Friday, March 30, 2007

Vaccines for neglected diseases in Africa

The big news this week in health and the developing world was the announcement by super pharma giant Glaxo Smith Kline (GSK) has initiated the registration process for Globoxis, a conjugate meningitis vaccine. The press releases have been careful to note that GSK will marketing its vaccine at a price that stands zero chance of recuperating the R&D costs (estimated at $400 million) the company put into Globoxis. GSK’s initiative aims to showcase the company’s commitment to the eradication of preventable but neglected diseases suffered by impoverished populations. Undoubtedly, here is another corporate public relations exercise, but if the hype-and-spin saves hundreds of thousands of African infants through low-cost, mass vaccination campaigns, bioethicists shouldn’t sniff too much at it.

Another item out this week offers a cautionary note. In a PLoS Medicine article, Ayodele Samuel Jegede analyzes why three states in Nigeria boycotted the polio immunization campaign back in 2003. As Jegede describes it, there were a number of factors at play, including the rumor (fed by US military involvement in Iraq) that the vaccine would be used by the Western world to make people in the Muslim areas of Nigeria infertile or infect them with HIV. Another factor was the 1996 scandal of the Pfizer Trovan trial, where the experimental antibiotic trovafloxacin was tested against the standard of care during a meningococcal meningitis outbreak in Northern Nigeria. But the factor that struck me was that communities in Nigeria were reluctant to embrace the very idea of free vaccines. Jegede quotes from a report in the Baltimore Sun:

The aggressive door-to-door mass immunizations that have slashed polio infections around the world also raise suspicions. From a Nigerian’s perspective, to be offered free medicine is about as unusual as a stranger’s going door to door in America and handing out $100 bills. It does not make any sense in a country where people struggle to obtain the most basic medicines and treatment at local clinics.

Successfully vaccinating a population apparently involves more than just making it cheap. It remains to be seen whether GSK’s commitment extends to the nitty-gritty work of engaging with local communities to find appropriate ways of putting new high-tech drugs into the bodies of African children.


Blogger Daniel Goldberg said...

Evans-Pritchard's classic account of witchcraft among the Azande explains that the very idea of a gift of medicine is suspicious, at least among the Azande. It is insulting to offer nothing in exchange for a therapeutic intervention, not least of which because among the Azande offering nothing for an intervention signals the individual's belief in the therapeutic potential (i.e., none at all).

At least among the Azande when Evans-Pritchard was writing, the very idea of free medicine was problematic.

3:05 PM  
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9:04 PM  

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