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Liberia Identifies Two Doctors To Receive ZMapp
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Author:  niman [ Wed Aug 13, 2014 8:36 am ]
Post subject:  Liberia Identifies Two Doctors To Receive ZMapp

Liberia has identified the two doctors who will receive ZMapp, Zukunis Ireland and Abraham Borbor.

Author:  niman [ Wed Aug 13, 2014 8:36 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp


MONROVIA, August 12 (LINA) - The Liberian Government has received approval from the United States Food and Drug Administration (US-FDA) to use the experimental serum on two Liberian medical doctors who have contracted the deadly Ebola virus.

According an Executive Mansion clarification, Doctors Zukunis Ireland and Abraham Borbor, who contracted the disease while attending to patients, including a late colleague, gave written consent for the drug to be administered to them.

The consent was given to the US-FDA and the drug maker by the affected doctors through the Ministry of Health and Social Welfare.

The FDA’s approval is to allow the drug maker send the experimental drug to the Ministry of Health and Social Welfare only for use on the two doctors.

The drugs should be in the country within the next 48 hours, the release said.


http://micatliberia.com/index.php/ebola ... -drug.html

Author:  niman [ Wed Aug 13, 2014 8:50 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Liberia doctors to get ‘untested’ ebola medication
By Clair MacDougall, Monrovia

Liberia said it would treat two infected doctors with the scarce experimental ebola drug ZMapp, the first Africans to receive the treatment, while authorities in Spain said a priest had died of the disease.

The death toll from the worst ever outbreak of the highly contagious disease has climbed to 1,013 since it was discovered in remote southeastern Guinea in March, according to the World Health Organisation.

It said ZMapp doses were very scarce, raising ethical questions of who should have priority.

Spanish authorities said a 75-year-old Spanish priest who contracted ebola in Liberia had died.

The government had announced on Sunday that Fr Miguel Pajares, the first European infected by the strain, would also be treated with ZMapp manufactured by California-based Mapp Biopharmaceutical.

The hospital would not confirm that he had been treated with the drug, but his order and Spain’s Health Ministry said earlier that he would be. His body will be cremated today to avoid any further public health risks.

ZMapp has already been administered to two US aid workers, who are now in a hospital in Atlanta, Georgia, after being medically evacuated and have shown some signs of improvement.

The virus — one of the deadliest diseases known to man — has spread to four African countries, infecting 1,848 people, according to the WHO. It has branded the outbreak an international health emergency.

The epidemic in one of the world’s poorest regions, where crumbling healthcare systems are unable to cope, has opened an ethical debate on the use of trial drugs on humans.

After a meeting with medical experts, the World Health Organisation declared it is ethical to use unproven ebola drugs and vaccines in the current outbreak in West Africa provided the right conditions are met.

Its statement, however, sidestepped the key questions of who should get the limited drugs and how that should be decided.

With medical staff lacking the equipment and training to tackle the first outbreak of ebola in West Africa, over 60 healthcare workers have died and dozens more been infected, severely hindering countries’ ability to cope with the disease.

Information Minister Lewis Brown said the Liberian government had received written consent from the two doctors — who he identified as Zukunis Ireland and Abraham Borbor — for the treatment, which has not been fully tested in humans.

"The drug maker could not export… the drug without the approval of the FDA so our authorities approached the FDA and received specific approval for the treatment of these two doctors."

He said the drug was expected to reach Liberia within the next 24 hours.

A spokesperson for the US Health and Human Services Department said US authorities had simply assisted in connecting the Liberian government with the drug’s manufacturer and followed procedures for the export of pharmaceuticals.

Mapp Biopharmaceutical said its supply of the drug has been exhausted, after the company provided doses to a West African nation, according to a report published by the Wall Street Journal.

The Liberian presidency statement said the head of the WHO, Margaret Chan, had authorised the dispatch of additional doses of the experimental drug to Liberia, but Brown said it was not clear if this was true.

This story appeared in the printed version of the Irish Examiner Wednesday, August 13, 2014

http://www.irishexaminer.com/archives/2 ... 79364.html

Author:  niman [ Wed Aug 13, 2014 9:03 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Ebola death toll tops 1,000 in West Africa; WHO says use of test treatments is ethical

By Abby Phillip and Lenny Bernstein August 12 at 6:36 PM
As the death toll from the Ebola outbreak in four West African nations officially climbed above 1,000, the World Health Organization on Tuesday said the use of unproven, experimental treatments and vaccines is ethical given the magnitude of the crisis.

Marie-Paule Kieny, assistant WHO director general, said she hopes that efforts to produce more of an Ebola treatment developed by a small San Diego biopharmaceutical company, as well as other drugs under development, could result in wider availability late this year or early in 2015. There currently is no vaccine or cure for Ebola, but several treatments are in various stages of clinical development.

The San Diego company, Mapp Pharmaceutical, has said that the remaining supply of its ZMapp treatment, which was used on two U.S. missionaries who contracted the Ebola virus, was exhausted after it sent several doses to Liberia. The Liberian government said Tuesday it would give ZMapp to two doctors, Zukunis Ireland and Abraham Borbor, who had fallen ill with the virus while treating patients.

A panel of experts convened by the WHO this week agreed that the use of experimental treatments for the disease is ethical, but the agency’s declaration Tuesday did not address the difficult questions about who should receive the limited amount of drugs available.

The shortage of medications amounts to “a market failure,” Kieny said. “It’s a market failure because this is typically a disease of poor people in poor countries, and so there is no market.” As a result, she said, “there are no clinical stockpiles” and the best authorities can do is “accelerate development and scale up” as quickly as possible. Kieny said the WHO will convene another panel at the end of August to discuss prioritizing distribution of scarce medications.

The use of an experimental drug to treat two Americans and a Spaniard diagnosed with Ebola is raising questions about who gets access to new therapies

The two American patients who were sickened while treating the outbreak in Liberia both received ZMapp, which had never been tested in humans. Both are improving after being flown to the United States for treatment in an Atlanta hospital. But a Spanish priest who reportedly was also given the drug died Tuesday, according to media reports.

The WHO said Tuesday that the death toll from Ebola in Guinea, Sierra Leone, Liberia and Nigeria had reached 1,013. A total of 1,848 cases have been reported.

Several other African nations are closely monitoring ill patients suspected to have contracted the disease. Aside from Guinea, Liberia and Sierra Leone — the three countries where the outbreak initially spread — only Nigeria, Africa’s most populous country, has confirmed cases of Ebola. Nigeria has confirmed 10 cases, and two of the patients have died.

Still, fear over the spread of the virus has continued to cripple West Africa. In Liberia, aid workers fear they are losing the battle with the virus as the country’s frail medical system is stretched beyond its limits. The situation is “catastrophic,” Lindis Hurum, Doctors Without Borders’ emergency coordinator in Liberia, said in a recent statement. The organization has more than 600 doctors working in the region but says that more are desperately needed.

As the outbreak worsens, U.S. officials have said they intend to fast-track development of an Ebola vaccine and could begin human trials next month. The potential vaccine has shown encouraging results in non-human primates, and if human testing goes well it could be available in limited amounts next year.

At the same time, the Food and Drug Administration has said it continues to work with other federal agencies, such as the National Institutes of Health, to fund the development of Ebola drugs and to speed up treatments already in the pipeline. Last week, the FDA said it had removed one regulatory hurdle for an Ebola drug under development by a Canadian company, Tekmira. The move would allow the potential use of the drug for Ebola victims in the near term.

Brady Dennis contributed to this report.
Abby Phillip is a general assignment national reporter for the Washington Post. Before that, she covered politics at ABC News and Politico. She can be reached at abby.phillip@washpost.com. On Twitter: @abbydphillip

Lenny Bernstein writes the To Your Health blog. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports.

http://www.washingtonpost.com/national/ ... story.html

Author:  niman [ Wed Aug 13, 2014 10:13 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Written by Rodney D. Sieh, rodney.sieh@frontpageafricaonline.com
Published: 13 August 2014

Monrovia - Information dissemination continues to be a major dilemma for the Ellen Johnson-Sirleaf-led government – and the government’s handling of the ongoing Ebola crisis appears to be shedding more light on the government’s information lapses.

The Executive Mansion distributed a news release on Monday, August 11 stating that U.S. President Barack Obama had approved the Use of Experimental Drug on Two Liberian Doctors undergoing Treatment for Ebola.

Health Minister Claims Credit

In a 24-hour somersault, the Ministry of Information is now saying that it was not the U.S. President but an initiative of the Ministry of Health that has made it possible for the experimental drug to be tested on the two Liberian doctors – Phillip Zukunis Ireland and Abraham Borbor - who have contracted Ebola. “The two doctors gave their consent, themselves being medical professionals, for the drug to be administered,” a statement of clarity from the Ministry of Information now says.

The statement says: “The request to use this drug was made by the Liberian Ministry of Health directly to the drug maker for the use only on two Liberian doctors. The drug maker has agreed to supply a sufficient amount of this drug only for these two patients. As part of this request, the Liberian Government also directly contacted the US Government’s Food and Drug Administration who have officially agreed for the supply of the drug to be released. The drug is expected to arrive in Liberia in the next 48 hours.”

The Information Ministry's clarification was preceded Tuesday by Health Minister Dr. Gwenigale who moved to dismiss suggestion that U.S. President Barack Obama had any role to play in the disbursement of the serum to Liberia.

“I just want to say that Obama had nothing to do with the drug coming to Liberia. The only thing that the Federal Agency FDA had to do was to say send the drug at the range of the people who are asking for it. But they have not approved the use of the drug themselves. This is an experimental drug. It has not been approved for general use, it cannot therefore leave the United States,” Gwenigale said Tuesday during an appearance on UNMIL Radio in Monrovia.

The minister staked his claim further on the BBC Focus on Africa Tuesday, when he noted that upon the request from Liberia for the drugs, the government was promised three doses but was not sure how many would come to the country. Said Gwenigale: “Originally we were going to get only three doses, but I don’t know how many they will send because it seems that the WHO may have spoken to them, they may be sending more? I do not know. But we are not just going to take them and start using them. It is an experimental drug so people have to sign a waiver and ask us to give it to them because it is not just a drug that is for general use.

Visible Lack of Coordination

The clarification from the government’s information dissemination agency validates concerns from many government critics over an issue that has been a major Achilles for the Sirleaf-led government which has been criticized for its poor handling of the Ebola health crisis. Lack of coordination has also been cited in the government’s handling of the Patrick Sawyer tragedy.

Sawyer, a former consultant at the Ministry of Finance managed to receive government per diem and travel bonuses even though his sister, Princess had just died from the deadly Ebola virus. Lack of communication between the Ministry of Health, whose Chief Medical Officer, Bernice Dahn, has acknowledged telling Sawyer not to travel, and the Ministry of Finance have contributed to the deaths of several doctors and nurses in both Liberia and Nigeria where Sawyer died.

Even more troubling, documents obtained by FrontPageAfrica this week, showed that ArcelorMittal, where Sawyer also worked as a consultant had suspended him from work and isolated him after it became aware that he had contact with his sister who died of the virus on July 8. The mining company went as far as to issue an internal memo to staff of the company informing them that Mr. Sawyer had been referred to the Liberian Health ministry for testing and close observation.

Critics are now wondering why the government did not duplicate ArcelorMittal’s actions over Sawyer. More importantly, why wasn’t Sawyer quarantined? Mittal took the key step of notifying its employees when it received information that Sawyer’s sister, Princess had died from Ebola and after Sawyer’s death in Lagos:

“A family member of an ArcelorMittal Liberia employee died on Tuesday, July 8th, in Monrovia due to a confirmed case of the Ebola virus,” the July 11 edition of Satellite, an internal newsletter of ArcelorMittal Liberia, said. “The employee had minimal contact with the victim, at the state where the virus was infectious.

“Doctors say the risk of potential transfer to any member of the ArcelorMittal staff or contractors is very low. The employee has submitted to the Ministry of Health for a medical examination for possible Ebola infection, and has also requested the Ministry of Health to make the result available to ArcelorMittal Liberia and its close affiliates.

“There is no evidence to suggest that the employee has been infected. Under the Ministry of Health guidelines, the employee is being monitored on a daily basis and will continue to do so for a period of 21 days. During this time the employee will be absent from work.” Then on July 25, ArcelorMittal again told employees that Sawyer had died and even made note of steps it took to keep him from potentially infecting others.

“Patrick was last at the Buchanan site (of AncelorMittal) on 9th July when he informed us about the death of his sister. Having informed us of this news, Patrick was submitted to the Ministry of Health for a medical observation and isolation and requested not to return to work until he had passed through the incubation period. He has not been at the Buchanan site or in any ArcelorMittal office since that time.”

Contradictions Over ‘Quarantine’

Sebastian Muah, former Deputy Finance Minister for Budge then took to social media Facebook to defend why he approved Sawyer’s travel against criticisms and questions over his decision. A discussion between Muah and another discussant has now gone viral and generating a lot of tweets in various social network circuits.

Says Muah: “The man was on NO watch list. I approved his travel. He emailed us several weeks earlier that his sister had died from the disease and that he had asked that his blood be taken for testing. That test result did not come back positive. So to say someone made him travel and exposed him to others is pure hate and misuse of a tragedy that have somehow brought the message home to the many who are in denial of this deadly disease, which by the way has NO CURE.”

In contrast, Information Minister Lewis Brown, who has been garnering commendations for his sudden-turnaround and frank observations of the outbreak, a turnaround from his earlier days as Minister, has admitted that the government was aware of Sawyer’s ailment prior to his travel to Lagos.

“I can confirm to you that he was advised by the Chief Medical Officer at the Ministry of Health not to leave the country because he was under observation,” Brown is quoted by the Premium Times of Nigeria this week. “It was regrettable that he left the country while being observed. We felt he had a duty to his colleagues to tell them that he was under observation for the disease. We also felt he had a duty to our country and yours (Nigeria) not to leave Liberia so as not to endanger the lives of others.”

Brown’s admission raises more questions than answers and also draws scrutiny over Muah’s defense and what some say insensitivity to the grave issue which has now put the lives of nearly 100 persons at risk in both Liberia and Nigeria.

Adding more fuel to the fire is the credibility of the Liberian government, which now has two versions in the public domain about what it did or did not do to prevent Sawyer from leaving Liberia even though it was clear within government circles that Sawyer’s sister had died from Ebola and he was possibly infected.

Renewed Hopes for many Quarantined

The clarification of the experimental drug to Liberia comes hours after a panel of ethicists convened by the WHO said on Tuesday that it is ethical to use the treatments given the size of the outbreak, which has killed at least 1,013, and the challenges of controlling it through regular measures that have stopped other Ebola outbreaks.

"We find ourselves facing a dilemma," Marie Paule Kieny, a WHO assistant director-general, said about a handful of medications and vaccines that have been developed but never tested in humans. "Far too many lives are being lost right now."

ZMapp is a cocktail of three so-called monoclonal antibodies, which are derived from living cells and are designed to bind to and neutralize the Ebola virus. The product has shown promise in monkey studies, but the drug's safety hasn't been established in human clinical trials. A unit of tobacco-products maker Reynolds American Inc. RAI -0.56% manufactures ZMapp using tobacco plants in Kentucky.

The decision by the WHO has now armed manufacturers with the assurance that there will be a market for their drugs if they boost production for this outbreak. But for countries like Liberia, Sierra Leone, Guinea and Nigeria, the clock may be ticking as a lot of lives are at stake. Scores of citizens are in quarantine and awaiting a miracle cure, they could do if one does not come soon enough to save their lives.

Hopes were renewed Tuesday as the Canadian government has also said it would donate 800 to 1,000 doses of experimental Ebola vaccine to the WHO for use in combating the outbreak. The vaccine has shown promise in animal research, said the Public Health Agency of Canada. The vaccine was developed by scientists in the agency's National Microbiology Laboratory. The Canadian government owns the intellectual property and licensed the rights to a U.S. Company, BioProtection Systems Corp.

For now, the impact the experimental drug has had on the two infected Americans, Kent Brantly and Nancy Writebol, who are still undergoing treatment at Emory University Hospital in Atlanta is not known. This has been complicated by the fact that Father Miguel Pajares, a 75 -year-old Spanish priest who had been airlifted to Madrid from Liberia last week and also administered the same drug, did not survive.

What remains clear to many, is that the Ebola crisis has further exposed the frailties of not only, the Sirleaf-led government’s information machinery, but a broken health system, some say is long overdue for a much-needed repair - a painful lesson for a country yet to fully recover from its rugged transition from war to peace compounded by a deadly outbreak that has spun out of control.

http://frontpageafricaonline.com/index. ... bola-serum

Author:  niman [ Wed Aug 13, 2014 10:25 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Liberia: Washington gives the green light for the experimental drug against Ebola
Published Tuesday, August 12, 2014 | APA

Monrovia (Liberia)
The Food and Drug Administration (FDA), United States Agency for Food and Drug Administration and the manufacturer of the experimental serum against Ebola virus have given their approval for the use of this drug on two Liberian doctors infected with the deadly virus. A statement issued Tuesday by the Liberian government said that this experimental drug that will be delivered to the Liberian Ministry of Health and Social Welfare in the next 48 hours, will be used on the two doctors Zukunis Ireland and Abraham Borbor. According to the Liberian government, the two doctors, who contracted the disease by treating patients with Ebola including the late colleague Dr. Samuel Brisbane, gave their written for this drug to be given their consent. The FDA approval follows the green light Tuesday from the WHO estimates that experimental drugs may be made ​​available to those infected with the Ebola virus which has killed more than 1,000 people in Liberia, Sierra Leone, Guinea and Nigeria since its appearance in February. TSS / as / lb / od / APA


Author:  niman [ Wed Aug 13, 2014 10:04 pm ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

MONROVIA (Reuters) - A consignment of experimental Ebola drugs arrived by plane in Liberia on Wednesday to treat two doctors suffering from the virus, which has killed more than 1,000 people across four West African countries.
The drug, ZMapp, arrived in white boxes on a commercial flight, a Reuters witness said. It will be taken to the John F. Kennedy Memorial hospital in the capital and administered to doctors Zukunis Ireland and Abraham Borbor, government officials said.
(Reporting by Clair MacDougall; Writing by Matthew Mpoke Bigg; Editing by Daniel Flynn)

https://uk.news.yahoo.com/experimental- ... ml#1BtH3nr

Author:  niman [ Wed Aug 13, 2014 10:14 pm ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Ebola outbreak: Experimental drug arrives in Liberia to treat doctors; questions raised over ethics, safety
Updated 14 Aug 2014, 10:42am

A consignment of experimental Ebola drugs has arrived by plane in Liberia to treat two doctors suffering from the virus, which has killed more than 1,000 people across four West African countries.

The drug, ZMapp, arrived in two boxes on a commercial flight from the United States carried by Liberia's foreign affairs minister, Augustine Ngafuan, and was unloaded at the VIP terminal, a Reuters witness said.

It will be taken to a hospital in the capital and administered to Liberian doctors Zukunis Ireland and Abraham Borbor, who officials said contracted the disease while attending to patients, including a late colleague.

The world's worst outbreak of Ebola has claimed the lives of 1,069 people and there are 1,975 probable and suspected cases - the vast majority in Guinea, Liberia and Sierra Leone - according to new figures from the World Health Organisation (WHO).

Three people have died in Nigeria.

The UN health agency says only about 10 to 12 doses of the drug have been made and this raises difficult ethical questions about who should get priority access.

What is ZMapp?

The experimental treatment was developed by US company Mapp Biopharmaceutical based on years of US and Canadian research. Read more.
The doctors will be the first Africans to receive it, although it has been given to a Spanish priest, who later died, and two US aid workers who are reported to have shown signs of recovery.

Authorities are also concerned that ZMapp's unproven status could leave them open to the charge that humans are being used as guinea pigs.

"This is not the panacea to the problem. It is at the risk of the patient," Liberia's assistant health minister, Tolbert Nyenswah, told journalists at Monrovia's main airport.

Information minister Lewis Brown told Reuters the drug merely offered a "glimmer of hope" and its use was little more than a gamble.

Even so, the clamour for it is strong given the contagious haemorrhagic disease is killing more than half of its victims and there is no known cure or vaccine.

"I welcome it. It is very good. Our nurses are dying. If you bring them the medication it will make them stronger to fight Ebola," Monrovian stationery seller James Liburd said.

Sierra Leonean doctor dies

In evidence of the ethical dilemma, Melvin Korkor, the first Liberian doctor to survive Ebola, said he would not have used ZMapp when he was fighting for his life because US authorities said they were not responsible for any adverse effects.

"Any drug that has not been approved by [the] FDA should not be administered," he told Reuters.

Ebola virus explained

What is Ebola, and how does this highly contagious and deadly disease spread?
One of the epidemic's most tragic consequences is the toll on healthcare workers, who rushed in only to become infected themselves due to inadequate protection measures or diagnoses of patients that came too late or were inaccurate.

The WHO said this week 170 healthcare workers had been infected and at least 81 had died.

Sierra Leonean doctor Modupeh Cole became the latest medical practitioner to die of Ebola, a health ministry spokesman said on Tuesday.

He contracted the disease after treating a patient who later proved to have the virus and died. The country's leading Ebola doctor, Shek Umar Khan, also died last month.

Eight Chinese health workers are in quarantine in Sierra Leone because they may have contracted Ebola, according to the spokesman for the Chinese embassy in Freetown, Xu Zhou.

The seven doctors and one nurse treated patients at two Chinese-run hospitals in Freetown who later died from Ebola.

One of the doctors has emerged from quarantine after a 21-day observation period.

Guinea declares 'state of emergency'

West African and other governments, including some which have seen no cases of the virus, have taken measures intended to prevent the spread of the disease.

Guinea-Bissau has decided to close its frontier with eastern neighbour Guinea, prime minister Domingos Simoes Pereira told a news conference.

Germany on Wednesday urged its nationals to leave Liberia, Guinea and Sierra Leone, although the request did not apply to medical workers or German diplomatic staff, a foreign ministry spokesman said.

In Guinea, the president has declared what he calls "a national health emergency" over the ebola crisis.

The death toll there is about 380.

The outbreak has brought fresh attention to efforts to find a cure.

Scientists in the US say they have found how it blocks and disables the body's ability to battle infections in a discovery that should help the search for potential cures and vaccines.

The scientists found that Ebola carries a protein called VP24 that interferes with a molecule called interferon, which is vital to the immune response.

http://www.abc.net.au/news/2014-08-14/e ... ia/5669712

Author:  niman [ Thu Aug 14, 2014 8:37 am ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

MICAT Liberia ‏@MicatLiberia 7m
Mr. Nyenswah: The #ZMapp drugs will be administered today to the concerned patients at part of the #EbolaInLiberia fight.

Author:  niman [ Thu Aug 14, 2014 4:06 pm ]
Post subject:  Re: Liberia Identifies Two Doctors To Receive ZMapp

Liberia deciding who gets scarce Ebola drugs

Jonathan Paye-Layleh and Sarah DiLorenzo, Associated Press 2:02 p.m. EDT August 14, 2014

MONROVIA, Liberia - Liberian officials faced a difficult choice Thursday: deciding which handful of Ebola patients will receive an experimental drug that could prove life-saving, ineffective or even harmful.

ZMapp, the untested Ebola drug, arrived in the West African country late Wednesday. Assistant Health Minister Tolbert Nyenswah said three or four people would begin getting it Thursday, although another health official said there was only enough for three people.

The government had previously said two doctors would receive the treatment, but it was unclear who else would.

These are the last known doses of ZMapp left. The San Diego-based company that developed it has said it will take months to build up even a modest supply.

The Ebola outbreak was first identified in March in Guinea and has since spread to Liberia, Sierra Leone and Nigeria, killing more than 1,060 of the 1,975 people sickened by it, according to the World Health Organization.

The outbreak has overwhelmed the already strained health systems in West Africa and raised questions about whether authorities are doing enough to respond.

On Thursday, police in riot gear dispersed an angry crowd in the Liberian capital of Monrovia who were protesting that an Ebola victim's body had not been taken away by health workers.

The outbreak has also sparked an international debate over the ethics of giving drugs that have not yet been tested to the sick and deciding who should get the drugs. So far, only two Americans and one Spaniard have received ZMapp. The Americans are improving, but it is unclear what role the drug has played. The Spaniard died within days.

Doctors Without Borders, which is running many of the Ebola treatment centers and whose staff have tussled with whether to provide ZMapp, said such choices present "an impossible dilemma."

Now Liberian officials are facing those questions.

"The criteria of selection is difficult, but it is going to be done," said Dr. Moses Massaquoi, who helped Liberia obtain the drug from Mapp Biopharmaceutical. "We are going to look at how critical people are. We are definitely going to be focusing on medical staff."

He added people who were past the "critical phase" and looked likely to survive would not be chosen.

In this outbreak, more than 50% of those sickened with Ebola have died, according to the U.N. health agency.

Massaquoi said there was only enough of the drug to treat three people. Treatment will be staggered, so doctors can observe the effects in one patient before moving on to the next. It was not clear yet whether the treatment had started.

The confusion over how many people could be treated may stem from the fact that doctors don't know the best dose to try since the drug has never been tested in humans.

Arthur Caplan, director of medical ethics at NYU Langone Medical Center, said the choice of who to treat would have to balance helping the largest number of people with learning the most from the treatments.

He said the question is not "whose life do we save?" but "who gets the chance to be experimented on?"

For that reason, recipients need to be good experimental subjects - people who have recently contracted the disease and are more likely to respond to treatment or perhaps younger patients, he said. In order to study the long-term effects, doctors will likely prefer people who can be observed for months, which might eliminate people living in remote places, he added.

Nigeria announced Thursday that one more person has been infected with Ebola, bringing the country's number of cases to 11. Health Minister Onyebuchi Chukwu said the latest patient is a doctor who helped treat the country's first Ebola case, Liberian-American Patrick Sawyer who flew in last month and died July 25.

All Nigerians who contracted the killer virus have had direct contact with Sawyer.

http://www.usatoday.com/story/news/worl ... topstories

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