Cures for the Poor

Today we took our infant son to the doctor for his regular checkup and vaccinations. We do not relish these visits. We gang up on the baby; I restrain my son’s hands, my husband pins his legs, all so the nurse can administer four different vaccine shots. The baby screams, later becomes lethargic and fussy, and may develop a fever or rash. And no wonder we have just introduced small amounts of deadly diseases into his healthy body, to encourage him to develop immunities to illnesses that might later save his life. We watch him carefully overnight for any signs of adverse reactions to the shots. In two months we’ll go back and do it all over again.

Much as we detest this duty, we are blessed. We have access to high quality medical services and insurance. Many do not. Thousands of unvaccinated children and teens in Maryland were recently barred from attending school. But at least vaccines exist for our diseases.

Internationally the problem is much worse. Every 30 seconds a child dies from pneumonia. It is the leading childhood killer worldwide, killing 1.9 million children a year, according to the Bill and Melinda Gates Foundation. Most families around the world do not have the option of vaccinating their children against diseases like pneumonia. Cures aren’t developed for the poor. In the United States, infants receive vaccinations against the most common strains of pneumonia here, streptococcus pneumoniae, at a cost of $40 to $60 a dose. This cost is well out of reach for the world’s poor, most of whom exist on less than $1 a day. Not only can the poor not afford the cure, but a cure has not been developed for the varieties of the disease that afflict them. Ninety percent of pneumonococcal deaths occur in developing countries, but vaccines do not exist for the strains of the disease found there.

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The problem is familiar. From malaria to H.I.V./AIDS to pneumonia, the world’s poor die from diseases that could be prevented or treated. Outgoing United Nations Secretary General Kofi Annan often cited the problem, It is a shocking fact that, out of the 1,233 drugs licensed in the world between 1975 and 1997, only 13 were for tropical diseases, and only four were commercially developed specifically for tropical diseases suffered by human beings. At the same time, numerous drugs were developed for the rich for non-life threatening afflictions, such as acne and wrinkles. More than 90 percent of drug investments go to the diseases that affect the richest 10 percent of people. The gap exists because drug companies develop and distribute medicines not for those who suffer from the world’s worst diseases, but for paying customers. They are businesses, not charities. The problem is euphemistically disguised by the term market failure. Markets can function efficiently and still allow millions to die. Markets create profits; they do not solve all human problems.

A hopeful recent initiative, the Advanced Market Commitment, works to combat this problem. A group of wealthy countries joined forces with the Gates foundation and the World Bank, promising to create a market for pneumonia vaccines, to be those paying customers for companies who produce cures for the poor. Britain, Italy, Canada, Norway, Russia and the Gates foundation pledged $1.5 billion to guarantee advance purchases of vaccines, should drug companies develop effective, affordable vaccines for poor countries.

Pope Benedict XVI celebrated the program as being inspired by that spirit of human solidarity which our world needs.... Such vaccines are urgently needed to prevent millions of human beings, including countless children, from dying each year from infectious diseases.

The Advanced Market Commitment is a pilot project. If it works on pneumonia, futures markets will be created for vaccines for other diseases that heavily affect the poor. It is not a panacea. Other barriers to bringing cures to the poor must be addressed. Clinics need to be built, doctors and nurses trained, and fees for medical treatment scrapped so people can afford to seek medical help in the first place, notes Jeffrey Mecaskey of Save the Children. Some critics are concerned that the A.M.C. program will offer rewards to the first drugs developed for poor markets, but not necessarily the best drugs. How the program is implemented will be crucial to its success.

Although U.S. academics, doctors and philanthropists developed the approach, so far the United States government has not joined the effort. A State Department official noted that while the United States supported the A.M.C., budgetary constraints prevented the U.S. government from contributing funding at this time. In 2005 President Bush made a call for action on global health. We seek progress in Africa and throughout the developing world because conscience demands it... We are moved when thousands of young lives are ended every day by treatable disease....

Where is that call now? According to CNN, President Bush’s tax cuts largely benefit the wealthiest 1 percent of U.S. taxpayers, and will cost an estimated $1.6 trillion over 10 years. The president also has requested $623 billion for the military, including over $140 billion for the wars in Iraq and Afghanistan in 2008. Saving millions of children from preventable disease ought to be a higher U.S. government priority.

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