|Johns Hopkins bioethicist Nancy Kass defends the unique treatment given to the two Americans infected with Ebola yet advises proceeding with caution, informed by data, for wider distribution of the drug in an opinion published Monday in the Annals of Internal Medicine.
Kass, the deputy director for public health at the Johns Hopkins Berman Institute of Bioethics, writes in Annals:
"When a health care provider is willing to work amidst Ebola, or SARS, or pandemic influenza, we, as a society, must fulfill our own end of the bargain."
“That it remains heart wrenching to watch people dying in Africa from this killer virus does not make our special treatment of the doctors and nurses who fly in to help them unfair."
Kass addresses the question on many minds: if it was reasonable to treat these two Americans, shouldn’t the experimental treatment also be provided to African patients? She answers:
"Callous as it may seem, the answer is no, or at least, not yet. The threshold for determining that an individual patient receive access to a highly experimental drug on a compassionate use basis is, and ought to be, different from the threshold for rolling out a treatment program to an entire community, even one facing a life-threatening epidemic."
Kass cautions that a rapid, widespread rollout could backfire, to the long-term detriment of public health:
"In addition to considering safety risks of untested treatments, the risk they will be ineffective also must be weighed. A top priority in this, and any, public health emergency is public health cooperation—those affected must be willing to follow directions from international and local health authorities... What is at stake in a decision about using experimental treatments may be far greater than the risks to the individuals who take them."
Instead, Kass calls for a more gradual, evidence-creating and evidence-informed dissemination:
"…any roll out must proceed with caution… Starting with small numbers is itself a protection, as is unwavering commitment to ongoing data collection. Ultimately, such data will be our best ethical guide."