Pharmaceutical greed clouding science
The germ may be as old as the earth. It infects animals including cows, birds, fish and reptiles. Its first evidence in humans is from Germany, dating back to 5000BC. It has also been found in the spines of mummies dated around 2500 BC. By the mid 17th Century, it became epidemic in Europe and the USA, where it was called the ‘white plague’.
By the turn of the 19th Century, it was killing about 7 million people per year. London and New York were two of the worst affected cities. This led to the fear that by the end of the 19th Century, European civilization might be destroyed by this killer disease.
In 1882 in Germany, Robert Koch discovered the bacterium that causes this disease. In 1931 in France, Calmette and Guerin made the first live vaccine, termed Bacillus Calmette-Guerin (BCG). In the USA in 1942, Feldman and co-workers reported the first drug trial (Promin) in the treatment of the disease. Unfortunately this trial was unsuccessful due to significant side effects. In January 1944, Schatz et al announced to the world the discovery of a drug called Streptomycin.
In 1946, Lehmann discovered Para-Amino-Salicylic (PAS) in the treatment of the disease and in 1952 at Seaview Hospital, New York, a new wonder-drug called Isoniazid was used to treat patients.
In 1960, John Crofton proposed a triple combination of Streptomycin, PAS and Isoniazid and declared war to conquer the disease. His proposals included the pasteurization of milk, testing of cattle, BCG vaccinations of whole human populations, mass radiography for the early detection of disease, triple therapy for every infected patient, isolation of the infectious patients and reduction in household overcrowding.
In case you are wondering, this is part of the medical history of Tuberculosis (TB), a disease now treated by Directly Observed Treatment Short-course programs (DOTS). DOTS combines five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems and use of highly efficacious drugs with direct observation of treatment.
But why all this history? Thirty-six years into the gene revolution, science can triumph over disease if it is not clouded by pharmaceutical greed. I believe that the methods to discover a vaccine or a cure to diseases facing humankind today- including AIDS- are available to the scientific community if only there was a global urgency devoid of geopolitical neglect and profiteering greed. Notably, as long as these pharmaceutical companies continue to rake huge profits from anti-retroviral drugs, we can forget about a cure or a potent vaccine for HIV/AIDS.
This is not an empty accusation, because we have seen it with malaria, a disease that kills one million Africans per year. Is there a good vaccine to prevent malaria? No. Why? Because malaria is largely an African problem, that is the first point. Secondly, the big companies are busy making money by selling anti-malarial drugs, so there is no urgency to discover a vaccine.
On the contrary, the history of TB illustrates the point that when a disease threatens American and European societies, potent treatment drugs and vaccines are found without procrastination. See how a vaccine for bird flu is on the horizons? But my fear is that if the western research and pharmaceutical worlds neglect diseases that burden millions of poor people in developing countries, there is a real possibility this may cede moral ground to extremist behaviour among pro-poor activists.
Away from drug politics, TB is a contagious infectious disease caused principally by Mycobacterium tuberculosis. Transmission occurs when airborne droplets of TB germs are propelled into the air by a patient with pulmonary TB (TB of the lung). Infectious people can propel these droplets by talking, sneezing, spitting and most notably coughing. One cough from a pulmonary TB patient produces up to 3000 droplets. Only people who have active pulmonary TB can transmit the bacteria, though, in fact, only about half of these people are contagious.
A person infected with TB does not necessarily feel ill- and such cases are known as silent or “latent” infections. When the lung disease becomes “active”, the symptoms include a cough that lasts for more than 2-3 weeks, weight loss, loss of appetite, fever, night sweats and coughing up blood.
The rise in the number of TB patients has also coincided with the rise in HIV infection rates. TB affects many people living with HIV and it is likely that 50 per cent of HIV patients will get TB at some point in their lives. The WHO estimates that TB accounts for up to a third of AIDS-deaths worldwide.
The World Health Organization estimates that 9 million people get TB every year, of whom 95% live in developing countries. An estimated 2-3 million people die from TB every year, that’s more than 10,000 people everyday- one person every 10 seconds.
TB is killing more than half a million people a year in Africa. In Mozambique, 30,000 TB cases were diagnosed in 2004, but this is likely to be an under-estimation because many people in rural areas are unable to seek treatment. South Africa will have 300,000 cases and 30,000 deaths from TB this year. Of the estimated 25 million Africans now living with HIV, about 8 million are infected with TB.
Stigma is now extended to TB patients and in some communities, TB is synonymous to HIV infection. This means that some TB-infected people do not seek medical attention for fear of knowing their HIV status and others prefer TB treatment without testing for HIV.
When a strain of TB is resistant to two or more ‘first-line’ antibiotic drugs, it is called multi-drug resistant TB (MDR-TB). When it is resistant to three or more ‘second-line’ antibiotics as well, it is classed as extreme drug resistant TB (XDR-TB).
Drug resistance usually arises when TB patients do not take their medicine as prescribed, and drug-resistant mutations of the TB bacteria are allowed to replicate. People can also catch MDR and XDR-TB from others. More than 50 million people worldwide are infected with MDR-TB.
l KC is lecturer at the University of Namibia. Email: firstname.lastname@example.org