The full recovery of two American aid workers from Ebola after being treated with ZMapp, an experimental drug by California-based manufacturers has raised important questions about the rationale behind the allocation of these resources. The family of Dr. Sheik Umar Khan, Sierra Leone’s “hero” Ebola doctor grievingly wondered why their kin was denied ZMapp before his death, while the two American healthcare workers were not.

Dr. Khan was a local hero for strong-arming the fight against hemorrhagic fever from diseases including Lassa fever, which kills 5 000 individuals each year, and Ebola, which has reached a death toll of 1 427 in West Africa, according to the most recent reports by the World Health Organization (WHO). Ebola has taken the lives of almost 100 African healthcare workers due to the overwhelming strain on the region’s healthcare systems by the epidemic.

There is much looming tension over the response of several experts citing that the containment of the epidemic could have been possible had the world acted much faster. Despite the primary detection of the West African outbreak in March of this year, the WHO did not officially declare an international health emergency and promise more resources until August 8.

Such tension has been further exacerbated by the idea of the selective availability of experimental drugs that have shown unprecedented success in treating Ebola. Staff at the Medecins Sans Frontieres (MSF) hospital, who were treating Dr. Khan when he fell ill with the virus in late July, had heavily debated the ethics of treating him with the experimental ZMapp.

Not only were they choosing between favouring one individual over the rest, but they were also plagued by the ethics of using treatment that had only been tested in the lab and never before in humans. Additionally, staff were bogged down with the considerable consequences of causing the death of a national hero if the treatment were to kill Dr. Khan.

In an environment where the inherent local distrust of healthcare workers was further adding to containment issues of the epidemic, MSF simply could not afford a misstep in treatment decision.  Treatment with ZMapp was ultimately decided against for Dr. Khan, and he passed away on July 29. Dr. Khan was never made aware of the fact that ZMapp was available for his treatment.

ZMApp was successfully administered to the American aid workers in the United States a few days after Dr. Khan’s death, and the WHO approved the use of experimental drugs for Ebola patients on August 12. “If it was good enough for Americans, it should have been good enough for my brother,” said C-Ray, Dr. Khan’s elder brother. “It’s not logical that it wasn’t used. He had nothing to lose if it hadn’t worked.”

“Now you can look back at that and say it was a mistake,” said American doctor Daniel Bausch of Tulane University, who worked with Khan and advocated giving him ZMapp at the time. “We didn’t know what the consequences would be. We didn’t know how sick he was and we didn’t know how efficient it would be,” commented President of Medecins Sans Frontieres, Joanne Liu.

Zmapp is currently being administered to three African healthcare workers in Liberia, who are recovering well. Supplies for trial vaccines are also highly limited, and the odds of such circumstances changing do not look favourable from an economics perspective. With a comparatively low death toll of 1 590 in four decades, and due to the occurrence primarily in poor African countries, pharmaceutical companies are gravely lacking in incentive to pursue further research and produce effective treatment for Ebola.

Companies including GlaxoSmithKline, however, have recognized the potential for the epidemic to rapidly manifest into a pandemic due to the frequency of travel and lack of travel restrictions from affected areas. Human trials for vaccines have been fast-tracked by GSK following the death of a U.S. citizen in Nigeria after flying from Liberia.

From September 4-5, the WHO is expected to host a consortium of more than 100 pharmaceutical companies, clinical effectors, and experts on the ethics, legality and regulation of expediting promising experimental therapies in an attempt to contain the Ebola outbreak. Among the experts, over 20 are to be from West Africa.

 “We need a lot more people to bring this under control. We haven’t seen the worst of this yet.”said Robert Garry, the main investigator at Viral Hemorrhagic Fever Consortium, a partnership of research institutes.