Ebola: Why Children Are Often the Last to Receive Treatment in Medical Crises

More than 3,000 people have died in the current Ebola outbreak in the Democratic Republic of Congo since it began in mid-May. Young children face some of the highest risks: Doctors Without Borders says more than 60% of infected children under five are expected to die.

The organisation argues that the problem is not only the disease itself. A shortage of medication and limited information about how to use treatments in young patients also leave children at a disadvantage. “Children must be centred in Ebola treatment and prevention research,” Doctors Without Borders wrote in a commentary published in The Lancet.

The debate focuses on the EBO-PEP study, which began in mid-July and is examining the experimental antiviral obeldesivir. The drug is being studied for its ability to protect people exposed to the Bundibugyo Ebola virus, the strain responsible for the outbreak. The original study excluded children weighing less than 30 kilograms, or roughly 12 and younger. New protocols could include children above 20 kilograms, but those under 20 kilograms, approximately six and younger, will remain excluded.

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Children must be centred in Ebola treatment and prevention research.

Their alternative is remdesivir, administered intravenously. Doctors Without Borders says a 10-day course of infusions is difficult to deliver during an outbreak, particularly to small children. Pediatrician Neal Russell, who advises the organisation and led the Lancet commentary, says children may be especially vulnerable because of weaker immune systems, underlying conditions and the difficulty of treating them in an outbreak.

Children can also be harder to diagnose because early Ebola symptoms resemble other illnesses. Young patients may struggle to describe what they feel, and parents or caregivers cannot always accompany them into treatment centres. They need closer monitoring and specially trained staff. The article also describes a case in Berlin, where doctors treated an American physician’s wife and four children prophylactically with the experimental antibody MBP134 after the physician contracted Bundibugyo Ebola while caring for patients. Hospital doctor Han Ngoc Le said the team had to carry out a careful assessment of the drug’s risks and benefits.

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Of course, a careful risk benefit assessment had to be carried out.