Earlier this month, news broke that one of the first new
classes of antibiotics in quite some time was discovered. Understandably, the
news was met with jubilation. Most of the reporting highlighted pharmaceutical and technological
developments, yet fail to remind the public that infectious diseases are
largely considered diseases of the poor. After all, it is easier to rally
behind a “miracle” technology than it is to rally behind a restructuring of
society that prevents multi-drug resistant diseases in the first place. The
discovery of a new class of antibiotics does as much to highlight the many
economic and social issues in our world as it does to kill deadly pathogens. Drug
development has major limitations for curing infections of poverty.
The history of medicine show the same infectious diseases
that once killed the Romans of antiquity were the same infections that killed
poor Americans until the early 1900s. Only one hundred years ago, Americans
were more likely to die from infectious diseases, tuberculosis and the flu,
than they were to die from the chronic diseases that now afflict the country. However,
with the serendipitous discovery of penicillin by Alexander Fleming in 1928,
many felt infectious disease would become a thing of the past. Unfortunately, the
antibiotic pipeline has dried up and dangerously resistant organisms have
started to emerge. Health leaders are again recognizing infectious diseases as
a leading problem, which explains the excitement that has surrounded the recent
discovery.
This new anti-biotic drug that has garnered so much
excitement has not yet been put through rigorous clinical trials. These trials
can cost well over 100 million dollars, and less than 8% of drugs that begin
trials are brought to market. This means that unless there is the potential for
a hefty profit, pharmaceutical companies steer clear of testing many drugs in
development. It is harder for pharmaceutical companies to recoup an investment
in treatments for infectious disease. In this case, it also means that there is
still a low likelihood that the antibiotic that made the news last week will be
available anytime in the near future.
We’ve seen what happens when a pharmaceutical company
decides to get behind a cure for an infectious disease. In 2014, Gilead
received approval for the first cure for Hepatitis C, a disease that largely
impacts those with less education and living in poverty. However, when Gilead
priced their drug regiment at over $80,000, they effectively limited access for
the patients with real need. If this new wonder-antibiotic is made available,
why should anything different be expected?
Effective treatment of infectious diseases ranging from
Ebola to chikungunya does require an understanding of the science behind new
antibiotics. However, and equally important, effective treatment also requires
an understanding of what it means for an infection to be a disease of poverty. A
2011 Institute of Medicine report revealed alarming data that the poorest of
the poor in the United States are disproportionally affected by a host of
infectious diseases that preferentially infect those in low-income and
middle-income countries. The groups most likely to be afflicted by neglected
infections of poverty include minorities; single-family, low-income households;
racially segmented cities; the American South; and other groups that live along
the fault lines of society. These fault lines within society have deep
historical roots in the power relations of class, gender, and race. Our social
institutions – political, economic, cultural, religious, and legal – reinforce
these unequal power relations.
In commenting on how to treat and prevent the spread of
Ebola, for example, infectious disease specialist Paul Farmer notes that, “the
only formula we’ve come up with is the following: you can’t stop Ebola without
staff, stuff, space and systems.”
One new antibiotic will only buy us time in the fight
against the ever-evolving microbes that surround us. The real issue is that
infectious diseases are diseases of poverty. The real issue is that new
antibiotics alone will not save us from these diseases, but social solutions
just might. It is far easier and less expensive to fund research into novel
drug discovery than it is to develop a society in which everyone has equal and
affordable access to quality care.
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