Abstract
Science and the political economics of affliction
Microorganisms—parasites, bacteria and viruses—are the invisible, mindless rulers of the animate world. They evolve, mutate and recombine to find their way through the defences of 'higher' organisms with devastating consequences. From an evolutionary perspective they are 'the fittest' and the chances are slim that human ingenuity will ever get the better of them. One in three people in the world may be infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB), and people with multiple HIV infections may become the source of new, even more virulent, strains (see the articles by P. van Helden and R. Weiss, in this issue). These scourges cannot be eradicated with the tools available at present. The best we can hope for is a gradual advancement in knowledge and technologies that allow us to slow down, restrict or contain the pathogenic onslaught. Such successes, as marginal as they may appear, are of vital importance to humanity, because infectious diseases remain the greatest cause of death and suffering in the world, killing more people than famine, war, accidents or crime.Box 1
Infectious Diseases: challenges, threats and responsibilities.
Third EMBL/EMBO joint conference on Science and Society, held in Heidelberg, Germany, on 8 & 9 November 2002.
For more details regarding this Science and Society event at the EMBL, please check the EMBL/EMBO post-conference website: http://www.embl-heidelberg.de/Conferences/SciSoc02/index.html
The entire conference was recorded digitally and, as a means of disseminating its high-quality contents to a wider audience, all of the keynote lectures that were given over the two days have been issued as a pair of DVDs. These are available on request through the website, or directly from the Office of Information and Public Affairs at the EMBL.
Alleviating infectious diseases calls for a global mobilization of experts across many professional fields. Such a concerted action requires not only taking stock of the available scientific know-how and technologies, but also elucidating and tackling socio-economic and environmental factors that breed vulnerability and pave the way for disease (see the articles by C. Morel, D. Fassin, J. Sommerfeld, and P. Farmer & A. Castro, in this issue). To this end, the European Molecular Biology Laboratory (EMBL) and EMBO organized a two-day Science and Society conference in Heidelberg, Germany, in November 2002 on infectious diseases and bioweapons, to promote a holistic approach to those problems. The meeting gathered together more than 200 life scientists, social scientists and decision-makers to deliberate and debate on how to generate and make available the scientific and economic means to protect humanity against infectious agents. This special issue of EMBO reports is a collection of essays written by speakers and panellists from the conference.
AIDS, TB and malaria are increasingly being recognized as the most important factors in the political and economic destabilization of the developing world. History has shown that there has always been a political and economic price to be paid for not dealing with international health issues, but such a price is made all the more tangible in our era of global movements of goods and people. Consequently, one unifying theme of the EMBL/EMBO conference, which runs through nearly all the essays in this issue, is the need to encourage more research to develop better vaccines, drugs and pesticides to control infectious diseases and their vectors, particularly in developing countries. The authors all concur that the current approaches used to deal with infectious diseases have failed to deliver effective measures in too many instances. Critics often single out the pharmaceutical industry as the main culprit, castigating it for immoral conduct. But they ignore the fact that businesses are run for commercial, and not altruistic, interests. In recognition of such a fundamental property of the neo-liberal market economy, a more realistic approach now explores various ways of providing companies with greater incentives to undertake research on diseases that predominantly plague developing countries. The World Health Organization, for instance, advocates public–private partnerships (PPPs) as a way of improving the current situation, and is already involved in several such projects (see the article by R. Ridley, in this issue). These include the International AIDS Vaccine Initiative, the Medicines for Malaria venture and the Global Alliance for TB Drug Development.
Another major theme to emerge from the conference, again echoed in several of the essays in this volume, is the importance of considering social, economic and cultural factors when devising measures to fight infectious diseases. Although it is crucial that the biomedical sciences succeed in producing new tools to control diseases, these can only be effective when deployed in programmes that take local factors into account. The drugs available at present could already make an enormous difference to the global disease burden, but they are difficult to deliver in many places because of a lack of locally adapted health care infrastructures. The social sciences therefore have an important role in devising policies that make the most effective use of the tools provided by biomedical, clinical and public health research.
The best we can hope for is a gradual advancement in knowledge and technologies that allow us to slow down, restrict or contain the pathogenic onslaught
Only about 10% of the world's total health care spending is used for research into the infectious diseases that constitute 90% of the world's health problems. Infectious diseases kill more than 14 million people a year, 90% of whom live in the developing world. Faced with these appalling statistics, the United Nations (UN) recently launched the Global Fund for AIDS, Tuberculosis and Malaria. The UN Secretary General, Kofi Annan, originally proposed that US $7–10 billion per year is needed from rich governments, corporations and private donors to achieve the Fund's goals. The US government announced that it would spend US $10 billion over the next 5 years to fight AIDS worldwide, and the European Union (EU) has launched a US $640 million project to test drugs against AIDS, malaria and TB in the developing world. But these amounts are still far from what Kofi Annan was asking for. Although support from governments and international agencies remains seriously inadequate, substantial funding from the private sector, mainly The Carter Centre and The Bill and Melinda Gates Foundation, has begun to fill in these gaps in financing. The Gates Foundation launched its 'Grand challenges in global health' on 26 January 2003 at the World Economic Forum in Davos, Switzerland. It was already one of the world's biggest donors in this area, but it is now offering to inject an additional US $200 million into research and to support about ten large collaborative projects. Such a contribution from the private sector, although still dwarfed by the amount of resources called for by the UN, is highly praiseworthy and is a promising sign of increased awareness and global responsibility.
The biotechnology industry has, until now, only devoted about 4% of its resources to the pursuit of cures for diseases that ravage the poorest populations of the world (Brower V., Genetic Engineering News, 23, 8; 2003). But an increasing number of biotech companies are now forging research partnerships with government agencies, foundations and non-governmental organizations to develop drugs for neglected infectious diseases, in spite of the fact that such diseases mainly plague nations with poor purchasing power (see the article by R. Ridley). As the business climate within the sector is changing and financing becomes more difficult to obtain, managers are becoming more interested in alternative funding opportunities and incentives. In this regard, PPPs for research into neglected diseases can become 'good business', because they result in the diversification of risk. Many companies have technologies and compounds relevant to combating infectious diseases that are ready for latestage development, but they lack the incentive to turn them into final products and make them available to the individuals that need them. More efforts are now underway to match public and private sponsors with promising biotechnological ventures to encourage drug development for poor markets (see the article by R. Ridley). To launch a drug on the market in the affluent parts of the world often takes 15 years and US $300–500 million. In view of the disastrous state of affairs with global infectious diseases, the time and cost of producing remedies for afflicted populations will have to be drastically reduced to produce less expensive drugs and diagnostics. This will open up the pharmaceutical field to competition from many new and smaller players.
Obviously, there is more to infectious microbes than meets the eye. As Homo faber has always been haunted by his Faustian alter ego, all the major tools and technologies he has developed have turned out to be double-edged, fitted to serve constructive as well as destructive ends. It should not come as a surprise that biotechnology, which is rapidly becoming the dominant technology of our age, is following the same route. Here, biotechnology refers to all scientific ability and practice that makes it possible to exploit and intervene in the biological processes of living organisms. One diabolical example of a destructive application would be the use of genetic modification to increase the pathogenicity of viruses such as the smallpox virus, or bacteria such as anthrax and plague. It is now widely acknowledged that a knowledge of microbial genomics and skills in genetic engineering can be used to create 'enhanced' bioweapons (see the articles by F. Frischknecht, and J. van Aken and E. Hammond, in this issue). The most chilling question raised at the conference was whether an increased knowledge of variations in the immune systems of historically distinct groups of individuals, which has accompanied the progress of pharmacogenetics, could enable the production of selective bioweapons for future ethnic cleansing.
The social sciences [...] have an important role in devising policies that make the most effective use of the tools provided by biomedical, clinical and public health research
The Biological and Toxin Weapons Convention (BTWC) was created with the aim of preventing such abuses of knowledge, and states should see it as being in their own interests to comply with the basic principles of the treaty. One hundred and forty-four nations signed and ratified the treaty, making it, along with the Universal Declaration on Human Rights, one of the most widely adhered-to international agreements. Significantly, the greatest resistance to joining the BTWC has come from the Middle East, the most deeply troubled region of the world at present. Egypt, Syria, Israel and Iraq are still refusing to sign the BTWC. The treaty was based on the prediction that its quasi-universal support should dissuade states tempted to violate it, and to facilitate a joint response of the international community if violations occur. The convention exhorts its members “...never in any circumstance to develop, produce, stockpile or otherwise acquire or retain” microbial or other biological agents, the equipment or means of delivery designed for the use of such agents or toxins (see the article by V. Beck, in this issue). But the tragedy of 11 September 2001 and the ensuing anthrax incidents profoundly changed the political landscape and affected common perceptions of national security and public health in the USA and beyond. During his administration, former US President Bill Clinton declared that HIV/AIDS posed a major threat to US national security. Soon after 11 September, however, it became apparent that his successor, George W. Bush, had redefined national priorities and identified a host of new enemies. He announced the creation of a Department of Homeland Security to respond to those new threats, and an increase in the military budget of US $48 billion with a US $11 billion programme to combat bioterrorism. The federal government's recently announced 2004 budget for research and development has been fixed at a record US $123 billion, with more than half of the sum being earmarked for the Department of Defense. Its priority is domestic preparedness for terrorism by improving national public health capabilities. However, to put these developments into a global perspective, “the death toll of HIV/AIDS worldwide is equivalent to the collapse of six World Trade Centre towers every day” (see the article by R. Weiss, in this issue).
The aftermath of 11 September 2001 unleashed a radical restructuring of the US ruling authorities' official view of the world. If the main source of 'evil' threatening 'the American way of life' was previously seen as residing in 'hostile nature', it has now been squarely relocated in the reign of 'culture'. The 'axis of evil' doctrine espoused by President Bush's entourage succinctly states this official credo. Seemingly, what now constitutes the greatest threat to US national security are oppressive, rogue states, terrorist organizations and religious cults that have acquired weapons of mass destruction or are planning to acquire them. In line with this geopolitical perception, in December 2001 the US government unilaterally brought down the ongoing negotiations to strengthen the BTWC. Unlike the Chemical Weapons Convention, the BWTC has no standing organization, no legally binding requirement for declarations and no provision for
What molecular biologists could best contribute to world civilization in the 21st century are universally accessible and applicable means to resist infectious agents
investigations. The US government rejected the collective efforts of other signatory states to introduce forms of compliance control, on the grounds that the protocol would not serve to bolster US confidence in compliance by others and may entail the disclosure of US biodefence and pharmaceutical company secrets. This development raises some troubling questions regarding the future of biodefence activities everywhere. Regrettably, the prospects of making the production and use of biological and chemical weapons a crime under international law have been seriously set back by the creation of the US Department of Homeland Security. Classified research related to bioweapons is inextricably linked to that of naturally occurring infectious agents and the development of new antibiotics, antivirals, diagnostics and vaccines (see the article by J. Walker, in this issue). Therefore, because research within the new defence department is to serve US national interests, it is likely to give rise to a new monopoly of dual-use technologies, and a resurgence of a state-organized proliferation of bioweapons.
The international life science community must accept a more active role in the development of universally available instruments of protection by inventing increasingly effective tools for the detection, diagnosis and suppression of infectious biological agents. What molecular biologists could best contribute to world civilization in the 21st century are universally accessible and applicable means to resist infectious agents, whether they afflict us 'spontaneously' or are used voluntarily against us as instruments for mass destruction. As chemists and physicists had before them, biologists have a historical mission: to wrestle a microscopic Leviathan.
