Written By Kwame Asiedu - I have over the past few weeks, since an experimental drug was used for the treatment of two United States aid workers (who contracted Ebola) been enjoying the commentary regarding why this drug had never been used. The innuendos, conspiracy theories and blame game that followed, have been to me, of comic value.
The reality is those drugs could never have been used in West Africa thanks to the inaction of governments and public health leaders across the sub region. As far back as 2010 the United States Defence Department had patents for certain strains of Ebola isolated from the outbreak in East and Central Africa. Most people have argued that this was because of some sinister motive, unfortunately a careful understanding of how drug discovery and regulation works will point to a very different view.
In sum, to treat any infection similar to Ebola one will require triggering the body’s natural defence mechanism to fight the intruder; this is the basis for most vaccines in use today. To do this one has to first isolate the actually offending organism and grow it in a laboratory environment, a process termed culturing.
Any scientist or institution for that matter worth its salt would always patent its medical isolates especially if there are no known cures available for the diseases. These isolates then form the basis for vaccines or medicines that may cure the disease.
It is thus not surprising that having isolated strains of the Ebola virus the United States scientist applied for a patent with the United States Food and Drugs Administration.
These isolates are then used in animal trials in a controlled laboratory environment to develop treatments if possible or vaccines.
Unfortunately the nature of diseases like Ebola or many blood-letting (haemorrhagic) fevers is such that human trials are not often possible. The reasons being that from a clinical and statistical stand point the numbers required for clinical trials are difficult to obtain. The mortality rate is too high, making it inhumane to attempt any form of clinical trials.
Currently the disease has killed over 900 people across the sub region, 900 too many I would say but the sad reality is in terms of sample size this is not significant; secondly from a pharmaceutical research stand point there is no incentive for multinational companies as profitability is non-existent. The populations that get infected with such diseases are poor and can’t afford the cost of any potential viable treatment.
This lack of profits for scientific research into certain diseases is what has accounted for what is termed the Global drug gap; this is the gap between the costs of funding research into diseases that are common to the developed world compared with the developing world.
According to Michael R. Reich “Global inequities in access to pharmaceutical products exist between rich and poor countries because of market and government failures as well as huge income differences. Multiple policies are required to address this global drug gap for three categories of pharmaceutical products: essential drugs, new drugs, and yet-to-be-developed drugs. . Policies should combine “push” approaches of financial subsidies to support targeted drug development and “pull” approaches of financial incentives such as market guarantees and “process” approaches aimed to improve institutional capacity.”
This is where we failed as a sub region, in the last financial year for every $1 put into sub Saharan Africa as health related donor support; governments in the sub region took out $1.14 from their own budget allocations to fund non healthcare related expenditure.
Thus the health budgets in the sub region were short changed by $0.14 for every $1 donor support, is it any surprise that the sub regional countries public health infrastructure failed so woefully when Ebola struck? In our world new drug research is not an item on the health agenda.
Secondly for diseases that are poorly funded from a pharmaceutical research stand point, there is an option available to get help quickly in a crisis through what is termed the international orphan drug programme. To do this however, governments in countries where the crisis has occurred must waive certain World Health Organisation (WHO) regulations for the movement of pharmaceutical products in international commerce; this amongst other things allows unlicensed or unregistered medicines to be used to combat the crisis.
My understanding is that none of the countries in the sub region where the pandemic is causing serious problems opted to go down this route until the WHO declared Ebola an international crisis, taking the decision making regarding orphan drugs out of the hands of regional health officials.
I am aware that today the WHO is holding a meeting to explore the orphan drug route that will allow experimental medicines to be used for the first time in the fight against Ebola.
The question is for how long will we as Africans allow leadership to fail us so badly? For how long will we continue to use conspiracy theories and innuendos to explain away our failure of leadership? Let’s always remember once a life is lost it cannot be returned.
Yes, America knew the complexity of transporting drugs across countries without market authorization and yes exploited the orphan drug route by repatriating their kinsmen and using the Unite States Food and Drugs Board orphan drug route; thankfully their citizens are recovering and we are still dying. That is what good leadership looks like.
I hope Ebola never gets to Ghana but should it do, I hope our public health leaders will not continue in this debacle that other countries in the sub region have engaged in.
I would end by saying “don’t blame the gods, for the gods are not to blame, don’t blame America, for America is not to blame.” Let’s put the blame of this pandemic squarely at the door step of our regional leaders, they have let us all down.