New Zimbabwe (London)

9 August 2014

Zimbabwe: Ebola - What Lies Beyond the Endless Conspiracy Theories?

opinion

I would like to commence with a foreword to readers. This is a general commentary about some of the issues I personally believe are barriers to our progress as Africans. I will also highlight some issues without going into technical details. Most of my thoughts have been provoked by unfolding and unfortunate Ebola events in West Africa, and the comments about the West's 'intentional' poor response to the so called "African problem".

Well, I don't know where to start. It would be fitting maybe to begin by saying that developing and testing a treatment or vaccine takes decades, especially for viral infections. It's the reality we can't run away from. Even if you develop a vaccine or treatment for those several years, the chances of it being effective to be accepted in practice is less than 20% - much, much lower for viral infections. This is one reason among many why we are still struggling with HIV today. With all these issues, it means that there are enormous resources committed upfront with huge uncertainty about the success of new treatments or vaccines.

Due to this challenge, most medical breakthroughs in drugs and vaccines are being led by pharmaceutical companies such as: http://www.currentpartnering.com/insight/company-tracker/top-50-pharma/. What drives these companies is commercial interest, irrespective of their location or target market. It doesn't matter whether it's in Asia or Africa. That should not be mistaken. That is why Apple and Samsung are almost everywhere (not sure about North Korea). Therefore, like any other business model, there is a key element of prioritisation regarding which molecules (treatments or vaccines) to pursue to maximise their profits. It's not robotic science to see that factors such as burden and seriousness of the medical condition come into play.

Nowadays, consideration is also given to whether you are targeting a cure (unlikely) or vaccine or even trying to modify the disease to make it chronic instead of being fatal (such as ARVs for HIV) or risk factors of the disease such that it becomes manageable (such as Statins). In an ideal world you would want medical innovation which cures diseases, but everything is muddled by the commercial interests. One important point to note is that governments offer massive incentives for companies to develop treatments for orphan diseases - those affecting a very small fraction of the population. It's the name of the game in "developed" countries; otherwise there wouldn't be any incentive for companies to spend billions only to get millions in return.

There has been a lot of comments and noise about pharmaceutical companies in the "West" not doing enough to come up with a treatment or vaccine for Ebola because it's an "African problem" - some have even reached a point of calling it an "African disease". Fair enough, that's freedom of opinion which is a right to everyone I suppose. We have seen this trend from Malaria to HIV and I suspect it won't end. However, the same arguments don't even apply to cancer in developing countries regardless of billions spend on treatment and in search of a cure for so many years. It's a blinded side of the arguments we don't see and hear about a lot.

On the contrary, it's in the national and security interest of developed countries to contain outbreaks because the spread doesn't have boundaries in this modern world. Whilst suspicion is a key trait for survival in a complex and competitive environment, too much dwelling on it dwarfs our reasoning and limits us from foreseeing what lies beyond it. We can't even diagnose the underlying source of the so-called African problems. For your own information, since the outbreak of Ebola different molecular compounds have been under development by the pharmaceutical industry but this is shrouded in secrecy due to strategic commercial interests. One such drug in the pipeline but in early stages is TKM-Ebola developed by Tekmira Pharmaceutical Corporations (http://www.tekmira.com/pipeline/tkm-ebola.php).

Firstly, whose primary responsibility is it to provide health care and championing medical innovation to African citizens for emerging problems? Is it Pfizer or GSK or African governments or the West? Of course there are global initiatives to facilitate and foster the notion of health for all through organisations such as WHO but honestly, someone has to take responsibility. Who is supposed to take the first punch in this blame game? I'm sorry, but I would point my finger at African governments without hesitation. Some may choose otherwise for some reasons - I'm yet to be swayed by even 1% to do so. Second, confidentiality is very important to these companies - they don't just disclose compounds under development until it's under testing or showing promising results for commercial reasons. Moreover, it takes decades of frustration for them to develop one.

The news that Nancy Writebol received an "experimental serum" and Dr. Kent Brantly a blood transfusion from a patient who recovered from Ebola were received with outrage in some quotas who believe that the West AGAIN is not doing enough because it's an "African disease". I am getting irritated with this notion. Well, I understand it's the freedom of expression that people need to have but a sense of responsibility also encompasses it. What is most disturbing is that most, if not all, of these conspiracy theorists don't even know the ethics and regulatory frameworks underpinning drug development and testing.

Let me be cynical for a bit. To start with, there has been outrage about the West using Africans as guinea pigs in some experimental trials. I am not disputing or agreeing with that notion. I understand the level of suspicion given some historical cases such as Dypraxa and Trovan. That is why there are ethical and regulatory bodies in every country governing the testing and use of medicinal treatments in humans. The use of "untested experimental treatments" in humans requires ethical approval even in cases of emergency or serious outbreaks.

It's the responsibility of individual countries within their regulatory and ethical frameworks to come up with such arrangements. It's not the responsibility of FDA in the US or EMA in Europe to govern use and approval of medicines in African countries. That should not be mistaken - responsibilities lie with individual countries. Thus, FDA or EMA cannot authorise the use of experimental treatments beyond their jurisdictions. The consequences of unethical use of medicinal treatments are dire and there is no pharmaceutical company willing to take that risk. It's unacceptable - period‼

What is required in most African countries is the ethical flexibility enshrined within regulatory statutes governing the use of "experimental" treatments in exceptional cases such as serious outbreaks and emergencies. It's a trade-off between unknown efficacy and safety profile given the seriousness of the situation at hand. Giving something in such cases is better than nothing, but it's not that straightforward. Most western countries have some contingency plans for this - that is why American citizens were treated with untested experimental drugs within the US regulatory framework.

Most importantly, the nationalism enshrined in the culture of some countries dictates that they have to take every step necessary to save the lives of their citizens regardless of where they are. These are the values that have kept generations going and are cherished by societies. Even in such societies you always get muppets - well, nincompoop like Donald Trump who are self-absorbed and ignorant to the extent that they can't even think of helping their own.

To sum it up, every society has extremes. So what's the problem about a responsible government taking care of its own citizens in times of need? I would be grateful if my Zimbabwean government could do the same for its citizens. Well, I'm allowed to day dream, am I not?

But let's get this right - it's in the national and security interests of western countries to contain outbreaks of infectious diseases no matter how localised they are. Infectious diseases don't have boundaries and that is the reason why millions are spent fighting diseases abroad. Failure to do so will directly or indirectly undermine their future national security.

Just to put my basic points across; first and foremost, African governments must take the lead to facilitate innovation from medicines to engineering. Collaboration with private players is imperative but governments must lead the way in creating a conducive environment. Leadership is my beloved continent's curse. Where is the collaboration between governments on research of mutual interests? What has been done by African countries since the first outbreak of Ebola in 1976? Your guess is as good as mine. We spend millions a year - billions in few years keeping ourselves in so called "power" at all costs, despite the crumbling health systems, education, industries, quality of life, etc.

We have "Black hole" budgets on unnecessary security vis-à-vis other pressing social and economic issues can't even be mentioned. Corruption is the order of the day - if you can't do it you become a fool. Even the fight against diseases such as malaria, TB, HIV and cancer today is being led and funded by foreigners. We have an ancient disease like cholera killing thousands these modern days. This is shameful and a travesty indeed. Next morning these are the same people who we say the West is not doing enough for our problems. Hang on, what the hell is that‼

Second, the issue of nationalism has gone to the dogs. Some of the people who pretend to be the architects of it are just hiding behind a needle. Some of them are the ones pillaging national resources and running cartels. Wealth generation for families is beyond imagination. Resources to run a political party are even more than those of the government itself. Have you ever heard that the government sent resources to SA to help citizens under xenophobic attacks? Those are values of nationalism which differentiate prospering and visionary nations from those going under for good. There are issues and values we should learn from the West as well as from the East.

It's a shame to see leaders today climbing on top of mountains denouncing certain countries for their myopic political games at the expense of the whole nation; you just have to question their wisdom and mental capacity. Only those nations capable of balancing relations while moving with the tide are the ones destined for greatness. Too much emotion and conspiracy blinds our reasoning. Listen to what they say, but don't believe it all and don't bury your sense of reasoning. We need new young leaders with raw nationalist values and an understanding of today's modern challenges. Gone are the days of blaming the West for all of our problems.

Munya Dimairo is a Research Fellow in Medical Statistics with interests in Political Science. Views are my own and no conflict of interest to declare. Happy for any related constructive debate on the matter.

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