It took more than 15 years of tireless research and millions upon millions of U.S. government dollars to produce a few grams of the experimental Ebola drug that may have saved the lives of two U.S. missionaries stricken by the virus in West Africa.
The news of Kent Brantly's and Nancy Writebol's improved conditions is wonderful. But it leads inevitably to the next question: How fast can we get some to the people dying in Liberia, Sierra Leone, Guinea and Nigeria?
The answer, at least from the information I've been able to gather so far, is: Yes, this can be done. It would be expensive. It would take a few months to produce. It would be complicated. No one could even remotely guarantee it would work.
But there's little doubt it's possible.
"Two months," said Charles Arntzen, Regents' professor at the Biodesign Institute at Arizona State University, who has collaborated for the past 15 years with Mapp Biopharmaceutical, the tiny San Diego company that produced the experimental serum given to the two Americans. "Maybe they could do it in a month. If they were [already] planning on it, I'm sure they could produce 10,000 doses in a month."
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, was more cautious in an interview on CNN Tuesday. "It is not easy to make this serum," he said. "The number of doses that are available right now, today...is less than a handful.
"It really is going to be a supply problem," Fauci added. "It would take months to produce a significant amount more."
There is only one place approved by the U.S. government to produce ZMapp, the cocktail of antibodies injected into Brantly and Writebol, the two U.S. missionaries who contracted the deadly disease in Liberia. That is Kentucky Bioprocessing in Owensboro, Ky., where the antibodies are produced in specially modified tobacco plants, which are then harvested, ground up into a green liquid, purified and turned into tiny doses -- perhaps half a gram or a gram -- of the ZMapp that was administered to the two missionaries.
A spokeswoman, Maura Payne, said in an e-mail Tuesday that "KBP is working closely with Mapp, various government agencies and other parties to increase production of ZMapp, but this process will take several months."
And that is only the beginning of the litany of issues that would have to be addressed if, hypothetically, one of the West African governments wanted to try the drug as a last-ditch effort to stem the Ebola outbreak, which has sickened more than 1,600 and killed 887 in four countries. For starters, let's remember that ZMapp had never been tried on a human being when Brantly and Writebol -- and their physicians -- opted to try it. That means years of safety testing and clinical trials were skipped, presumably because the two had few other options as they tried to survive Ebola.
"The fact that somebody had the risk-taking mentality to actually do this just blows me away," Arntzen marveled in an interview Tuesday. "I'm just delighted...T0 me, it's absolutely flabbergasting. But I love it. It restores my faith in government."
Fair enough, but as Fauci is quick to note whenever he speaks, even if the drug helped the two Americans, there is no guarantee it will work on others. And no guarantee it wouldn't have some harmful side effects.
We simply don't know.
Experts told me they expect a lot of research to be done on Brantley and Writebol when they recover, in an effort to determine why the drug may have helped them.
As for cost, no one I've been able to talk to so far could even hazard a guess, other than to say it would probably be expensive. Liability issues might have to be addressed. But Arntzen said that any government, especially the Untied States, could afford it.
Arntzen said he spoke Monday night with Larry Zeitlin, one of the two founders of Mapp Biopharmaceutical, whom he described as a free spirit and "Renaissance man" who cares little for profit and has dedicated the past 15 years to finding an Ebola treatment that could be made widely available in the developing world.
Zeitlin and partner Kevin Whaley "were just happy as a clam," Arntzen said. "Most of us in science...our greatest reward is we get to publish a scientific paper and other nerd scientists get excited and that's the highlight of our life.
"And here he reads in the newspaper that his drug probably saved a life. That's beyond anything I'd expect to hear in my life."