By Lambert Strether of Corrente.
“A nation,” he heard himself say, “consists of its laws. A nation does not consist of its situation at a given time. If an individual’s morals are situational, that individual is without morals. If a nation’s laws are situational, that nation has no laws, and soon isn’t a nation.” –William Gibson, Spook Country
Far be it from me to introduce the slightest hint of cynicism into a feel-good story like two health workers — and Christians! — being whisked from a hemorrhagic fever-infested hellhole to safety in a United States isolation ward and even, we may hope, cure through the injection of a miracle serum developed by a plucky California startup! It’s a wonderful story, even if the serum hadn’t actually been tested in humans, and the workers and their families all seem like nice people, and who would wish stress like that on anyone? Unfortunately, once we look at the figures moving in the shadows beyond the media spotlight… we see vague outlines of a story, other stories, that might not be so simple. I’m not going to connect any dots, I promise! I’m just going to do the old school media critique, lay the dots out, and hope that others can suggest or watch for with evidence-based, hairball-free connections between them.
The Patients: Dr. Kent Brantly and Nancy Writebol
On Thursday, Dr. Kent Brantly thought he was going to die.
It was the ninth day since the American missionary worker came down sick with Ebola in Liberia.
His condition worsening by the minute, Brantly called his wife to say goodbye.
Thankfully, the call was premature.
Brantly is back on his feet — literally — after receiving a last-ditch, highly experimental drug. Another American missionary with Ebola got the same.
Brantly’s and Nancy Writebol’s conditions significantly improved after receiving the medication, sources say. Brantly was able to walk into Emory University Hospital in Atlanta after being evacuated to the United States last week, and Writebol is expected to arrive in Atlanta on Tuesday.
(One hopes, indeed expects, that Brantly and Writebol were only medical workers, as has not been the case in Afghanistan and Cuba.) Reading Gupta’s breathless prose, I can only hope that Brantly and Writebol secured the movie rights.
The process by which the medication was made available to Brantly and Writebol is highly unusual.
World Health Organization spokesman Gregory Hartl cautioned that health authorities “cannot start using untested drugs in the middle of an outbreak, for various reasons.”
Doctors Without Borders similarly weighed in on the side of caution.
“It is important to keep in mind that a large-scale provision of treatments and vaccines that are in very early stages of development has a series of scientific and ethical implications,” the organization said in a statement.
“As doctors, trying an untested drug on patients is a very difficult choice since our first priority is to do no harm, and we would not be sure that the experimental treatment would do more harm than good.”
“[O]ur first priority is to do no harm.” Loose ends: Are other entities involved with other priorities? Why Brantly and Writebol, and not others? (Others not from the United States, or middle class, or Christian, or white.) And now did such an “unusual” “process” happen? As we shall see — unfortunately! — all these loose ends will remain loose ends.
Their Employer: Samaritan’s Purse
CNN’s Gupta, although he makes nothing of it, mentions that Brantly and Writebol work for Samaritan’s Purse (SP). SP is a powerful and politically wired evangelical Christian organization run by Franklin Graham, son of Billy Graham. (Both of the two cases to follow are in the context of Bush’s then-controversial decision to fund “faith-based” organizations with Federal money. I’m not concerned with that issue; rather, I want to get a sense of how SP as an institution operates.) Here’s one case involving their work in post-Saddam Iraq, from Steven Waldman of Beliefnet in 2003:
Graham is also, he says, “poised and ready” to send representatives of the charity he runs to Iraq as soon as possible. His primary purpose is humanitarian aid—providing food and shelter—but he also admits, “I believe as we work, God will always give us opportunities to tell others about his Son….”
[I’m not sure] that America’s foreign-policy objectives are served by having a Bush-loving, Islam-bashing, Muslim-converting Christian icon on the ground in Iraq tending to the bodies and souls of the grateful but deeply suspicious Muslim population.
The Bush administration has taken a highly principled position of removing itself from discussion of the matter: Ari Fleischer insists that the administration can’t block a private group from doing its thing. Ellen Yount, a spokeswoman for the U.S. Agency for International Development, which is coordinating the humanitarian efforts, elaborated: “What private charitable organizations choose to do without U.S. government funding is ultimately their decision. How could the U.S. government control that? We can’t just say to an organization, ‘You can or cannot do something,’ if we don’t fund them. Imagine what the United States Congress would say to us.”
Here I’m not concerned with the merits, if any, of Samaritan’s Purse involving itself in Iraq reconstruction; rather it sounds like Samaritan’s Purse is pretty much used to operating independently of the U.S. government; in other words — and here I’m speculating freely — pulling whatever strings they need to pull, and calling whichever Congresscritter they need to call. Here’s a second case, from El Salvador in 2001:
GUADALUPE, El Salvador, March 3 — An American evangelical relief group that is using private donations and United States government money to help victims of two earthquakes has blurred the line between church and state as its volunteers preach, pray and seek converts among people desperate for help.
[SP spokesperson Dr. Paul Chiles, the country director for SP] insisted that his group was not looking for converts, and that need was the only criterion for help. The conversion of 150 people mentioned on Samaritan’s Purse’s Web page is credited to the pastor of a local evangelical denomination that is the group’s aid partner.
In other words, the local paster was a nominee, a straw. So the loose ends here are how, exactly, SP got the “miracle serum” to Brantly and Writebol, and then got Brantly and Writebol into the United States, and into an isolation ward. And we don’t know, but we do know that SP blurs the line between church and state, uses “straws” or nominees, basically acts as if they were a sovereign, and has a lot of political clout with Congress.
The Plane: N173PA
So I was watching a video of Brantly’s plane arriving, and I spotted the tail number: N173PA. N173PA, a Grumman Gulfstream III, was originally owned by the Royal Danish Air Force (then numbered F-313) and became N173PA in January 2005 (planespotter). N173PA does not appear on Wikipedia’s list of rendition aircraft — although, when you think of it, evacuating a patient in an isolation hood is, logistically, a lot like rendition — although Shannon Watch, monitors foreign military use of Shannon Airport in Ireland, includes it on its list of suspects. This may not be remarkable; William Gibson uses the world of very private aviation as local color in his stylish Spook Country, and in that world, much like the world of Richard Smith’s shell companies, it can seem like everybody’s a suspect. From 2005 to 2010, N173PA was operated by Phoenix Air (planespotter). N173PA and its sibling, N163PA (planespotter) “are fitted with a large freight door on the starboard side and seem to be used … mainly on cargo and air ambulance work” as in this ebola episode. (See here for a third potential use case for freight doors.) And speaking of shell companies, N173PA is owned by N173PA LLC, BRANDYWINE BLDG, 1000 N WEST ST FL 10, of Wilmington, DE. Irish Indymedia has more, in 2008:
Wilmington, Delaware is one of those addresses that instantly makes you sit up and take notice. A number of CIA shell companies operate out of Wilmington. Don’t take my word for it – check out the report on CIA shell companies from from the European Parliament Temporary Committee on the alleged use of European countries by the CIA for the transport and illegal detention of prisoners, November 16 2006. http://www.statewatch.org/cia/documents/working-doc-no-…6.pdf
N163PA LLC and N173PA LLC
The company name is the registration number of the planes. Both are listed as the same address, 824 Market St Mall Ste 1000, Wilmington, Delaware and both operated by Phoenix Air. These planes are known to have landed at Shannon a number of times and frequently fly to US military air bases.
(It looks like the address changed between 2014 and 2008.) From the military site FoxTrot Alpha, “This Amazing Jet Will Transport Ebola Victims From Africa To The U.S.”:
‘F-313′ was sold to U.S. military air support provider Phoenix Air in January of 2005. Phoenix Air is well known for providing adversary support and electronic warfare training to the DoD. … These jets appear to have been used as government contract aircraft on and off over the last decade, as their large cargo doors and convertible interiors allows them to carry out-sized cargo, passengers or modular medical components and stretchers. Also, the jets’ inconspicuous [that screams “spook”] business jet nature and civilian ‘N number’ allows them to operate in and out of sensitive areas [and that] while keeping a relatively low profile [and that] …. This unique aircraft, and the Federal Government’s already close relationship [and that] with Phoenix Air, makes the jet and its operator logical candidates for such a challenging mission.
The writer concludes by raising an interesting point:
The US Army’s SMART-AID, Special Medical Augmentation Response Team- Aeromedical Isolation Team, part of the US Army’s Medical Research Institute For Infectious Diseases, is the Pentagon’s crack outfit that was established to carry out this exact kind of task, even in a war zone environment. They are equipped with top of the line equipment and have been on high alert during the Global War On Terror. Seeing as this is the first time an Ebola patient has been brought to the United States, one would think that such a unit would want to handle the mission instead of a government air ambulance contractor.
Indeed. One would. So, plenty of loose ends here. Why Phoenix Air and not the military? I don’t know, just as I don’t know why Phoenix Air got picked; perhaps Franklin Graham flipped open the Yellow Pages to M for Medevac, and Phoenix Air had the biggest ad. And I can’t prove that N173PA, with its handy and “unique” freight doors, was a rendition plane, or that its use on this project was anything more than coincidence; such a thing might happen to anyone. Although, if I were a Christian, I might want to know.
The Serum: Mystery, Miracle
Another breathless headline, this one from the Atlantic:
what exactly is the secret serum? It’s a question practically everyone’s been asking. The answer: Something the National Institutes of Health and Mapp, the biopharmaceutical firm that manufactured it, are largely keeping mum about.
According to a report in August 2013, the company, which collaborated with the U.S. Army Medical Research Institute of Infectious Diseases, tested the serum on monkeys. When administered to monkeys within 48 hours of infection, there was significant chance of survival. The results showed that all four monkeys that received the serum within 24 hours of infection survived, and two of four who received the serum within 48 hours did so.
But beyond that study, Mapp provides little information on its Ebola research—its website, for example, is sparse, including few news updates to their research. The serum appears to have evolved from evolved from research conducted by the U.S. Army Medical Research Institute in 2012 that showed a mix of various antibodies could stave off the Ebola virus.
But did the monkeys recover “in an hour,” as CNN said Brantly did? LA Times:
“I would be ecstatic if Larry’s product helped save these people, but I also need to be extremely cautious,” said Thomas Geisbert, a professor of microbiology and immunology at the University of Texas Medical Branch at Galveston.
“To say the whole thing cleared up in an hour, that doesn’t happen in reality,” Geisbert said. “That’s like something that happens in a movie.”
So the composition of the ZMapp is one huge loose end — and there’s that Hollywood feeling again!
The Company: MAPP Biopharmaceutical
Here is Mapp’s skeletal website; they currently have only one major government contract, with the Defense Threat Reduction Agency, for $2.33 million. (For William Gibson fans: I can’t resist free associating Mapp Biopharmaceutical with Maas Biolabs.) From the San Diego Union-Tribune, “San Diego firm has sudden starring role in Ebola rescue” (and note again the Hollywood language):
A San Diego biotech firm with nine employees was thrust into the international spotlight (and made local headlines) Monday for its role in developing an experimental Ebola treatment. … ZMapp is a combination of two agents, made by Mapp with LeafBio in San Diego and Defyrus Inc. in Toronto. One of them, MB-003, provided 100 percent protection to monkeys when given right after exposure to Ebola virus, and even helped after symptoms developed. The other is ZMAb, a combination drug that its developer says provided 100 percent survival in primates a day after exposure and 50 percent survival after two days.
(It’s important to note that “100%” is not stated to come from a clinical trial. In fact, Mapp’s products aren’t even commercialized; LeafBio will do that.) Fine, but why Mapp? But there have be other companies, even in the San Diego area, that look just like Mapp. A reader writes in:
There are a *lot* of small firms in the area, all congregating around UCSD, the Salk Institute and Scripps Research. Let’s just say I’m not surprised that the serum was developed in the area.
The San Diego Union-Tribune once more:
Samaritan Purse’s outreach resulted in Mapp Biopharmaceutical sending three frozen vials of ZMapp to Liberia last week. The privately held biotech company has just nine employees, and it has only tested its cocktail of antibodies on a small number of monkeys with mixed success.
I dunno. SP “reaches out,” just like that?
Its Funding: Defense
From an interview with Dr. Larry Zeitlin, President of Mapp, in January 2014 (that is, before this story blew up):
There has been no treatment or cure that has been effective against the Ebola virus, and with the potential ability to turn Ebola into a bio-weapon, it is labeled as Risk Group 4 Pathogen.
[Dr. Zeitlin] started studying Ebola virus when he was offered funding from Defense Advanced Research Projects Agency in 2002.
1. How did the idea to test MB-003’s effectiveness post infection come about?
[ZEITLIN] This was driven by funding agencies.They wanted post-exposure efficacy rather than prophylactic protection.
Well, that does tie up one loose end: I’ve been wondering why prevention (like a vaccine) as opposed to cure, but the answer is the defense spending: If the requirement is to defend against weaponized Ebola, then “post-exposure efficacy” is exactly what you want.
The Sudden Entry Of The World Bank
The Financial Times (“World Bank pledges $200m to fight Ebola”) totally buries the lead:
“In the mining sector, if the evacuation of skilled expatriate staff continues, there will be a sizeable decline in production,” the World Bank said.
The very last paragraph. I’m not kidding! So here, I’m not sure there are many loose ends at all, although it would be nice to know who from the mining sector called the World Bank.
The Oddly Silent Administration
The role of the Obama administration, indeed of the government generally, in moving the patients from Africa to the United States seems curiously muffled in the reporting I’ve seen; we’ve covered funding above. Here is AP’s coverage, “US gov’t had role [what role?] in Ebola drug given aid workers”.
In a statement, [Mapp Biopharmaceutical] said it was working with LeafBio of San Diego, Defyrus Inc. of Toronto, the U.S. government and the Public Health Agency of Canada on development of the drug, which was identified as a possible treatment in January.
Oh? “The U.S. government”? Any particular agency? Not, apparently, the FDA:
The U.S. Food and Drug Administration must grant permission to use experimental treatments in the United States, but the FDA does not have authority over the use of such a drug in other countries [even over experimental drugs manufactured in the US?], and the aid workers were first treated in Liberia. An FDA spokeswoman said she could not confirm or deny [Huh?] FDA granting access to any experimental therapy for the aid workers while in the U.S.
Surely this is cut and dried? Surely, as a functioning bureaucracy, the FDA knows which experimental drugs its granted access to? So why not give a straight answer? (The FDA does have a “compassionate use” exception for access to investigational drugs without trial, but the process is typically time-consuming.) And presumably they’re going to be treated with something? Else why move them?
[Samaritan’s Purse ] contacted U.S. Centers for Disease Control and Prevention officials in Liberia to discuss various experimental treatments and were referred [By whom? Why?] to an NIH scientist in Liberia [for what purpose?] familiar with those treatments.
The scientist answered some questions and referred them to the companies but was not officially representing the NIH and had no “official role in procuring, transporting, approving, or administering the experimental products,” the [NIH] statement says.
“No official role.” Oh, OK!
To make this all even weirder, the White House is hosting a meeting of African leaders right now, while all these events are taking place, and isn’t trying to spin — heck, mention — the story of how a generous America is helping to stop a terrible epidemic in Africa with the very latest in medical science. The administration, typically, isn’t shy about claiming success, and so, along with whether the FDA was circumvented, or not, the role of the CDC as go between, and the role of the NIH in the US and Liberia, I’d classify that as yet another loose end.
1) The Patients: Dr. Kent Brantly and Nancy Writebol — Why them and not others? Especially since SP is a humanitarian institution?
2) Their Employer: Samaritan’s Purse — Who exactly did SP reach out to, and how? Did they blur the lines between church and state?
3) The Plane: N173PA — Was it a torture plane? And do that plane, and Phoenix involvement, signal a role for the intelligence community?
4) The Company: MAPP Biopharmaceutical — Why them? And how did SP find them?
5) Its Funding: Defense
6) The Sudden Entry Of The World Bank Ka-ching.
7) The Oddly Silent Administration — Obama never goes near anything that might make him look bad. He’s not going near this. Why?
Then add to all those loose ends the Hollywood feeling that keeps cropping up….