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Ebola Vaccines: Who Cares About Ethics When Money Is Concerned?

Ebola has found its way from Liberia to Texas.  If the press is any indication, you might say that we in the West have finally awakened and smelled the proverbial coffee.

According to the World Health Organization (WHO), as of Sept. 23 approximately 6,600 people were confirmed with, or suspected of, Ebola infection and 3,100 deaths were reported, none in the U.S.  (Because of underreporting, the true numbers are likely much higher.)  Infections are multiplying rapidly in three West African nations: Guinea, Liberia and Sierra Leone.

Ebola viral disease is a deadly infection spread mainly through direct contact with the bodily fluids of symptomatic individuals, including corpses.  There is no indication that the recent outbreak has gone airborne.  This is positive because transmission can be controlled through isolating and treating infected individuals as well as using other ordinary techniques of infection control.

Nevertheless, the African outbreak is the worst on record and the countries most affected face enormous challenges implementing effectual control measures given the expanse of infected territory.  The Center for Disease Control and Prevention (CDC) reported [1] on Sept. 26, 2014 that in Liberia the number of infections are doubling every 15–20 days; and in Sierra Leone they are doubling every 30–40 days.  And The Washington Post reported [2] on Sept. 19 that by the end of January, the epidemic could infect up to 500,000 people.

The international aid effort is enormous.  The U.S. has committed more than $100 million; the EU more than $180 million; and private organizations such as the World Bank and African Development Bank, tens of millions of dollars.  Pharmaceutical giants like GlaxoSmithKline (GSK) and Johnson & Johnson (J&J) have turned full attention to vaccine development and are poised to make windfall profits. 

Many experts are saying that containment will not be possible without a vaccine.  This is obviously a problem since effectual vaccine development can take years.  Given the extent of the crisis, everyone admits that ordinary protocol will have to be set aside.  The WHO hopes [3] to see “small-scale” availability of the first experimental vaccines by January 2015.  How many people did The Washington Post say could be infected by then?

The 64-million-dollar question: Why hasn’t there been an effective Ebola vaccine for humans developed before now?  We’ve known about the virus since 1976.  The CDC clearly records [4] over 33 outbreaks worldwide in the past 40 years (not including the recent epidemic) in which nearly 2,400 people have been infected and 1,600 have died.  Why no human vaccine?

Isn’t the answer obvious?  Till now, Ebola wasn’t profitable.  The human lives it has consumed since 1976 are not believed to be worth the investment.  Consider the numbers.  Of the 33 occurrences, 23 have been in African countries.  Of the ten occurring outside of Africa (England, U.S., Russia, Philippines), a total of two people have died.  Two.  Both in Russia.  All the rest have occurred in Africa, most in the Republic of the Congo (formerly Zaire).  In 1976, 318 people were infected in the Congo and 280 died; in 1995, 315 were infected and 250 died; in 2002, 143 were infected and 128 died; and in 2007, 264 were infected and 187 died.  Uganda got hit with a serious outbreak in 2000: 425 people were infected and 224 died.  In addition, Sudan has had 335 infections over the years and 180 deaths; Gabon 150 infections and 100 deaths.  And so on.

If instead of the Congo, Uganda and Sudan, the infected regions were San Francisco, London and Munich do you think it would take forty years for the U.S. and E.U. to pony up sufficient funds for a vaccine or for executives at GSK and J&J to “prioritize” the project?

Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, told Scientific American [5]two months ago: “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.”  And again, in USA Today [6], “We never could get any buy-in from the companies.”  To be more precise, we’ve had a highly-effective [7]Ebola vaccine for primates for nearly 15 years.  As one commentator has said [8], the human vaccine has been “within spitting distance.”

The outbreak began in Guinea almost a year ago and was first reported to the WHO on March 23, 2014.  In early August, the WHO announced that the epidemic was a “public health emergency of international concern.”  “International,” of course, meant “intercontinental.”  It’s been an international concern on the continent of Africa for four decades.

Ebola has been taunting the world for 40 years.  But obviously from what most in the Plutocratic West consider the back seat of an old car.

John Ashton, president of the UK Faculty of Public Health, writes [9]: “We must also tackle 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.”

Scandal is right.  For us in the “international community” it’s early in the morning in the Ebola outbreak.  For our brothers and sisters in the Congo and Uganda, it’s high noon.

It is about time we sat up and took notice.

 

Bioethics
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Ebola has found its way from Liberia to Texas. If the press is any indication, you might say that we in the West have finally awakened and smelled the proverbial coffee.
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