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September 24, 2018

Why Ebola Is A Tough Business Case

Volunteers lower a corpse, which is prepared with safe burial practices to ensure it does not pose a health risk to others and stop the chain of person-to-person transmission of Ebola, into a grave in Kailahun July 18, 2014. Hundreds of troops were deployed in Sierra Leone and Liberia on Monday to quarantine communities hit by the deadly Ebola virus, as the death toll from the worst-ever outbreak reached 887 and three new cases were reported in Nigeria. Picture taken July 18, 2014. REUTERS/WHO/Tarik Jasa...
Volunteers lower a corpse, which is prepared with safe burial practices to ensure it does not pose a health risk to others and stop the chain of person-to-person transmission of Ebola, into a grave in Kailahun July 18, 2014. Hundreds of troops were deployed in Sierra Leone and Liberia on Monday to quarantine communities hit by the deadly Ebola virus, as the death toll from the worst-ever outbreak reached 887 and three new cases were reported in Nigeria. Picture taken July 18, 2014. REUTERS/WHO/Tarik Jasarevic/Handout via Reuters

It is difficult to disengage from the Ebola coverage at the moment. Even if you follow it from a public interest/current affairs perspective, I am sure you probably have had some very emotional, personal reactions, too. Two of those stayed with me: One to a comment from a doctor that there was no good death to be had with Ebola – that you die not just miserably, but in isolation. And then to the story of Patrick Sawyer, the Liberian American man who flew from Liberia to Lagos despite knowing his health status and died shortly after his arrival, infecting more people.

It is easy to hate and condemn Sawyer for doing this – surely a supremely selfish and dangerous action, even if he seemingly tried to avoid physical contact with people on the way. But I can’t even begin to imagine what you feel and how you react when you realise that you are infected with Ebola.

Every single, individual story is horrific beyond my imagination. And maybe because we all react so strongly, there are two strands of reporting in the media, and general internet writing. One, carefully trying to pick up what we do know with some certainty about Ebola and another one a fertile swamp of conspiracy theories.

Chief amongst them is the narrative that ‘The West’ (whatever exactly that is) and its pharmaceutical industry will happily watch hundreds of Africans die. The British Independent didn’t really help with misreporting a piece in its own Independent on Sunday, claiming that ‘Britain's leading public health doctor today blames the failure to find a vaccine against the Ebola virus on the "moral bankruptcy" of the pharmaceutical industry to invest in a disease because it has so far only affected people in Africa – despite hundreds of deaths.’ The original piece is far more nuanced, and considerably less targeted at the pharmaceutical industry. Still, the accusation quickly made the round on social media: ‘The West’ is not developing an Ebola cure because it’s only Africans who die, and pharmaceutical companies are evil for just wanting to make money.

Of course there are lots of issues with the pharmaceutical and medical industry and the fact that it is an industry. But it also has achieved extraordinary things, whether it’s the sweet relief of popping an antibiotic for cystitis that water won’t flush out, or the miracle of organ transfers. Pharmaceutical research and product development are expensive, very very expensive. If you cannot make a profit on this, your company will go bankrupt: The end result of that is that there will be no more research and development at all.

Purchasing power is a challenge in sub Saharan Africa, that’s true. But for many drugs, there have also been longstanding discussions around allowing generics to make them more affordable, and also concerted multinational efforts like the Global Fund to provide drugs, and finance research into drugs for markets with low purchasing power. Ebola, however, as horrible as it is, has simply not been a large enough market so far: outbreaks were usually contained reasonably quickly, and several hundred deaths – probably even a couple of thousands – would still pale into insignificance compared to the annual deaths from malaria or tuberculosis.

The WHO estimates that around 25,000 people have died from TB in 2011 (although around two thirds of those also had HIV). There are simply plenty of other deadly candidates with a much larger market out there. Ebola has so far been very much an ‘African’ disease not because of anything specific human African characteristics, but because of the virus living in African animals. One of the modes of transmission is thought to be through undercooked bush meat. But the neglect of the pharma industry has little to do with this. There are a host of diseases around the globe that affect a tiny number of people, and they all struggle with the same challenge of not being a viable market.

Should governments then not chip in? Well, maybe, maybe not: governments have limited resources, and the many people affected by, say, malaria and TB might object to such scarce resources being diverted to diseases that affect only a very small number of people.

And there is also the point that the recent outbreak was so catastrophic because local healthcare systems in the affected countries are weak and inefficient. If there is no way of reliably updating healthcare staff on the status of the Ebola outbreak, and measures to be taken, if there are too few healthcare staff, if there are too few or counterfeit drugs, if there are no facilities (and it doesn’t take complicated ones) to take care of patients, if healthcare staff don’t have enough protective clothing, and if you can’t even ensure that nurses get the USD30 a week in hazard that they were promised for such a gruesome and dangerous job: then this is where your primary weakness lies. Rather than ask for millions of dollars to be spent on research on a drug for a few hundred to thousand people, maybe it’d be far more sensible to ask for those healthcare systems to be fixed – which would then also have an obvious benefit for all other diseases.

And for all the outrage against ‘The West’ giving two of five available courses of a very early-stage, largely untested drug to two American volunteer medical professionals: where are the African pharma firms researching the African solution to Ebola? Public hospitals in Uganda, the recent aid suspensions showed, are largely financed through aid (by ‘The West’?) – why are we not, first and foremost, raging at African governments for abdicating their responsibility towards their own citizens?

The writer is an independent country risk analyst

 

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