{"id":12437,"date":"2014-10-17T11:10:08","date_gmt":"2014-10-17T15:10:08","guid":{"rendered":"https:\/\/pierrejoris.com\/blog\/?p=12437"},"modified":"2014-10-17T11:10:08","modified_gmt":"2014-10-17T15:10:08","slug":"the-political-economy-of-ebola","status":"publish","type":"post","link":"https:\/\/pierrejoris.com\/blog\/the-political-economy-of-ebola\/","title":{"rendered":"The Political Economy of Ebola"},"content":{"rendered":"

\"EbolaMap\"<\/a>Via: Retort, this Leigh Phillips<\/strong> piece from the Jacobin<\/em> of 13 August 2014 is very clear on why the Ebola situation is stuck where it is today. Phillips is\u00a0a science writer and EU affairs journalist whose writing has appeared in Nature<\/em>, the Guardian<\/em>,\u00a0Scientific American<\/em>, the EUobserver and the Daily Telegraph<\/em>.<\/p>\n

\n

The Political Economy of Ebola<\/b><\/p>\n

The Onion<\/i>, as ever, is on point with its \u2018coverage\u2019 of the worst recorded outbreak of Ebola, and the first in West Africa, infecting some 1,779 people and killing at least 961. \u201cExperts: Ebola Vaccine At Least 50 White People Away<\/span><\/a>,\u201d read the cheeky headline of the July 31 news brief.<\/p>\n

Our shorthand explanation is that if the people infected with Ebola were white, the problem would be solved. But the market\u2019s role in both drug companies\u2019 refusal\u00a0to invest in research and the conditions on the ground created by neoliberal policies that exacerbate and even encourage outbreaks goes unmentioned.<\/p>\n

Racism is certainly a factor. Jeremy Farrar, an infectious disease specialist and the head of the Wellcome Trust<\/span><\/a>, one of the largest medical research charities in the world, told the\u00a0Toronto Star<\/i><\/span><\/a>: \u201cImagine 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 \u2014 and it\u2019s unacceptable in West Africa.\u201d<\/p>\n

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. \u201cWe moved heaven and earth to help a German lab technician. Why is it different because this is West Africa?\u201d<\/p>\n

But Ebola is a problem that is not being solved because there is almost no money to be made in solving it. It\u2019s an unprofitable disease.<\/p>\n

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).<\/p>\n

Yet the economic constraints retarding progress in developing Ebola treatment also explain why drug companies are resisting<\/span><\/a>\u00a0developing treatment to those diseases as well as many others.<\/p>\n

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 \u2014 five of which have successfully protected non-human primates from Ebola.<\/p>\n

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 \u2014 if it weren\u2019t for the corporate skinflints.<\/p>\n

\u201cWe have been working on our own Ebola vaccine, but we never could get any buy-in from the companies,\u201d he told USA Today<\/i><\/span><\/a>.<\/p>\n

\u201cWe 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 \u2014 well, that\u2019s not much incentive,\u201d he told Scientific American<\/i><\/span><\/a>.<\/p>\n

Almost everyone familiar with the subject says that the know-how is there. It\u2019s just that outbreaks are so rare and affect too few people for it to make development worthwhile \u2014 that is, profitable \u2014 for large pharmaceutical companies.<\/p>\n

\u201cThese outbreaks affect the poorest communities on the planet. Although they do create incredible upheaval, they are relatively rare events,\u201d 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<\/span><\/a>. \u201cSo 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.\u201d<\/p>\n

John Ashton, president of the UK Faculty of Public Health<\/span><\/a>, wrote a vituperative opinion piece in the Independent<\/i><\/span> on Sunday<\/span><\/a> decrying \u201cthe 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\u2019t justify the investment.<\/p>\n

\u201cThis is the moral bankruptcy of capitalism acting in the absence of an ethical and social framework,\u201d he concluded.<\/p>\n

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 \u201cdiscovery void<\/span><\/a>,\u201d 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.<\/p>\n

In April, the World Health Organization issued its first-ever report<\/span><\/a> tracking antimicrobial resistance worldwide, finding \u201calarming levels\u201d of bacterial resistance. \u201cThis 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,\u201d the UN health body warned.<\/p>\n

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<\/span><\/a> (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.<\/p>\n

Every year in the US, according to the CDC<\/span><\/a>, some two million people are infected with antibiotic-resistant bacteria. 23,000\u00a0die as a result.<\/p>\n

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<\/span><\/a> current vaccine shortages and delays.<\/p>\n

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.<\/p>\n

Virologist Thomas Geisbert of the University of Texas Medical Branch at Galveston told Scientific American<\/i><\/span><\/a> about his hope for the VSV vaccine, one of the most promising options against Ebola:<\/p>\n

We\u2019re trying to get the funds to do the human studies \u2026 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\u2019s a small global market \u2014 there\u2019s not a big incentive for a large pharmaceutical company to make an Ebola vaccine, so it\u2019s going to require government funding.<\/p>\n

William Sheridan, the medical director of BioCryst Pharmaceuticals, the developer of experimental anti-viral drug BCX4430<\/span><\/a>, describes the financial predicament facing Ebola treatment research and development: \u201cIt just wouldn\u2019t make the cut at a major company.\u201d<\/p>\n

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). \u201cThere is a market, and the market is the US government,\u201d he told NPR<\/span><\/a>.<\/p>\n

USAMRIID, along with Canada\u2019s 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<\/span><\/a> to two American doctors, Kent Brantly and Nancy Writebol, working with the evangelical Christian missionary group Samaritan\u2019s Purse.<\/p>\n

The pair had fallen ill in Liberia while taking care of patients infected with Ebola. Brantley\u2019s 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.<\/p>\n

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 \u201cup and walking,\u201d after her arrival in Atlanta from the Liberian capital.<\/p>\n

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 \u201cclinical trial,\u201d 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.<\/p>\n

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 \u201clife sciences biodefense company,\u201d 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.<\/p>\n

On hearing of the role of the Pentagon and Canada\u2019s defense establishment, some have jumped to conspiracy theories. Indeed, ZMapp appears to be a perfect storm of popular\u00a0nemeses: GMOs, Big Tobacco, the Pentagon, and injections that look a bit like vaccines!<\/p>\n

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.<\/p>\n

However,\u00a0not all unprofitable diseases are subjects of the colonels\u2019 bioterror concern. And why should the private sector get to cherry pick the profitable conditions and leave the unprofitable ones for the public sector?<\/p>\n

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.<\/p>\n

In such a situation, we would no longer have to even argue whether\u00a0the 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\u2019t even trying.<\/p>\n

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, <\/i>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\u2019s lethargy and paucity of ambition.<\/p>\n

Focusing on a vaccine or drugs is critical. But doing so without also\u00a0paying 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.<\/p>\n

Phylogeographer and ecologist Rob Wallace has described<\/span><\/a> 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\u2019s Human Development Index.<\/p>\n

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.<\/p>\n

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.<\/p>\n

Epidemiologist and infectious diseases specialist Daniel Bausch, who worked on research assignments near the epicenter of the current outbreak, describes in a paper<\/span><\/a> published in July in the Public Library of Science journal Neglected Tropical Diseases<\/i> how he \u201cwitnessed this \u2018de-development\u2019 firsthand; on every trip back to Guinea, on every long drive from Conakry to the forest region, the infrastructure seemed to be further deteriorated \u2014 the once-paved road was worse, the public services less, the prices higher, the forest thinner.\u201d<\/p>\n

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.<\/p>\n

Ebola is a zoonotic disease, meaning a disease spread from animals to humans (or vice versa). Some 61\u00a0percent\u00a0of\u00a0human infections<\/span><\/a> throughout history have been zoonotic, from influenza to cholera to HIV.<\/p>\n

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 \u201cdeeper 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.\u201d<\/p>\n

As Bausch puts it: \u201cBiological and ecological factors may drive emergence of the virus from the forest, but clearly the sociopolitical landscape dictates where it goes from there \u2014 an isolated case or two or a large and sustained outbreak.\u201d<\/p>\n

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.<\/p>\n

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\u00a0wider neoliberal policies that indirectly undermine public health.<\/p>\n

We could take inspiration from HIV\/AIDS activist groups from the late 80s\/early 90s like ACT UP<\/span><\/a> and the Treatment Action Group, and, in the 2000s, South Africa\u2019s Treatment Action Campaign, which combined direct action and civil disobedience against both companies and politicians with a scientifically rigorous understanding of their condition.<\/p>\n

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\u2019s democratic conquest.<\/p>\n

We need a campaign to destroy the unprofitable diseases.<\/p>\n<\/blockquote>\n

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Via: Retort, this Leigh Phillips piece from the Jacobin of 13 August 2014 is very clear on why the Ebola situation is stuck where it is today. Phillips is\u00a0a science writer and EU affairs...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[1710,1585],"class_list":["post-12437","post","type-post","status-publish","format-standard","hentry","category-man-made-disaster","tag-capitalism","tag-ebola"],"_links":{"self":[{"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/posts\/12437","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/comments?post=12437"}],"version-history":[{"count":3,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/posts\/12437\/revisions"}],"predecessor-version":[{"id":12441,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/posts\/12437\/revisions\/12441"}],"wp:attachment":[{"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/media?parent=12437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/categories?post=12437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pierrejoris.com\/blog\/wp-json\/wp\/v2\/tags?post=12437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}