This article in the New York Times points out a problem in medicine and the pharmaceutical industry: how to support research and development of treatments and vaccines for rarely occurring diseases or conditions that only affect the poor. As Ebola shows today these diseases have a habit of becoming egalitarian real quickly, citing the Ebola virus and the discovery of a vaccine 5 years ago.
Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.
Instead pharmaceutical companies chase after profits, meaning that in the US tens of billions of dollars are spent on new erectile dysfunction drugs and cosmetic treatments such as botox injections, yet treatments for diseases that kill in poor countries such as malaria and chikungunya, or those that only affect a few in wealthy countries have to rely upon charity to fund their research.
Diseases don’t check your bank account before they infect you. Sure some diseases are more prone to the poor than wealthy due to sanitary conditions and other factors, but not all. A disease that strikes the poor abroad can easily take up residence among the wealthy at home, as the spread of HIV proved in the late 1970’s through early 1980’s, moving from Haiti to wealthy enclaves in the US.
So the question arises: How do we develop treatments for diseases that are uncommon and/or appear only in poor countries? Providing money to prevent an Ebola vaccine from being shelved is not a completely altruistic act given the reality of how contagious the disease is. The dollars spent today will not only save lives over there, they will also save our lives here. But how do we fund it?
Although I hate taxes in principle, why not levy a 5% tax on all elective surgeries and lifestyle drugs? That money could be placed into a pool and used to provide grants for the research and development of treatments for diseases that are too rare to justify researching, or to subsidize treatments of diseases like malaria, Guinea worm, and drug resistant TB. Alternately the corporate tax laws could be amended to deduct the costs spent on these diseases on a 1-1 basis: for each dollar spent a firm’s tax burden is reduced by a dollar. Neither is a perfect solution and both are prone to avoidance, abuse and the usual “unintended consequences” which are inevitable in any public policy change, but the Ebola scare in the US should serve as a wake up call.
Almost a hundred years ago the Spanish Flu influenza virus swept through the country, killing millions of Americans in their primes. It touched every family, rich and poor, black and white, immigrant and native born. In my own family it killed a great-aunt and a young cousin and left two other cousins orphans. A few decades later Jonas Salk tamed the beast of polio which had been the dread of all families that came with the approach of the cool autumn. For the past half-century only HIV has risen to the level of concern, but that virus is actually quite hard to catch. It doesn’t survive outside the body of its host for long and cannot penetrate the skin. Besides we have tamed that with anti-virals, turning what had once been a death sentence into a chronic condition.
Ebola has more in common with the Spanish Flu than it does HIV. It can survive for lengthy periods on surfaces outside of the body. It can penetrate the skin. There is evidence that it can be transmitted through the air. And besides Ebola there are other viruses lurking abroad just a flight away from our borders such as MERS and SARS. Each plane arriving here is a dice throw, and eventually we are going to be on the losing end of the odds.
The recent Ebola scare in the US has shown the authorities are not prepared for another pandemic. It has also showed us the limits of our health care system. We need to take these lessons and learn from them to prepare ourselves and our society for the next thing Mother Nature is going to throw our way. But America has a wonderful habit of hitting the snooze alarm until the very last minute. Hopefully it will awaken before more die here and millions die there.