Ebola and ethics: Are rich nations doing enough to fight the outbreak?

The battle to contain the Ebola virus is not just about disease control in West Africa, it's also about global ethics.

The ethical issues include questions about when experimental treatments should be used in the current outbreak and who gets them. But they also include whether greater global coordination is needed on health policy before such an outbreak occurs.

That’s partly a matter of money. In this case, a public-health emergency is centered in some of the world’s poorest nations – Guinea, Liberia, and Sierra Leone. These are countries that haven’t set up the basic disease-response infrastructure called for by the UN’s World Health Organization (WHO).

“I do think that there is a justice issue here and an ethical issue,” says Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law.

Mr. Gostin says rich nations have a self-interest in containing the spread of Ebola, which medical experts say is a particularly virulent communicable disease. But beyond that national interest, he says, advanced nations also have an unmet obligation under 2005 WHO regulations to help build global capacities to respond to infectious diseases.

The 2005 International Health Regulations came in response to concern about another communicable disease, SARS, and called on nations to be able to track such diseases, contain them, and to have public reporting.

“We haven’t done it,” Gostin said Tuesday, as he participated with other Georgetown experts in a conference call for reporters. And in declaring the Ebola outbreak an international health emergency last week, the WHO didn’t call for new funding to bridge the gap.

Ana Ayala, another health-law expert at Georgetown’s O’Neill Institute, says a dedicated global fund “is definitely needed” to help vulnerable nations. The WHO has “a number of priorities to balance,” she says, so a focused fund might be the best way to ensure global compliance with the 2005 rules.

Such an international fund, starting as small as $200 million, could be “highly effective,” Gostin says.

Others who are closely involved in efforts to stem the outbreak say that, beyond the failure to build up adequate disease-response “capacity,” advanced nations have been slow to respond to the current crisis in West Africa.

“If there was any one thing that [demonstrated] a lack of attention of the international community on this crisis … it was the fact that the international community was comfortable in allowing two relief agencies to provide all of the clinical care for the Ebola victims in three countries,” Ken Isaacs of the group Samaritan’s Purse told a congressional hearing last week.

That is now changing.

But until recently, Mr. Isaacs said, his group and Doctors without Borders were struggling alone on the front lines to provide care.

And now, even as groups like the US Centers for Disease Control (CDC) are becoming more involved, the need for international help remains large, health policy experts say.

As global efforts ramp up, another emerging ethical issue is when – and on whom – experimental Ebola treatments should be used.

In the conference Tuesday, medical experts from Georgetown University emphasized the balance between efforts to provide care and the fact that, so far, it’s unclear whether experimental treatments help or hurt.

What’s most important, some say, is to provide basic care to those in need.

“We do know that supportive care for patients with Ebola makes a big difference,” CDC director Tom Frieden told the congressional hearing, referring to things like providing fluids and treating infections.