Saturday, July 7, 2007

Double Standards in Nigerian Health

Double Standards in Nigerian Health
By Roger Bate
Tuesday, June 26, 2007

What if Muslim clerics were held to the same standards as Pfizer?
Kano, Nigeria—There can be little more distressing than the death of a child. Intentionally, causing such a death rightly ranks as a heinous crime. So the allegation that U.S. pharmaceutical giant Pfizer negligently caused five such deaths in Nigeria a decade ago deserves our attention.
According to the Washington Post, a panel of Nigerian medical experts concluded that in 1996 Pfizer illegally tested a drug called Trovan on children with viral meningitis at a hospital in Kano, a northern city in Nigeria. According to the Post, the Nigerian government report says that Pfizer never obtained authorization from the Nigerian government to give the unproven drug to nearly 100 children and infants. Pfizer's experiment was "an illegal trial of an unregistered drug," the Nigerian panel concluded, and a "clear case of exploitation of the ignorant."
Pfizer's experiment was "an illegal trial of an unregistered drug," the Nigerian panel concluded, and a "clear case of exploitation of the ignorant."
Pfizer insists that the trial was properly conducted and oral approval was given by all parents of children involved. There are no written approval documents and it looks as though an approval letter from a Nigerian ethics committee, which Pfizer used to justify its actions, was forged and backdated by the company's lead researcher in Kano.
Congress is likely to pay attention to Pfizer’s activities and Rep. Tom Lantos (D-CA), is expected to introduce a bill requiring U.S. researchers to give regulators details of tests they plan in developing countries.
Pfizer made mistakes. But among the two hundred children in the trial, five children out of a hundred in the experimental group died from meningitis after being treated with Trovan, and six children out of a hundred in the control group died from the disease while taking an alternative drug. In other words, Trovan proved marginally better at combating the disease than the standard treatment. The children of Kano actually benefited, albeit briefly, from Pfizer’s trial.
If the company did something wrong, it should be held to account. The pending Nigerian state and federal government suits are already providing the company with bad enough headlines, and may hit the bottom line, either in court or through settlement.
But while Pfizer has its image damaged by the Post and an opportunistic Nigerian Government, others who cause far greater damage get off lightly. Kano is the capital of an Islamic state within Nigeria. Its clerics are the reason that polio is once again flourishing in the state.
Polio vaccination is a miracle. There is no need for an injection: just suck on a vaccine-encrusted sugar cube and you're protected for the next decade. Yet, in Kano you see muscular upper bodies moving with acrobatic abilities on their hands--a novelty until you realize they have no legs. These are the crippling results of polio. How did this come about?
When a World Health Organization campaign was launched in 1988 to eliminate polio from the 123 countries still afflicted, it almost succeeded. By 2003 only seven countries still had cases and the end was in sight.
But clerics in Kano counseled parents against the vaccination, proclaiming it an American plot to sterilize Muslim youth and give them HIV. When Muslim parents obeyed, the southern-based and largely Christian Nigerian government refused to demand vaccination in the north, since it did not want to create religious tension. Today, Nigeria has over 70% of the world's cases and is rapidly exporting polio. After the boycott it moved from Nigeria to Ivory Coast, from West Africa to Sudan, then across the Red Sea into Saudi Arabia and Yemen—which had been polio-free for a decade—even jumping continents to surface in Indonesia. Since the 2003 boycott, about 25 countries previously declared polio-free have been reinfected.
Authorities in Kano state are now blaming the Pfizer controversy for widespread suspicion of government public health policies. The polio vaccine boycott “by citizens of Kano state is a direct consequence of the 1996 actions" of Pfizer, state prosecutor Aliyu Umar said in the court documents.
Religious leaders and government agencies are complicit in the deaths of orders of magnitude more children than Pfizer.
But this is revisionist history to bolster a legal case against a foreign corporation. At the time the polio vaccinations were suspended, the governor of Kano state cited a belief that the polio vaccine itself was harmful, and didn’t mention Pfizer. Meanwhile, the same authorities who are bringing this suit still allow local pharmacies and street traders to sell fake and substandard drugs. And just prior to the meningitis epidemic in Nigeria, the federal government gave neighboring Niger 88,000 doses of a meningitis vaccine. 60,000 doses were used before it was realized they were fakes. 2,500 children died from the disease, far more that a real vaccine would have allowed.
To its credit the Nigerian government is trying to crack down on fake drugs. However, it needs the help of companies like Pfizer to identify fakes of the latter’s products, and should be working with them, rather than suing them.
All this is not to say that Pfizer should get off for anything they did do wrong. But religious leaders and government agencies are complicit in the deaths of orders of magnitude more children than Pfizer. It is bizarre, but not entirely unexpected that western drug firms are attacked for minor infractions, while others that do untold harm get off scot free.
Roger Bate is a Resident Fellow of the American Enterprise Institute.

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