reports indicate that seven individuals have received ZMapp to date, two of whom have died. The first recipients were two American health care workers from Liberia who were treated and airlifted to Atlanta last month. This is commendable – an outstanding example of the duty of rescue owed by the United States to two of its citizens engaged in voluntary work abroad. Likewise, also last month, a British nurse was airlifted from Sierra Leone to the United Kingdom. With respect to the American volunteers, we are told that the experimental intervention was used unconventionally under emergency conditions on compassionate grounds and with informed consent. The risk benefit ratio was clearly offset by the significant risk of death faced by both individuals. Arguably, the use of the experimental intervention in this scenario was justified.
Although the use of ZMapp in the current circumstances in West Africa may be ethically justifiable, it has challenged conventional wisdom and generated debate. Several questions have been raised about transparency, procedural justice, and engagement with local governments, regional bioethicists, and health care workers. Questions remain around whether the U.S. Food and Drug Administration approved the expanded compassionate use and why the drug was initially offered to American health workers only. Given the unconventional experimentation with ZMapp, widespread use would have been ethically questionable. However, careful and targeted therapeutic use in Liberia could not have generated charges of exploitation as occurred in the Trovan case in Kano, Nigeria. The two situations are hardly comparable. Adequate evidence has pointed to the questionable manner in which Pfizer conducted the Trovan trial, the lack of consent, and the suboptimal dosages of ceftriaxone used in the control group.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.