Medical ethicist Harriet Washington explains why most pharmaceuticals companies decline to produce drugs for the developing world yet use it for clinical testing
JESSICA DESVARIEUX, TRNN PRODUCER: Welcome to The Real News Network. I’m Jessica Desvarieux in Baltimore.
Ebola is all over the headlines in the United States. After two American health care workers were infected with the deadly virus in Liberia, more media outlets started to pay attention to this outbreak raging in the Western African nations of Liberia, Sierra Leone, Guinea, and now reports show that it’s spread to Nigeria. There is no proven treatment or vaccine for Ebola, which so far has infected more than 1,700 people and has killed more than 930 in West Africa.
But what we do know is that those two American health care workers infected with Ebola are now back in the U.S. recovering and receiving an experimental serum known as ZMapp. According to the BBC, the World Health Organization will convene a meeting of medical ethics specialists next week to decide whether to approve experimental treatment for Ebola.
Now joining us from New York to deconstruct the issues around the Ebola virus is our guest, Harriet Washington. Harriet is a medical ethicist and the author of the book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. And also she’s the author of the book Deadly Monopolies: The Shocking Corporate Takeover of Life Itself–and the Consequences for Your Health and Our Medical Future.
Thanks for joining us, Harriet.
HARRIET A. WASHINGTON, AUTHOR, MEDICAL APARTHEID: Thanks for having me.
DESVARIEUX: So, Harriet, the big news is that this serum that is ZMapp that I mentioned in the introduction was offered to the two American health care workers, and now they seem to be recovering. Why hasn’t it been made more widely available?
WASHINGTON: Well, what we’re told is that it’s not been made more widely available because there were initially only three doses. Of course, my first question was, why wasn’t it given to Sheik Umar Khan, the chief ebola health care worker in Sierra Leone who died just a week or so ago of Ebola?
DESVARIEUX: Then at the root of this would you say that the serum was—-essentially, whose interest is it for it not to be more widely available?
WASHINGTON: Well, it’s a very complex question. And I think–I’m not inclined to personalize it. Rather than asking whether a person has an inclination to deny it to Africans, my question is: what forces tend to separate drugs like this from Africans? There are networks, informal networks sometimes, of availability that are available to Westerners and not to Africans.
And there are also economic pressures. Decisions about the expense of producing large enough quantity of doses of this drug to give it to Africans is an expensive proposition, as it always is, and that is a factor as well. There’s a feeling among some that it would be too expensive to produce for African Americans. But my point is I always notice that they talk about the cost, but with they’re actually referring to is the price: it’s a manufacturer’s decision to impose a certain price, and that is what puts it out of the reach of people in the developing world.
DESVARIEUX: Yeah. And being out of reach for people in the developing world, I mean, there are going to be some real consequences. As I mentioned in the introduction, 1,700 people have been affected. More than 900 people have died from Ebola. So can we name some names here? Which kind of pharmaceutical companies are we talking about?
WASHINGTON: I’m not inclined to single them out by name, because what’s interesting about this is although most pharmaceutical companies are guilty of an economic mentality that tells them not to produce drugs for the needs of people in the developing world, an economist at Harvard, Michael Kremer, wrote some time ago about this tendency of pharmaceutical companies not to even test drugs for diseases of the tropical lands, because people there, quote-unquote, cannot afford them. In fact, if you look at the data, between 1975 and 1997, there were 1,233 drugs developed by pharmaceutical companies. Guess how many were intended for the use of people who lived in developing countries?
DESVARIEUX: How many?
DESVARIEUX: Wow. Only four.
DESVARIEUX: So, for you, at the end of the day, they might be testing them in developing nations, but they’re certainly not looking to these developing nations as being their market for these drugs.
WASHINGTON: Exactly. They certainly are testing them in developing nations. In fact, two out of every five clinical trials mounted by industry is conducted in the developing world. They go to the developing world not because they want to make drugs available for the people there, but because testing is cheaper and quicker, and time is money in testing. They have a narrow window in which to get approval. So it benefits the companies to go to these countries and get rather naive subjects, people who don’t have any kind of health care, so they have special pressures to get what care they can, even when it comes wrapped around a clinical trial. And they can do it more cheaply, they can do it more quickly, they can do more high-quality trials, because health care workers in the developing world ask for and make less money.
So I always say that although people portray Africans as poor people and speak about their inability to afford drugs, in reality we are the ones who owe them. They are making these drugs possible. They are making development of these drugs possible. They then don’t have access to them. So we are actually in their debt. If we have to pay a large amount of money to make Ebola drugs available to these people, that is what we need to do, not only from an ethical standpoint, but from an economic standpoint. That would be economic justice.
And we can’t, of course, forget the fact that we don’t know how and where Ebola will spread. It may never become a problem in the Western world, due to our better health care structure and our better public health infrastructure, but if it does, we’re going to need these drugs. And wouldn’t you prefer to have a drug against Ebola that’s already been tested in a clinical trial? So it’s to our advantage no matter how you look at it. It’s the right thing to do.
DESVARIEUX: Alright. Let’s pivot and talk about the reaction of Americans over this virus. There seems to besort of this level of hysteria here in the United States. For example, billionaire Donald Trump, he tweeted this message. Take a look at it.
“People that go to far away places to help out are great-but must suffer the consequences!”
Harriet after hearing that, what’s your response?
WASHINGTON: That’s pure Trump. I don’t know why we give this clown attention, frankly. I mean, I would hope he does not represent the mentality of most people. He is an especially–it’s just an especially callous and, frankly, uninformed response. I’m not even sure it demands response.
But, for those people, I think there is an interesting question, and which he managed to completely miss, and that is, when we talk about who’s going to get the drug, I believe the people who are affected and at risk in Africa should get the drug. Many people say that it should be health care workers who get the drug first. I see their point. They say the health care workers should get the drug first of all because Africa needs more health care workers, needs more people to deal with Ebola epidemics. And also they say that health care workers came out of selflessness and generosity. They did not have to be there and expose themselves to harm, that they are medical heroes. I could not agree with that more. But I also say health care workers who go to the developing world to help people there, especially in a crisis like this, are to be thanked and are to be praised, but they had made the decision for reasons of their own, and they need to assume the risks inherent in that choice.
DESVARIEUX: Okay. Let’s pause the conversation here, and in our second part of the interview, we’ll get into how West African nations are trying to contain the spread of the virus and the challenges that they face.
Harriet Washington, thank you so much for joining us.
WASHINGTON: Thank you.
DESVARIEUX: And thank you for joining us on The Real News Network.
DISCLAIMER: Please note that transcripts for The Real News Network are typed from a recording of the program. TRNN cannot guarantee their complete accuracy.