“There have been reports about Ebola survivors selling their blood on the black market in the affected countries,” one audience member from Lagos, Nigeria said at a roundtable discussion on Ebola during the recent American Society of Tropical Medicine and Hygiene meeting in New Orleans in early November. “Is there any effort to regulate this? Are they selling it to facilities or individuals, and is there any evidence that it is working?”
The blood of patients who have recovered from Ebola Virus Disease (EVD) may contain antibodies that could help to suppress the replication of Ebola virus when administered to other patients, but its use has not been rigorously evaluated in clinical trials. However, there have been precedents in using convalescent serum or whole blood products to treat a number of other infections and outbreaks, such as SARS in China, and since the first outbreak of Ebola, convalescent serum has been used in a number of cases, though with, at best, mixed outcomes. Recently, its ‘successful’ use has been reported in some of the Westerners, including cases in the healthcare workers in the US who recovered. However, they also received outstanding supportive care, and in some cases, other experimental therapies, so it is difficult to attribute their recovery to convalescent serum alone. Nevertheless, WHO has noted the growing interest in the use of whole blood or plasma from recovered Ebola patients, and have given a high priority to its clinical evaluation — and apparently, word of this has reached some of the communities in Ebola-affected West Africa.
“I’ve first-hand seen requests for this from several survivors,” said Dr. Lina Moses of Tulane University, who has spent considerable time in Sierra Leone during this outbreak, and who is now stationed in Liberia. “But one of the problems with black market convalescent serum is that it has not been screened for other pathogens — which makes it particularly dangerous. It is also something that a lot of organizations don’t have the power to enforce. The ministries of health in these three countries really need to take a hold of this very serious issue.”
According to Dr. Donald Grant, of the Kenema Government Hospital in Sierra Leone, the danger is considered real enough that they have made it part of their educational support for Ebola survivors. “We educate the survivors so that they are fully aware that they should not just donate blood like that. It should only be done in a hospital setting, with the approval of the ministry of health — but as of yet, I have no evidence that it has actually happened,” he said.
“One of the most important things to do is actually figure out whether this actually works. Convalescent sera has everything going for it except demonstrated efficacy,” said Dr. Armand Sprecher of Médecins Sans Frontières. “If it doesn’t work, it would be very important to make that sort of thing clear, to make that sort of thing stop. Our survivors have a rough road coming out — they don’t need to be labeled as six liters of black market gold walking around when you send them home.”
Other researchers at the conference reiterated that there is no evidence that it actually works to date, and the procedure would require pooled blood in order to have enough antibodies for it to potentially work. This is probably the reason why it has not been consistently effective in animals and in some of the human case studies. Because of this, educational programs should advise recovered individuals that they do not have enough antibodies on their own to help another patient, but if they want to donate their blood to help other patients, it should be through a program that could adequately process it.
None of this should diminish the drive to evaluate the effectiveness of convalescent therapies. In fact, the sooner there is a yes or no answer to whether it works, the less chance there will be for a black market to flourish. Furthermore, simply setting up the programs to evaluate and deliver it could develop useful infrastructure for research, according to Dr. Dan Bausch of Tulane University.
“I confess that when the idea of convalescent blood first came up, I was not particularly enthusiastic about it,” he said. “However, there are still some questions that need to be answered to put it to bed one way or another; and also setting up the capacity to collect and deliver this product — if it could be done safely — is something that could help drive the capacity that could then be transferred to conduct clinical trials of other compounds in West Africa.”
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Global Health Strategies generously supported Theo Smart’s attendance at the 63rd Annual American Society of Tropical Medicine and Hygiene Conference in New Orleans.