What should we learn from West Africa’s Ebola outbreak? – By MG Zimeta
The recent outbreak of Ebola virus in West Africa has captured international public attention that seems disproportionate to the scale of the outbreak itself. This is not surprising. Ebola is a communicable disease – that is to say, it is transmissible between humans. In this regard, Ebola is unlike, for example, obesity, which affects c10-30% of adults in Europe and which the WHO has identified as one of the greatest public health challenges of the 21st century. The Ebola virus also has a long incubation period – up to 21 days before symptoms become detectable; and a high fatality rate – up to 90%. The communicability of Ebola, and the long incubation period of the virus, mean that an outbreak may not be contained to a small geographical location, and may become an epidemic. Given the globalised nature of trade and travel, the stakes might be even higher: a pandemic.
An obvious approach to the management of a communicable disease is to respond to an outbreak by trying to contain the disease. This is the approach that we have seen in West Africa in recent weeks. In this, the Ministries of Health of Guinea, Liberia, Sierra Leone and Mali have been swiftly and robustly supported by a number of international organisations. There is an alternative approach to the management of a communicable disease: development of a cure or a vaccine. It has been widely noted that there is currently no known cure or vaccine for the Ebola virus; the reasons for this have been less well noted. The new possibilities of globalisation for travel and trade may lie at the heart of the international alarm about the current Ebola outbreak; but these new possibilities of global travel and trade may also be core to the reasons why there is not yet a cure or vaccine for Ebola.
One such reason may be financial. Research into Ebola must take place in research facilities that meet the highest level of micro-biological containment – Biosafety Level 4 (BSL-4). Under BSL-4 directives, a research facility must include strict and extensive physical and procedural safety features, including physical isolation of the research facility, a dedicated and non-recycling ventilation system, and meticulous decontamination procedures for any personnel or objects entering or exiting the research facility: one researcher described BSL-4 labs as being like “a submarine inside a bank vault”. But these biosafety features are expensive: a typical BSL-4 lab may cost around 2.5m euros annually (or c£2m or c$3.4m) to maintain. These high costs would make it very difficult for the government of a developing world country, like Guinea, to run a research programme into the most dangerous diseases like Ebola. Thus the overwhelming majority of BSL-4 labs are in North America and in north-west Europe; according to 2010-11 data, only 2 out of 42 known BSL-4 labs internationally are in Africa; none are in South America.
These financial reasons lead to ethical and legal issues. The high cost of specialised research facilities creates the conditions and opportunities for biopiracy against communities of developing world countries.
Science reported on the controversy behind Captropil, a drug for hypertension produced and marketed in the 1980s. Brazilian tribes, knowing that the Bothrops jararaca viper’s venom thinned human blood, used it as a poison with which to coat their arrow tips. Academic research at a state-funded institute in Brazil about the poisons used by the indigenous tribes isolated a unique peptide responsible for the venom’s effect. This academic research was the genesis of the commercial development by US company Bristol-Myers Squibb of a drug whose active compound was a synthetic mimic of the active compound of the peptide in the Bothrops jararaca pit-viper’s venom: Captopril.
None of the commercial or medicinal benefits of Captopril were shared by Bristol-Myers Squibb with the indigenous Brazilian tribes or the Brazilian government. In their defence, the researchers at Bristol-Myers Squibb pointed to the significant capital investment and scientific ingenuity that had gone into creating a suitable synthetic compound. It may well be that a possible cure for Ebola can be found among the natural resources local to the virus’ origins – including in the DNA of local human or animal populations. But appropriate research facilities have not been created in those regions; and there is a strong chance that successful research conducted outside those regions need not be shared.
These ethical and legal issues lead to difficult political calculations and impasses. In a 2004 speech, Dr Gro Harlem Bruntland, former Director-General of the WHO and former PM of Norway, remarked: “[W]hile we diligently take anti-malarials and top up our vaccinations when we travel to developing countries”‰–”‰the people living there, those threatened most by these diseases”‰–”‰don’t have this access.” In this context, it is perhaps not altogether surprising that in 2006, Indonesia, the country with the highest number of deaths from avian flu cases at the time, withheld flu samples from the World Health Organization and instead gave them to a private pharmaceutical company – intending, apparently, to broker a deal for that company to develop a bird flu vaccine tailored to the Indonesian strain of the flu, and on commercially favourable terms for the Indonesian government. The Indonesian government explained that many developing world countries “did not want their flu strains made into patented vaccines that only rich countries could afford.”
The Nagoya Protocol, established in 2010 under the UN Convention on Biological Diversity, was created to protect biodiversity and to counter biopiracy by ensuring that the benefits of research into natural resources are shared equitably. The Protocol itself is a success, in the spirit and detail of the agreement secured. But participation has been disappointing. The Protocol needs to be ratified by at least 50 signatory countries to become active, but so far only 29 of the 92 signatories have ratified it. Of the 29 who have ratified it, only one is an affluent, industrialised, Western country: Norway. Countries that have neither ratified nor signed the Protocol include China, Russia, Canada, and the USA.
Early indications are that the Ebola virus outbreak in West Africa, though unprecedented, is being successfully contained. But questions will remain about why, when it comes to Ebola, we settle for containment.
Dr Mahlet Zimeta is lecturer in Philosophy at University of Roehampton and Honorary Research Associate at Department of Science and Technology Studies, UCL; M.Zimeta@roehampton.ac.uk