Gates Package — page 45

Casco, Tony (NIH/NIAID) [C] From: Hensley, Lisa (NIH/NIAID) [E] Sent: Friday, August 15, 2014 3:09 PM To: Kobinger, Gary (Public Health Agency of Canada); Olinger, Gene (NIH/NIAID) [C] Subject: RE: Your Perspectives Nice email BTW I got an email trying to send IFN's to SL-- They send me my own paper that said it didn't work on it's own... there is some other company that has silver nanparticles that they are supposedly using in Nigeria... All crazy I am going on leave next week but will be on emails etc. ili al emil.com. I will have my b berry of course but just in case. Lisa E. Hensley Oo Associate Director, Science NIH/NIAID/IRF Ft Detrick MD From: Kobinger, Gary (Public Health Agency of Canada) Sent: Thursday, August 14, 2014 3:13 PM To: Hayden, Frederick G *HS Cc: Olinger, Gene (NIH/NIAID) [C]; @who. int; Hensley, Lisa (NIH/NIAID) [E]; Shindo, Nikki; f@who.int Subject: Re: Your Perspectives Dear Frederick Sorry I am a bit late here, Yes I have followed also some of this. As I have responded to one of this group, I think that there is real damages that can come out of testing some of these drugs indeed approved but for other indications. Some were shown to worsen Ebola disease in animals, others had no apparent effects. My point of view is that testing drugs that have not shown at least partial efficacy in animal species modelling at least some of the clinical sequelae of EVD is taking an undue risk. At best nothing will happen but then this means that hope that will be arising from these tests will be crushed and bring a negative impact that will affect the entire response, including on the evaluation of drugs or vaccines that have shown efficacy (and there is many more than what is listed in this letter). At the minimum, experts like Gene and Heinz who have been looking at FDA approved drugs should be brought in that process. The use of the MAbs in a few cases in the field has opened an important door due to what may be important benefits (confirming similar findings in nonhuman primates). Hopefully this will be managed carefully for other approaches as to not end up with angry populations that will set everything back. Lastly as now disclosed the first to be considered for the ZMapp was Dr Kahn, an MD from Sierra Leone. Currently Liberia has the remaining of the ZMapp doses because they made the request.