Scitech | Ebola: symptom of a larger problem

Epidemic driven by socioeconomic discrimination

The Ebola outbreak plaguing West Africa exposed the inability of the current market system to act in a socially responsible manner. It made abundantly clear the reluctance of unaffected states to intervene in the crisis, and the lack of tools to effectively curb the outbreak once they do.

At the onset, medical personnel working in West Africa had no means of rapidly diagnosing patients with Ebola. This explains the World Health Organization’s (WHO) delineation between ‘suspected cases’ and ‘confirmed cases’ in its data. That in and of itself posed a huge risk to patients who presented with Ebola-like symptoms, such as fever and headaches, who did not ultimately have Ebola. Because local hospitals closed en-masse at the onset of the epidemic due to their inability to meet the acute need of Ebola patients, pregnant women and those with the flu were forced into quarantine with highly infectious Ebola patients for weeks pending results. That field test does not exist merely because those who need it, i.e. the West African population, do not constitute enough of an attractive market for the private sector to justify production.

According to Heather Culbert, president of the board of Médecins Sans Frontières Canada, the outbreak claimed over 500 local medical professionals, decimating the health infrastructure of already fragile countries. Culbert spoke on February 18, along with Gary Gottlieb, CEO of Partners in Health, and Srinivas Murthy, an infectious disease specialist working with the WHO, at “McGill Students Fight Ebola,” a conference organized by the McGill Global Health Network.

The current market system also failed West Africans when desperately-needed protective gear was put up for auction, instead of donated to NGOs on the ground. Even in the midst of a then-exponentially increasing death rate and an almost uncontrollable infection rate, the profits this auctioning brought to companies outweighed the number of human lives that could have been saved if the preventative materials were donated. This conscious decision to prioritize profits over human lives on the part of the healthcare industry raises the question: if the speed and severity of the Ebola outbreak did not merit corporate altruism, what will?

However, what was truly needed at the peak of the outbreak was a vaccine. The absence of an available Ebola vaccine is symptomatic of a market that allocates research and development for essential medicine through a profit-maximizing framework. Because Ebola is primarily a disease of poverty, a vaccine simply does not exist. Those in the ‘developed’ world who enjoy the comprehensive infrastructure and quality of life that renders Ebola benign constitute the bulk of the pharmaceutical market. Pharmaceutical companies have little incentive to bring drugs to market that lack demand from their customer base, even if large groups of people outside their primary market are suffering from a disease they could prevent. Companies essentially turn a blind eye to those who cannot pay. Because of the lack of an attractive market, it is interesting to examine the motives behind the limited Ebola research that had taken place before the outbreak.

Ebola vaccine research initially emerged purely to serve American interests. The U.S. Department of Defense (DoD) lept to fund hemorrhagic vaccine research after whispers of an impending Soviet bioterrorist attack surfaced during the Cold War. Eventually, researchers deemed Ebola not significant enough of a threat to justify continuing research. The progress made was left to gather dust until Dick Cheney gained a public platform as former President George W. Bush’s running mate. Cheney’s fearmongering succeeded in funding a vaccine for clinical testing, but the tepid political will and equally tepid market incentive left the VSV-ZEBOV variant, initially developed at the U.S. Army Medical Research Institute for Infectious Diseases, to stall in the backwaters of Phase I clinical trials after being licensed to NewLink Genetics, a private corporation whose primary focus is curing cancer. However, NewLink did not acquire the vaccine’s license straight from the DoD. The Canadian National Microbiology Laboratory took up where the DoD left off with a substantially smaller budget before selling it to NewLink. This intermediary research was funded entirely by a Master’s student’s research grant.

The fact that one of the few Ebola vaccines in the pipeline has such strong ties to American military interests comes at no surprise after examining the trend of complete and utter neglect of diseases of poverty. 90 per cent of the global burden of disease is targeted by only 10 per cent of total research. This 10/90 ratio shrinks to 1/99 when updated to reflect the amount of research allocated to the number of people suffering from neglected tropical diseases, such as Ebola.

There is no question that the healthcare industry in the developed world is unable and, more abhorrently, unwilling to allocate research and development to better the lives of those suffering from preventable diseases simply because they cannot pay. A few different approaches to change this, ranging from principled to pragmatic, already exist and await implementation.

The most basic change needed to reverse the divergence of global health research from global health problems is one of principle. Medicine should be a public good. Incentive to develop should never come from an individual’s willingness to pay, but from a governmental or global prioritization of the basic human right to good health. This drastic paradigm shift will not occur anytime soon. Pharmaceutical companies and entities reliant on industry profits – including universities patenting and licensing discoveries – all have a stake in continuing the status quo profit-maximizing framework. This ‘business as usual’ mindset comes at the cost of millions living with and dying of preventable and treatable diseases of poverty.

More practically, a change to an open-access paradigm in terms of drug discovery and development should be made. Because science builds on itself, innovations in one field can be applied to drug development in the pharmaceutical industry. Currently, prohibitive paywalls protect the academic literature surrounding medical experiments and discoveries. Entire countries are barred access due to these expensive institutional subscriptions. Perhaps if the DoD had not classified its Ebola research or if NewLink had not been able to purchase exclusive ownership of the data, a vaccine could have been developed in time. Current steps to insert open-access clauses in the Ebola vaccines being brought to clinical trial, and the creation of hemorrhagic fever research centres with the same aim, come too little, too late.

Because the development of essential medicines responds exclusively to market signals, those same market signals could be used to incentivize production of medicine for neglected tropical diseases. The promise of cash prizes allocated in proportion to the degree of impact of a newly developed drug can incentivize the market just as effectively as a patent monopoly – with an important caveat. In exchange for accepting the payout, the developer must allow for generic versions of their intellectual property to be sold at affordable prices, ensuring the interests of the developing world are protected. This works in theory, but would never be accepted by firms seeking to make grotesque profits from marketing pharmaceuticals.

Another market-augmenting strategy is amassing willing buyers from different locations around the world to increase their purchasing power. Nonprofits like GAVI, the Vaccine Alliance artificially manufacture attractive markets by pooling interested parties – typically small nations in Africa – to incentivize production and ensure equitable pricing. However, GAVI relies exclusively on funds from the Bill & Melinda Gates Foundation to operate, which is neither sustainable nor sufficient to tackle this structural issue.

The Ebola outbreak confirmed that we need a massive overhaul of the healthcare industry at the risk of allowing toxic apathy on the part of those with the power to persist. Some semblance of morality needs to re-enter the economic arena or else future outbreaks, similar to or worse than Ebola, are inevitable. Murthy ended the “McGill Students Fight Ebola” conference by stating, “Hopefully we’ve learned a lot from the outbreak for the next one, because there will be a next one.”