What happens when a treatment has a 5% mortality rate and no one’s making anything better?I recently finished reading Prof. Peter Kennedy’s book ‘The Fatal Sleep‘. It tells the story of Human African Trypanosomiasis (African Sleeping Sickness). HAT is one of the WHO’s neglected tropical diseases. The disease is complex, but in the late stages, the disease can reach the central nervous system (CNS) and without treatment is 100% fatal.
Fortunately there is a treatment, but the treatment itself has a 5% mortality rate. Such a treatment would never have been accepted, if made today, but the fact is, that Melasoprol was invented in 1949 and is the only effective treatment for HAT after it has reached the CNS.
Melarsoprol is a pretty nasty drug, it even has to be kept in glass, because it would corrode a plastic container, so it’s no surprise it burns when injected into patients. No alternative drug has been developed for HAT with CNS involvement since 1949. This is due to several reasons, but primarily lack of funding and a lack of interest from big-pharma.
The disease only affects certain areas of Africa, and those areas are also predominantly LEDCs (Less Economically Developed Countries). So the potential for profit is almost non-existent. Due to the vast costs of developing a drug, so far, no one outside of academia has been trying to develop a cure. This is not only the case for HAT, but for many of the WHO’s neglected tropical diseases. If there’s no potential profit, there’s almost no incentive for businesses to develop drugs.
Interestingly, many of the treatments for these neglected diseases were developed during colonial occupation or shortly after. I do not believe that this is coincidence and I certainly don’t believe it is purely benevolent. Rather, perhaps colonial powers invested in these diseases when their own countrymen were more likely to be exposed to these conditions and there was a greater potential profit. The wealthy people who emigrated to the colonies would be exposed to similar diseases to the local population, and therefore, it is possible that business and nations, chose to invest in these areas more during that time.
Colonialism is a very difficult topic as so much harm was caused during these times. While it does not excuse the actions of colonisers throughout history, it would be wrong to say that no good was done at all during these times. Colonialism did see a rise in education and healthcare after all.
After many ex-colonies gained their independence, they were often not adequately supported. They were left to their own devices, to manage the infrastructures and facilities that had been put in place during the colonial era. These countries, without the investment of a colonial power, often struggled to maintain their healthcare institutions. These pre-existing healthcare systems became unsustainable and unstable in many developing countries.
The results of post-colonial abandonment are still present today. The majority of investment in drug-development still comes from Western institutions. Therefore, it is no surprise that the focus has been on developing drugs for ‘Western’ diseases. Fortunately, philanthropists and organisations such as the WHO, are investing in healthcare in developing countries, without the incentive of profit. But in an increasingly capitalist world, would it not be better to help build research structures within developing countries, so that they can prioritise the health of their population when no one else is. Financial profit is a big motivator in business and whilst there’s a place for philanthropy, perhaps the patients will get the treatments they need, if they’re developed by local organisations for the local population, so the organisations can make a profit. In an ideal world, profit would not be the focus of healthcare, but for now it is, so how can we learn to live with that and to still get the most out of the system.
I understand that people may disagree with the views I have here expressed, and confessedly, I have not read a great deal into colonialism. So if you agree or if you disagree, please feel free to comment below – I’d really appreciate it.