Discussion:
The Political Economy of Ebola
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Sid Shniad
2014-10-20 22:21:08 UTC
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Raw Message
*https://www.jacobinmag.com/2014/08/the-political-economy-of-ebola/
<https://www.jacobinmag.com/2014/08/the-political-economy-of-ebola/>*
*Jacobin 8.13.14*
The Political Economy of Ebola 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
<http://www.theonion.com/articles/experts-ebola-vaccine-at-least-50-white-people-awa,36580/>,”
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 <http://www.wellcome.ac.uk/>,
one of the largest medical research charities in the world, told the *Toronto
Star
<http://www.thestar.com/news/world/2014/07/09/ebola_outbreak_not_right_for_testing_experimental_vaccines_drugs_experts.html>*:
“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
<https://www.jacobinmag.com/2013/06/socialize-big-pharma/> 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
<http://www.usatoday.com/story/news/nation/2014/07/31/ebola-vaccine-trial/13404609/>*
.

“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
<http://www.scientificamerican.com/article/cross-border-ebola-outbreak-a-first-for-deadly-virus/>*
.

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
<http://www.vox.com/2014/7/31/5952665/ebola-virus-vaccine-why-hasnt-it-happened>.
“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
<http://www.fph.org.uk/>, wrote a vituperative opinion piece in the
*Independent* on Sunday
<http://www.independent.co.uk/voices/comment/theyd-find-a-cure-if-ebola-came-to-london-9644515.html>
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
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021209/>,” 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
<http://www.who.int/drugresistance/documents/surveillancereport/en/>
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
<http://www.nature.com/nrd/journal/v9/n3/full/nrd3078.html> (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
<http://www.cdc.gov/drugresistance/threat-report-2013/>, 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
<http://www.cdc.gov/VACCINes/vac-gen/shortages/default.htm#why> 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
<http://www.scientificamerican.com/article/when-will-we-have-a-vaccine-for-ebola-virus1/>*
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
<http://www.nature.com/nature/journal/v508/n7496/full/nature13027.html>,
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
<http://www.npr.org/blogs/health/2014/04/11/301418627/ebola-drug-could-be-ready-for-human-testing-next-year>
.

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 <http://www.cnn.com/2014/08/04/health/experimental-ebola-serum/>
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
<http://farmingpathogens.wordpress.com/2014/04/23/neoliberal-ebola/> 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
<http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003056>
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
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088493/> 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 <http://en.wikipedia.org/wiki/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.
Leigh Phillips is a science writer and EU affairs journalist. His writing
has appeared in *Nature*, the *Guardian*, *Scientific American*, the
EUobserver and the *Daily Telegraph*.
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