Two-speed health

Health centre in Bamako (Mali) – June 2008. The ‘thick smear’ test makes it possible to immediately establish the presence of the malaria parasite plasmodium in the blood. © Gil Corre
Health centre in Bamako (Mali) – June 2008. The ‘thick smear’ test makes it possible to immediately establish the presence of the malaria parasite plasmodium in the blood. © Gil Corre

Everything is going global. Epidemics have no respect for continental borders and similar diseases are affecting the North and South. But they are not being treated in the same way. We take a look at the reality of double standardsand promises of a more egalitarian medicine.

Malaria kills 2 million people a year in tropical regions. Since 1977, 75 people have also contracted the disease in Europe, due to mosquitoes that were undetected stowaways on transcontinental trips.

Concealed in used tyres, the larvae of the dengue mosquito also manage to travel the world. Obesity is being exported as the middle classes in the southern hemisphere develop a taste for fast food while AIDS, tuberculosis and malaria are today responsible for 12% of deaths in developed countries. Threats to health are becoming global in scale. But can the same be said of health care and research?

A question of funds

"Health is now a global problem that demands a global approach. However, it has long been estimated that 90% of the research budgets of major pharmaceutical companies are allocated to 10% of the world's population.

But things are beginning to change. One example is the judgement pronounced in Pretoria obliging laboratories that produce retroviruses against AIDS to agree to develop, in Southern countries, generic products on which no patent has to be paid," explains Roland Schaer, head of the Science-Society programme at the Cité des sciences et de l'industrie in Paris.

One attractive feature is a programme to combat leishmaniosis in India. The organisation OneWorld Health, founded by the American pharmacologist Victoria Hale, with support from the Bill and Melinda Gates Foundation, is tackling this disease which is transmitted by a tiny fly and is second only to malaria in the death toll it exacts on human beings worldwide (600 000 deaths and 500 000 new cases every year). For Shyam Sundar, Professor of Medicine at the Banaras Hindu University, "the role played by foundations and philanthropists is by no means negligible.

It is significant not only in terms of the actual support provided but also through the way they incite governments to act."

A question of form

The North-South divide is not only to do with funds, but also with form - the way in which clinical trials are conducted, for example.

Such trials are obligatory before a treatment can be made available, and they are generally supposed to respect a universalist technical approach based on standards (Nuremberg Code, Helsinki Declaration, etc.) that apply in all places and in all circumstances. According to these principles, the trial population must benefit from the ‘best treatment' available in relation to the pathologies associated with the trial and give their ‘informed and written consent' before participating.

Some clinical trials carried out in developing countries are the subject of debate, even if they are in response to specific and urgent health situations. (1) One of the most wellknown and controversial examples concerns trials using tenofovir (an antiretroviral drug used in tritherapy against HIV and with a potential preventive role) carried out on a group of 400 illiterate seronegative prostitutes in Cameroon. The trials were interrupted when several associations contested them on the grounds of these women's vulnerability their inability to understand the precise significance of the experiment, and the absence of care available to them in their home country should they contract the HIV virus during the trial. "Depending on the context in which the clinical research is carried out, it can be difficult to rigorously respect the ethical standards in terms of information and treatment. This is often the only way for the people tested to have any chance of receiving genuine treatment.

In the light of such ambiguities, some believe in a method that is more in keeping with the sociological culture of the countries in which the trials are carried out," says Roland Schaer. "Clearly we cannot simply transpose, unchanged, our own methods of reasoning to other cultures." Doctor Ogobara Doumbo, director of the Malaria Research and Testing Centre at Bamako University (Mali), works with traditional healers.

He believes that "the world has become a village; one big research team." And a team must be receptive to the realities in the field.

Christine Rugemer

  1. See also Aiding Africa or using Africa?.