There are many actors and institutions with diverse interests and stakes in the “international community”. The United Nations public health arm, the World Health Organization (WHO), has been declining in capacity and under-resourced by its member states for years. Public health has been effectively routed by neoliberal strategies that advance privatization, corporatization, deregulation. The Ebola crisis should and could have been averted in early 2014, but the deaths of Africans got little attention until a couple of Americans became infected and were repatriated to the U.S for treatment. It took more than five months for WHO to wake up and declare a state of emergency in August. The people in the three heavily affected countries, Liberia, Sierra Leone and Guinea, are among the poorest in the world with minimal access to poor quality, pay-for-service health care that has been imposed through structural adjustment as a necessary condition for World Bank and IMF support. There were no health systems left. Community clinics, for what they were, carried out emergency procedures with no latrines, no anaesthetics, no water, no medication. People avoided them. Poverty, lack of resources for even basic sanitation and health needs, and understandable fear after years of civil wars and political unrest meant that assistance, when it finally began to appear, was not readily trusted. Even more so that it arrived in hasmat protective suits, upsetting and disrupting already grieving families trying to perform that last right of respect, to bury their dead. Worse that urgent Response began by taking away and quarantining the sick in compounds surrounded by tall fences, or in households without ensuring access to essentials like food, or information to family members. It took several months of consultations and community engagement to work out the details of effective urgent response. In Guinea, people are still running from the response teams, hiding in the forests. Rumours abound. Well more than a year after the first “case”, people continue to die.
Experimental vaccines funded by public health agencies in Canada and the U.S. were well in development years before this Ebola outbreak. No one was interested in them. The Canadian government sold the marketing rights for our vaccine (VSV-EBOV) for $205,000 to a small American biotech company, NewLInk Genetics, in 2010, on condition that they develop it (which involves testing and progressing through the regulatory pipeline to manufacturing). NewLink sat on the vaccine and did nothing. On November 24, 2014 they negotiated a deal with the pharmaceutical giant Merck for $30 million who will scale up manufacturing with the help of the international community. Nice deal for NewLink. Probably for Merck too. Not so much for Canadians, whose years of public investment go into NewLink and Merck’s accounting. Even so, in the true spirit of humanitarianism we Canadians have contributed another $26 million to further the clinical trials for Merck as well as address Ebola emergency response projects. Very few of us would say they would not support the research into a potentially life saving vaccine for a devastating infectious disease. We should be proud of our scientific accomplishment, and the public purse that supports it. But we might also ask some serious questions about the state (and politics) of public-private investment as we witness an era where the public pays for the bulk of the risky research and development and then signs away the intellectual property for a pittance to private corporations who hold off until they can figure out a way to make a profit before acting on those discoveries. Their goal is to make money. They’re not going to make it from poor, sick people. Meanwhile, the financial and health “international community” (can we distinguish between finance and health any more?), misguided by philanthrocapitalists exercising their Medician powers to work out new schemes to incentivize these corporations. They overlook the opportunities for real innovation at the level of communities, identifying instead techno-fixes that help to flip deals and merge companies while producing little real added value to most people. But why should these “priests of a ferocious breed”, as Paul Jorion calls them, change? The current system seems to be serving them well enough. Private interests seem to find a way to influence (capture) governments to “assist” them in marketing shiny new technologies for a fast quarterly profit rather than investing in the longer task of strengthening public health, agricultural, transportation and social systems. It’s more difficult to set up performance outcomes and game success in those domains. Imagine therapeutic advances instead of the long line of me-too drugs that tie up our regulatory timelines. We used to rely on our governments to protect its citizens, but our governments have been getting less and less tax dollars from these corporations to keep the public services (including United Nations agencies) afloat. Maybe we should be considering novel ways of recognizing innovation that include not just techno-products but improved systems that build capacity and capabilities, starting in communities, for a healthier and stronger civil society; a system in which the conditions that breed Ebola would be eliminated.
Janice Graham is a research professor in medical anthropology and infectious diseases in the Faculty of Medicine at Dalhousie University. Interested in the moral basis of profit when disease becomes a market opportunity, she works among those who develop, regulate, commercialize, implement and use emerging pharmaceuticals and vaccines. Studying vaccine logics in Africa, she wonders how philanthrocapitalists and industry can claim publicly funded research as their own intellectual property, and why those innovations never end up in improved health systems.