Image credit: Joseph Ferdinand Keppler / Library of Congress
PUBLISHED IN JACOBIN, 13 AUGUST 2014.
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.