Ebola is a
problem that will not be solved, because it isn’t profitable to do so.
by Leigh
Phillips
The Onion, as
ever, is on point with its “coverage” of the worst recorded outbreak of Ebola,
and the first in West Africa, infecting some 1,779 people and killing at least
961. “Experts: Ebola Vaccine At Least 50 White People Away,” read the cheeky
headline of the July 31 news brief.
Our shorthand
explanation is that if the people infected with Ebola were white, the problem
would be solved. But the market’s role in both drug companies’ refusal to
invest in research and the conditions on the ground created by neoliberal policies
that exacerbate and even encourage outbreaks goes unmentioned.
Racism is
certainly a factor. Jeremy Farrar, an infectious disease specialist and the
head of the Wellcome Trust, one of the largest medical research charities in
the world, told the Toronto Star: “Imagine if you take a region of Canada,
America, Europe, and you had 450 people dying of a viral hemorrhagic fever. It
would just be unacceptable — and it’s unacceptable in West Africa.”
He noted how
an experimental Canadian-developed Ebola vaccine had been provided on an
emergency use basis to a German researcher in 2009 after a lab accident. “We
moved heaven and earth to help a German lab technician. Why is it different
because this is West Africa?”
But Ebola is
a problem that is not being solved because there is almost no money to be made
in solving it. It’s an unprofitable disease.
There have
been around 2,400 people killed since Ebola was first identified in 1976. Major
pharmaceutical companies know that the market for fighting Ebola is minute
while the costs of developing treatment remain significant. On a purely
quantitative basis, some might (perhaps rightly) warn against focusing too much
on this one disease that kills far fewer than, for example, malaria (300,000
killed since the start of the Ebola outbreak) or tuberculosis (600,000).
Yet the
economic constraints retarding progress in developing Ebola treatment also
explain why drug companies are resisting developing treatment to those diseases
as well as many others.
The last
decade has actually seen a tremendous advance in research into therapies for
Ebola, usually in the public sector or by small biotech companies with
significant public funding, with a variety of treatment options on the table
including nucleic-acid-based products, antibody therapies, and a number of
candidate vaccines — five of which have successfully protected non-human
primates from Ebola.
Anthony
Fauci, the head of the National Institute of Allergy and Infectious Diseases,
has been telling everyone in the press who will listen to him in the last
fortnight that an Ebola vaccine would be within spitting distance — if it
weren’t for the corporate skinflints.
“We have been
working on our own Ebola vaccine, but we never could get any buy-in from the
companies,” he told USA Today.
“We have a
candidate, we put it in monkeys and it looks good, but the incentive on the
part of the pharmaceutical companies to develop a vaccine that treats little
outbreaks every thirty or forty years — well, that’s not much incentive,” he
told Scientific American.
Almost
everyone familiar with the subject says that the know-how is there. It’s just
that outbreaks are so rare and affect too few people for it to make development
worthwhile — that is, profitable — for large pharmaceutical companies.
“These
outbreaks affect the poorest communities on the planet. Although they do create
incredible upheaval, they are relatively rare events,” Daniel Bausch, the
director of the emerging infections department of Naval Medical Research Unit
Six (NAMRU-6), a biomedical research laboratory in Lima, Peru, told Vox. “So if
you look at the interest of pharmaceutical companies, there is not huge
enthusiasm to take an Ebola drug through phase one, two, and three of a trial
and make an Ebola vaccine that maybe a few tens of thousands or hundreds of
thousands of people will use.”
John Ashton,
president of the UK Faculty of Public Health, wrote a vituperative opinion
piece in the Independent on Sunday decrying “the scandal of the unwillingness
of the pharmaceutical industry to invest in research to produce treatments and
vaccines, something they refuse to do because the numbers involved are, in
their terms, so small and don’t justify the investment.
“This is the
moral bankruptcy of capitalism acting in the absence of an ethical and social
framework,” he concluded.
This
situation is not unique to Ebola. For thirty years, the large pharmaceutical
companies have refused to engage in research into new classes of antibiotics.
Due to this “discovery void,” clinicians expect that within twenty years, we
will have completely run out of effective drugs against routine infections. So
many medical techniques and interventions introduced since the 1940s depend
upon a foundation of antimicrobial protection. The gains in life expectancy
that humanity has experienced over this time depended on many things, but would
certainly not have been possible without antibiotics. Prior to their
development, bacterial infections were one of the most common causes of death.
In April, the
World Health Organization issued its first-ever report tracking antimicrobial
resistance worldwide, finding “alarming levels” of bacterial resistance. “This
serious threat is no longer a prediction for the future, it is happening right
now in every region of the world and has the potential to affect anyone, of any
age, in any country,” the UN health body warned.
The reason
for this is straightforward, as the companies themselves themselves admit: It
simply makes no sense to pharmaceutical companies to invest an estimated $870
million (or $1.8 billion accounting for the cost of capital) per drug approved
by regulators on a product that people only use a handful of times in their
life when suffering from an infection, compared to investing the same amount on
the development of highly profitable drugs for chronic diseases such as
diabetes or cancer that patients have to take every day, often for the rest of
their lives.
Every year in
the US, according to the CDC, some two million people are infected with
antibiotic-resistant bacteria. 23,000 die as a result.
We see an
identical situation with vaccine development. People purchase asthma drugs or
insulin, for example, for decades, while vaccinations usually require only one
or two doses once in a lifetime. For decades now, so many pharmaceutical
companies have abandoned not just vaccine research and development but
production as well, that by 2003, the US began to experience shortages of most
childhood vaccines. The situation is so dire that the CDC maintains a public
website tracking current vaccine shortages and delays.
But at least
with respect to Ebola, where the market refuses to provide, the defense
department is comfortable intervening and setting aside free-market principles
in the interests of national security.
Virologist
Thomas Geisbert of the University of Texas Medical Branch at Galveston told
Scientific American about his hope for the VSV vaccine, one of the most
promising options against Ebola:
We’re trying
to get the funds to do the human studies … but it really depends on financial
support for the small companies that develop these vaccines. Human studies are
expensive and require a lot of government dollars. With Ebola, there’s a small
global market — there’s not a big incentive for a large pharmaceutical company
to make an Ebola vaccine, so it’s going to require government funding.
William
Sheridan, the medical director of BioCryst Pharmaceuticals, the developer of
experimental anti-viral drug BCX4430, describes the financial predicament
facing Ebola treatment research and development: “It just wouldn’t make the cut
at a major company.”
But for a
small company like his, the federal government has both backed research and
promised to purchase stockpiles of anti-Ebola drugs as a preventative measure
against bioterrorism. BCX4430 is also co-developed with the US Army Medical
Research Institute for Infectious Diseases (USAMRIID). “There is a market, and
the market is the US government,” he told NPR.
USAMRIID,
along with Canada’s Public Health Agency, is also backing the development of
ZMAPP, a serum of monoclonal antibiodies by a small San Diego-based biotech
firm MAPP Biopharmaceutical, which was administered last week to two American
doctors, Kent Brantly and Nancy Writebol, working with the evangelical
Christian missionary group Samaritan’s Purse.
The pair had
fallen ill in Liberia while taking care of patients infected with Ebola.
Brantley’s condition had been rapidly deteriorating, and he had phoned his wife
to give his farewells. Within an hour of Brantley receiving the experimental
serum, his condition had reportedly reversed, with his breathing improving and
rashes fading.
The following
morning, he was able to shower on his own, and by the time of his arrival in
the US after being evacuated from Liberia, he was able to climb down out of the
ambulance without assistance. Writebol is now similarly “up and walking,” after
her arrival in Atlanta from the Liberian capital.
We should be
extremely cautious about drawing any conclusions from this development and
claiming that the drug has cured the missionaries. We have a sample size of
just two in this “clinical trial,” with no blinding or control groups. The drug
had until now never been tested on humans for safety or efficacy. And as with
any illness, a certain percentage of patients will recover on their own. We do
not know whether ZMapp was the cause of the apparent recovery. Nonetheless, it
is not unreasonable to state that this turn of events gives great hope.
Two of the
ZMapp antibodies were originally identified and developed by researchers at the
National Microbiology Laboratory in Winnipeg and at Defyrus, a Toronto-based
“life sciences biodefense company,” with funding from the Canadian Safety and
Security Program of Defence R&D Canada. The third antibody in the cocktail
was produced by MappBio in collaboration with USAMRIID, the National Institutes
of Health, and the Defense Threat Reduction Agency. The companies then
partnered with Kentucky Bioprocessing in Owensboro, a protein production
company that was bought earlier this year by the parent firm of RJ Reynolds
Tobacco, to pharm the antibody-laden tobacco plants.
On hearing of
the role of the Pentagon and Canada’s defense establishment, some have jumped
to conspiracy theories. Indeed, ZMapp appears to be a perfect storm of popular
nemeses: GMOs, Big Tobacco, the Pentagon, and injections that look a bit like
vaccines!
But the
Defense Department funding should not be viewed as nefarious. Rather, it is
evidence of the superiority of the public sector as shepherd and driver of
innovation.
However, not
all unprofitable diseases are subjects of the colonels’ bioterror concern. And
why should the private sector get to cherry pick the profitable conditions and
leave the unprofitable ones for the public sector?
If, due to
its profit-seeking imperative, the pharmaceutical industry is structurally
incapable of producing those products that are required by society, and the
public sector (in this case in the guise of the military) consistently has to
fill in the gaps left by this market failure, then this sector should be
nationalized, permitting the revenues from profitable treatments to subsidize
the research, development, and production of unprofitable treatments.
In such a
situation, we would no longer have to even argue whether the prevention of
malaria, measles, or polio deserves greater priority; we could target both the
big name and neglected diseases at the same time. There is no guarantee that
turning on the tap of public funding will immediately produce a successful
result, but at the moment, private pharmaceutical companies aren’t even trying.
This is
precisely what is meant when socialists talk of capitalism being a fetter on
the further development of the forces of production. Our concern here is not
merely that the refusal of Big Pharma to engage in neglected tropical disease,
vaccine, and antibiotic R&D is grotesquely immoral or unjust, but that the
production of a potential cornucopia of new goods and services that could
otherwise benefit our species and expand the realm of human freedom are blocked
due to the free market’s lethargy and paucity of ambition.
Focusing on a
vaccine or drugs is critical. But doing so without also paying attention to the
deterioration of public health and general infrastructure across West Africa,
and the wider economic conditions that contribute to the likelihood of
outbreaks of zoonotic diseases like Ebola, is at best using a bucket to empty
the water out of a leaky and sinking boat.
Phylogeographer
and ecologist Rob Wallace has described well how neoliberal fallout has
established the ideal conditions for the epidemic. Guinea, Liberia, and Sierra
Leone are some of the poorest countries on the planet, ranking 178th, 174th, and
177th out of 187 countries in the UN’s Human Development Index.
Were such an
outbreak to occur in northern European countries, for example, nations with
some of the best health infrastructure in the world, the situation would more
likely have been contained.
It is not
merely the dearth of field hospitals, lack of appropriate hygiene practices in
existing hospitals, absence of standard isolation units, and limited cadre of
highly trained health professionals that are able to track down every person
that may have been exposed and isolate them. Or that better supportive care is
a crucial condition of better outcomes, whatever the treatment available. The
spread of the disease has also been exacerbated by a withering away of basic
governmental structures that would otherwise be able to more broadly restrict
movement, to manage logistical difficulties, and to coordinate with other
governments.
Epidemiologist
and infectious diseases specialist Daniel Bausch, who worked on research
assignments near the epicenter of the current outbreak, describes in a paper
published in July in the Public Library of Science journal Neglected Tropical
Diseases how he “witnessed this ‘de-development’ firsthand; on every trip back
to Guinea, on every long drive from Conakry to the forest region, the
infrastructure seemed to be further deteriorated — the once-paved road was
worse, the public services less, the prices higher, the forest thinner.”
Wallace notes
that here, as in many countries, a series of structural adjustment programs
have been encouraged and enforced by Western governments and international
financial institutions that require privatization and contraction of government
services, removal of tariffs while Northern agribusiness remains subsidized,
and an orientation toward crops for export at the expense of food
self-sufficiency. All of this drives poverty and hunger, and, in turn,
competition between food and export crops for capital, land, and agricultural
inputs leads to an ever greater consolidation of land ownership, in particular
by foreign companies, that limits access of small farmers to land.
Ebola is a
zoonotic disease, meaning a disease spread from animals to humans (or vice
versa). Some 61 percent of human infections throughout history have been
zoonotic, from influenza to cholera to HIV.
The single
biggest factor driving growth in new zoonotic pathogens is increased contact
between humans and wildlife, often by the expansion of human activity into
wilderness. As neoliberal structural adjustment forces people off the land but
without accompanying urban employment opportunities, Wallace points out, they
plunge “deeper into the forest to expand the geographic as well as species
range of hunted game and to find wood to make charcoal and deeper into mines to
extract minerals, enhancing their risk of exposure to Ebola virus and other
zoonotic pathogens in these remote corners.”
As Bausch
puts it: “Biological and ecological factors may drive emergence of the virus
from the forest, but clearly the sociopolitical landscape dictates where it
goes from there — an isolated case or two or a large and sustained outbreak.”
These
outcomes are the predictable result of unplanned, haphazard development in
areas known to be the origin of zoonotic spillover, and without the sort of
infrastructural support and egalitarian ethos that permitted, for example, the
elimination of malaria from the American South after World War II by the CDC in
one of its earliest missions.
Over these
past few months, the worst Ebola outbreak in history has exposed the moral
bankruptcy of our pharmaceutical development model. The fight for public health
care in the United States and the allied fight against healthcare privatization
elsewhere in the West has only ever been half the battle. The goal of such
campaigns can only truly be met when a new campaign is mounted: to rebuild the
international pharmaceutical industry as a public sector service as well as
address wider neoliberal policies that indirectly undermine public health.
We could take
inspiration from HIV/AIDS activist groups from the late 80s/early 90s like ACT
UP and the Treatment Action Group, and, in the 2000s, South Africa’s Treatment
Action Campaign, which combined direct action and civil disobedience against
both companies and politicians with a scientifically rigorous understanding of
their condition.
But this
time, we need a larger, more comprehensive campaign covering not just one
disease, but the panoply of market failures with respect to vaccine
development, the antibiotic discovery void, neglected tropical diseases, and
all neglected diseases of poverty. We need a science-based treatment activism
that has the long-term, ambitious but achievable aim of the pharmaceutical
industry’s democratic conquest.
We need a
campaign to destroy the unprofitable diseases.
No comments:
Post a Comment