Epidemic ethics: four lessons from the current Ebola outbreak

By Ian Kerridge, University of Sydney and Lyn Gilbert, University of Sydney

The extent of the current Ebola virus outbreak in West Africa has belatedly focused the attention of non-governmental organisations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable.

The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people.

How Western national interest drives Ebola drug development

Christopher Degeling, University of Sydney

Ebola virus disease typically only occurs in rural and remote areas among resource-poor populations. Until the large, recent outbreak in West Africa, cases of the illness were a rarity.

So the fact that we even have experimental drugs for the disease tells a story about how responses to global health crises are shaped by the social and political interests of the developed world.

Major pharmaceutical companies have shown little interest in developing effective treatments for diseases such as this. There’s no incentive for the commercial risks of research and companies naturally prefer to focus on diseases that can sustain large markets of wealthy regular users.

A similar inattention is suffered by people who have what are collectively known as neglected tropical diseases, which affect about a billion of the world’s poorest people.

They cause death and ill-health but also entrench social and political disadvantage. Even though most are preventable, and easily treatable with appropriate resources.

For those affected, the burden of these diseases, on average, equates to the loss of 56 years of healthy life through early death or chronic disability. Yet, the US Centers for Disease Control estimates that for 50 cents per year per person, the burden of neglected tropical diseases could be eliminated.

So it seems a little incongruous that drugs for Ebola virus disease were in development at all, given the relatively small number of cases and the poverty of those most at risk of infection.

Let’s consider the most advanced drug: ZMapp, which is produced by Mapp Biopharmaceuticals and is the experimental treatment the fuss has been about. The incentive for developing ZMapp was clearly not its broad commercial potential. Instead, it is for developing capacity for biodefence.