Allocating an experimental drug in short supply
When only a few doses of an experimental drug exist, someone decides who receives them. The reasons given for that decision can hide an ethical breach, as they did when an experimental remedy was allocated in the 2014 West African Ebola epidemic. Economic and historical forces also shape who gets scarce drugs, even where no one intends to withhold them.
Who received the doses
Ethical breaches are sometimes not understood because the language around them hides them, and the 2014 West African Ebola epidemic is a case. Only a few doses of a potential remedy, ZMapp, were available, and there was a consensus that they should go to White and Western caregivers and not to West Africans.
The reasons given for the allocation
The excuses covered the gamut. Some said the caregivers had to survive in order to treat people, so they should get the drug first, and prioritising them is certainly understandable. Withholding the drug from Africans, however, was excused on the grounds that they did not really trust Western medicine, that it would be a waste, and that they would not take it or would not take it properly. Some, including Kent Brantly, a physician who treated West Africans and contracted Ebola, said that Africans could not really understand informed consent as he could. In the end Brantly received the drug, but Sierra Leone's chief virologist, Sheik Umar Khan, was never told it was available and died without receiving it.
The discussion around the decision was sometimes uninformed. One CNN doctor–journalist said that the drug could not be given to Africans because it had been tested only in monkeys, and that people would say giving it to them sounds racist, although by law every medication must be tested in animals first. His opinion seemed to carry the day.
What shapes access to scarce drugs
No one intends to withhold ZMapp from Africans, but for economic and historical reasons that is precisely what tends to happen. It is not an accident that Africans had so far not had access to it. Among the economic reasons is a network that Westerners tend to have access to and people from developing countries do not, and it influences who gets scarce drugs.