Ebola trial drugs raise anxiety  

Farouk Martins Aresa

Sierra Leone Telegraph: 3 October 2014

USA ebola patientAlarm at the first diagnosis of Ebola in the USA, raises more ethical questions about who gets experimental drugs, and where to dispense limited supply in case anything goes wrong.

There are histories of humans used as guinea pigs in the past. Best of intentions cannot erase retrospective mistakes.

Dr. Frieden – the Director of the Center for Disease Control assured everyone: if densely populated Lagos State can successfully employ Contact Tracing to fish out Ebola virus carriers, so can the United States without fear.

We have raised crisis of expectation over Ebola. Experimental drugs are not magic bullets to displace old fashioned medical management that worked well in Nigeria.

It’s not politically correct to tell Africans that even if all the experimental drugs for the cure of Ebola are available right away, no country will be able to make drugs accessible, cheap and fast enough for all its sick population.

We must learn from HIV drugs and how they gradually became available to many.

As much as the Center for Disease Control and other regulatory agencies tried to dampen the high unsustainable expectation for magic bullets for fear that it may hamper necessary efforts needed on the ground to arrest the transmission of Ebola virus, affected countries want drugs.

Anyone with a relative dying or sick with Ebola virus, surely wants a cure by any means. Some traditional healers have taken advantage of their desperation in the towns and villages.

Dr-Gobee-Logan-HIV-Ebola‘Prevention is better than cure’ – is not a cliché here, but a very basic principle of public health. It felt good to see the doctor in Liberia playing his unique role by giving an HIV drug called lamivudine to his patients, claiming very high survival rate.

Even Z-Mapp is not expected in the market until 2015. The question again becomes; how many people in Liberia, Sierra Leone and Guinea can be cured, if the exponential spread is not arrested now?

The exponential spread of Ebola virus must be kept in focus, and on how to arrest transmission as it is getting too late.

Nobody is advocating that hard and difficult work on drugs should stop. But it must not overshadow contact tracing by environmental health investigation and immunization if available. Production of drugs is far more expensive than the cost of prevention.

There were lessons learned from Congo outbreak of Ebola in 1976. Yet we lack determination for sustained effort to build on the work of insightful precedents. Once a conscientious worker retired or out of reach, all the effort and dedication are wasted.

New programs are started without completing the one they met. Indeed, inspection of the old project would show that it had been overrun by the bush and rodents in an abandoned area.

Nigeria and Ghana have helped with logistics, and offered training to healthcare workers in countries where Ebola is still endemic.

Ghana ebola centreThe United Nations’ decision to set up an Ebola Center in Accra, could have been made to reassure those sent there that they are not in an endemic area, while making sure the center is close enough to countries affected.

On the other hand, it has sparked fear in some, because of the risk of introducing the virus into the country.

It is challenging enough for Doctors Without Borders and the United States Army establishing and breaking ground for the proposed 17 Health Centers. Logistic support in developing countries can be very challenging for those breaking the ground. They need all the support they can get and not suspicion of their mission in the face of Ebola virus.

There is early study from Gabon that certain amounts of antibodies were found among healthy folks and the elders that survived 1976 Congo outbreak. Most traditions only last for a period, but we must change our attitude, as diseases around us may mutate – like the flu virus.

Any tradition that stands still will die with the changing times. We know the drugs that worked in one season for a flu virus might not be effective in the next season. The same is true for immunization.

There are modern ways to develop immunities to diseases. Africans must do more, and we cannot be expected to be saved from ourselves.

In the face of Ebola virus, we must break with certain traditions that claimed loyalty to the dead, such as washing faces or drinking the water used to wash the dead, or as a means of gaining immunity against diseases. It does not matter if the dead body is that of your husband, relative or child.

Local immunization by tradition has been practiced in Africa for ages. Some do it by slight cuts to the bodies and rubbing tiny bit of the infection into the wound, with the hope that antibodies would develop to fight the real infection.

Others drink or rub the body with water from the infected area of the body, just as they take a bit of snake venom to survive snake bites. These crude ways of immunization is dangerous and can easily kill and spread disease.

African politicians and elites have either stolen money meant for public health centers or spent it on themselves for treatments that only affect a few in the most expensive hospitals overseas.

It is not difficult to compare the amount spent on one person, with the care 100 health centers provide at home to arrest and prevent the outbreak of Ebola and parallel diseases.

These politicians take their beggar mentality to foreign countries, asking for drugs being developed by private companies.

The vigilant efforts deployed at airports in Ebola endemic areas, must be extended to other countries.

The fact is, these days, even humanitarians and countries with the best of intentions want your boots on the ground.

We have known about Ebola since the seventies, and politicians kept spending our limited healthcare money on the least amount of people, instead of most dollars on most number of people.

Had politicians spent the money where it matters most, by now infectious diseases such as Ebola, would have been Africa’s medical specialty. Heaven helps those who help themselves.

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