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The Economics of Infection

Ebola is a truly frightening disease, with a fatality rate as high as 95 percent (although the death rate in the current outbreak in West Africa is only 55 to 60 percent).

It could get much worse. If Ebola successfully made the jump to a more prosperous, densely populated country like Nigeria, whose citizens travel all over the world, the current 800 recorded deaths could become 8,000, or 80,000, or even more. And the worst of it is that there is no effective vaccine or treatment for Ebola.

Let me rephrase that. There is no approved vaccine or treatment for Ebola. There are candidates, some of which have shown promising results when tested on non-human primates. But they haven’t gone through the full testing process that is necessary before they are approved for human use, because nobody was willing to pay for it.

The normal procedure in the United States, home to more than half of the world’s major drug companies (“Big Pharma”), is that basic research for new drugs may be paid for by government grants or even by private philanthropy (like Bill Gates’s $200 million donation for research on a malaria vaccine), but the work of bringing the drugs to market is left to the commercial companies. All too often, they simply can’t be bothered.

It costs hundreds of millions of dollars to take a drug through the whole approval process and put it on the market. That’s worthwhile if the drug will then sell at a high cost and be used regularly over long periods of time: a drug that fights “rich people’s diseases” like cancer or heart disease, say, or even something like Viagra.

But a one-shot vaccine that would mainly be used by poor Africans will never make a profit, so it is ignored.

Galvanized by the panic over Ebola, the National Institutes of Health in the United States has now scheduled phase one trials of an Ebola vaccine on human subjects for next month. But there are two more phases after that, and the earliest a vaccine could be approved for general use is next July. And even in this emergency, it’s public money, not Big Pharma, that is funding the research.

The problem goes much wider than Ebola and other tropical diseases. It extends, unfortunately, to the antibiotics that vanquished the bacterial infections that were once responsible for about 25 percent of adult deaths.

The last new class of antibiotics, carbapenems, was approved in 1980. Since then, nothing—even though the usefulness of existing antibiotics is rapidly eroding as resistant strains of bacteria emerge.

That’s a big threat, but antibiotics are still not big money-makers, as they are used for relatively short periods of time to fight some specific infection. So no new type of antibiotic has been developed by Big Pharma for more than three decades.

A minimum of 23,000 people in the United States died last year of infections that would once have been easily ended by antibiotics; in the European Union the total was 25,000.

There are some measures that would dramatically slow the spread of antibiotic-resistant bacteria. Far fewer prescriptions should be written for antibiotics, and doctors should be monitored to ensure that they are not over-prescribing. Patients must complete any course of antibiotics that they begin, and report that they have done so. Over-the-counter sales of antibiotics in countries like China and Russia must cease.

Above all, it should be a criminal offence to feed antibiotics to animals just to make them grow faster and bigger. (That is where 80 percent of the antibiotics consumed in the United States go at the moment.) And even when all that has been done, the rise of antibiotic-resistant bacteria will continue, though at a much slower pace. Bacterial resistance is an evolutionary process that can only be slowed, not stopped.

So we desperately need new antibiotics, and there are none forthcoming. Without them, warned Dame Sally Davies, chief medical officer for England, “Modern medicine would quickly go out of the window.”

Almost all surgery, including things as commonplace as caesarian sections and hip replacements, and most cancer treatments as well, involve a significant risk of infection that must be controlled by antibiotics. As Prime Minister Davd Cameron told The Time”: “If we fail to act…we are cast back into the dark ages of medicine, where treatable infections and injuries will kill once again.”

Yet Big Pharma will not fill the gap, for those companies are answerable to their shareholders, not to the public. The case for direct state intervention to finance the development of the vaccines and antibiotics that the commercial sector neglects is overwhelming. And very urgent.