NB Health Care
Weekly Roundup (8/16/14) – Empowering the BoP. Or Not: When the few drown out the many
This week, we got hung up on messages of empowerment – or the lack thereof – that were sent to the 4 billion people at the base of the pyramid.
With the largest outbreak of the Ebola virus disease in history ongoing in West Africa, the World Health Organization convened a consultation via teleconference on Monday to discuss the ethics of offering unproven drugs those who have been infected. This 12-person panel included exactly two Africans – one from Senegal and the other from Uganda. The group concluded that using untested drugs was, in this case, ethical.
Seeing as how virtually all the 1,000-plus (and rising) fatalities from this outbreak have been African, and the experimental drug would be used almost exclusively on Africans, shouldn’t Africa have the most seats and loudest voice at the table? We think it’s fair to ask: If the outbreak was in Australia, would the consultation have been orchestrated differently?
The Ebola issue is nuanced and fast-moving, and the potential ramifications of distributing experimental drugs are scary. The urgency also puts drugmakers and health systems in an uneviable position, blogged Karen A. Grépin, assistant professor of Global Health Policy at New York University and a member of the Innovations for Poverty Action research network.
“… The typical development cycle for new drugs involves multiple phases of evaluation in order to establish safety, efficacy and ideally effectiveness of these new treatments in humans and in real world settings where these medicines are likely to be used. None of the treatments that are currently in development have undergone rigorous evaluation studies to establish if any of these treatments are effective. Until the most recent outbreak, there has also been another challenge to the development of a new Ebola treatment: In the time it would take to set up a proper study to test the effectiveness of treatment, infection control measures are so effective and Ebola itself so lethal, that localized epidemics have usually died out.”
She concludes: “Experimenting with human lives will always raise important ethical dilemmas. But in the absence of good evidence about effectiveness, these decisions are even more ethically challenging. Generating rigorous evidence should therefore not be seen as being at odds with doing what is right, but rather the right way to learn about what is right.”
WHO is to be congratulated for pondering the consequences in a public setting. But it came off as condescending – at least to us – to give relatively short shrift to those who would be most affected by the decision.
Bear in mind, the discussion wasn’t about science, it was about ethics, which are driven by culture and vary from country to country.
In a much more extreme example under the “We Know What’s Best for You Poor People” heading: Did you know that India is the world’s biggest asbestos importer, at $2 billion annually?
We learned that this week from the Bellingham Herald, which stated that asbestos is “a $2 billion industry with double-digit annual growth, at least 100 manufacturing plants and some 300,000 jobs” in India.
This, despite the fact that asbestos is almost universally outlawed in the developed world because, well, it causes disease and kills people – up to 100,000 annually.
With ethics out of the equation, selling asbestos in India makes sense. Hundreds of millions of Indians live in makeshift dwellings where they are exposed to the elements. Asbestos is a good building material in that it’s heat resistant, long-lasting and relatively inexpensive. It would be a great solution to a pervasive problem … if not for its proven fatal qualities.
India’s Asbestos Cement Products Manufacturers Association is ignoring the science, arguing that asbestos “uses in the West aren’t relevant in India.” Of course, these business executives won’t suffer any drastic consequences if they’re wrong – India’s poorest people will.
On the other hand, there was a literal and figurative example this week of empowering the BoP: Citi, the global bank, pledged $2.5 billion to help bring electricity to more Africans.
It’s part of the “Power Africa” initiative, which includes the U.S. government, several governments in Africa and other public and private organizations.
Jim Cowles, CEO of Citi for the Europe, the Middle East and Africa region, said, “We are proud to be a partner in this phenomenal project, an initiative to double the number of people who have access to electricity across Africa. Citi has a unique footprint in Africa (with offices in more than 40 African countries) and a commitment to enabling progress on the Continent through our technical expertise, financing and risk mitigation tools.”
At NextBillion, we recognize that the African power sector continues to emerge as a viable market and investment opportunity. That’s why we launched our “Going Off Grid” series. Check it out, and feel free to join the ongoing conversation.
And, while you’re at it, give us your examples of empowerment on the global stage.