By Martin Enserink
There’s little doubt what Erica Ollmann Saphire would do if she had Ebola or knew she had been exposed. The x-ray crystallographer at the Scripps Re- search Institute in San Diego, Califor- nia, is leading an international effort
to develop a potent mix of monoclonal antibodies against the virus, some of which have
already shown promise in animals. Knowing
the staggering case fatality rate of this hemorrhagic fever, Ollmann Saphire says she
would take the antibodies—never
mind that they haven’t been tested
for safety. “Believe me, I’d run for
the freezer and ask for forgiveness
instead of permission,” she says.
Many Ebola researchers say they,
too, would eagerly try the antibodies—or one of the promising candidate drugs, or an experimental
Ebola vaccine. And they would love
for people in Sierra Leone, Guinea,
and Liberia to have access to experimental therapies as well, as the
death toll from the largest Ebola
outbreak on record climbs past 600.
But it’s not going to happen.
As the outbreak in West Af-
rica worsened, debates intensified
among scientists, government offi-
cials, and company executives about
bringing some of these unapproved products
to Africa on a so-called compassionate use
basis—after all, “something is better than
nothing,” Ollman Saphire says. “I have been
on at least half a dozen conference calls
about this,” says Lisa Hensley, an expert in
hemorrhagic fever viruses at the National
Institute of Allergy and Infectious Diseases
(NIAID) in Frederick, Maryland.
But the organizations fighting Ebola on
the ground say they simply can’t bring an
untested, unlicensed drug to a population
that’s already distrustful of the teams try-
ing to stamp out the outbreak. “Some peo-
ple are throwing stones at us,” says Armand
Sprecher, a public health specialist at the
Brussels office of Doctors Without Borders.
“There are rumors that we are spreading
disease, harvesting organs, and other hor-
rible things. Bringing in unlicensed things to
experiment on people could be very counter-
productive.” A representative for the World
Health Organization (WHO) adds that using
vaccines now “would not be ethical, feasible,
Longtime Ebola researchers say they ac-
cept that decision, but they’re frustrated.
“It’s very, very disappointing,” says Heinz
Feldmann of NIAID’s Rocky Mountain Laboratories in Hamilton, Montana, who has
helped develop a promising vaccine candidate. But Feldmann hopes the tragedy will at
least help unclog the product pipeline.
With 1048 reported cases and 632 deaths
since March—a 60% fatality rate—the West
African outbreak shows no signs of tapering
off. People in the affected countries are more
mobile than in the central African regions
struck by Ebola in the past, Sprecher says, giving the virus more options to spread. What’s
familiar are the cultural problems in battling
Ebola. The measures that will contain the
virus—strictly isolating patients, tracing and
monitoring their contacts, and burying the
dead quickly and safely—are often difficult
for the local population to accept.
Despite the media’s fascination with Ebola, the disease is exceedingly rare, which
has slowed the development of countermeasures. Before the current one, all
known outbreaks had caused fewer than
2400 cases, across a dozen African countries over 3 decades. Add the poverty of
those countries, and the market for drugs
and vaccines looks unpromising.
(Complicating matters, Ebola-Zaire, now raging in West Africa, is
just the most common of five Ebola
species; each needs its own countermeasures.) Most research has
been funded by the U.S. government in response to worries about
biowarfare and bioterrorism.
But that support hasn’t been
enough to bring a single product
to the market. Feldmann’s vaccine,
for instance, consists of a livestock
pathogen called vesicular stomatitis virus (VSV) in which one gene
has been replaced with that for
Ebola’s surface glycoprotein. It
gives rhesus macaques full protection against Ebola-Zaire and saved
four out of eight animals when
Ebola drugs still stuck in lab
Experts discussed—and rejected—bringing experimental
vaccines and therapies to West Africa
364 25 JULY 2014 • VOL 345 ISSUE 6195
Too little, too late
A selection of Ebola vaccines and drugs in development. Only
TKM-Ebola has entered a phase I trial, which was halted by FDA.
VACCINES DRUGS DEVELOPERS
VSV-based vaccines Profectus BioSciences; Public
Health Agency of Canada
Adenovirus-based At least three different
TKM-Ebola (RNAi-based) Tekmira Pharmaceuticals Corp.
Nucleoside analog U.S. Army Medical Research
Institute of Infectious Diseases
Monoclonal antibodies Many labs/companies
AVI-7537 (antisense-based) Sarepta Therapeutics
Health workers carry the body of an Ebola virus
victim in Kenema, Sierra Leone, on 25 June 2014.