NB Health Care

Saturday
August 9
2014

James Militzer

Weekly Roundup (8/9/14) – Ethics and Africa: Controversy around a White House summit and an Ebola cure highlight tensions between the global north and south

There were plenty of smiles during the Obama administration’s first-ever U.S.-Africa summit in Washington this week. Billed as “the largest event any U.S. president has held with African heads of state and government,” the event brought nearly 50 African leaders together with not only the president, his cabinet and other U.S. government officials, but with CEOs from American companies like Coca-Cola, Caterpillar, Wal-Mart, General Electric and IBM. The summit’s focus on business – what some have called a “trade not aid” approach – was characteristic of Obama’s dealings with Africa.

While his predecessor George W. Bush’s legacy in Africa was defined by PEPFAR, a huge (and massively successful) aid package to fight HIV/AIDS, Obama has focused more on business solutions, including last year’s $7 billion “Power Africa” initiative to spur U.S. investment in Africa’s power sector. This week’s summit brought commitments that dwarfed Obama’s prior efforts, with the president announcing more than $33 billion in private and public U.S. assistance, including $7 billion in financing to promote U.S. exports and investments in Africa, $12 billion to boost the continent’s power supply and $14 billion in investments from American businesses in energy, banking, construction and other sectors. The investments were meant to counter a problem that the president summed up succinctly in his remarks at the event: “[America’s] entire trade with all of Africa is still only about equal to our trade with Brazil – one country.”

But though the president and African business leaders hailed the summit as a success, it sparked a surprising amount of criticism – and raised some tough questions.

Some wondered if the event – widely seen as an attempt to revamp what has been a rather lackluster approach toward Africa – was too little too late. As an African American with family ties to Kenya, Obama was expected to bring more of a focus to U.S.-African relations. Instead, many have looked on in alarm as China surpassed the United States as Africa’s largest trading partner in 2009, and as U.S.-Africa trade dwindled from $125 billion in 2011 to $85 billion in 2013. Obama seemed to allude to China’s natural resource-focused investment strategy in the continent in his remarks, saying, “We don’t simply want to extract minerals from the ground for our growth; we want to build genuine partnerships that create jobs and opportunity for all our peoples and that unleash the next era of African growth.“

Yet some critics pointed out that more than three-fourths of U.S. imports from Africa still consist of natural resources and raw materials like oil, precious stones and coffee beans. And others raised objections to the business-friendly nature of the initiatives featured at the event, including USAID’s New Alliance for Food Security and Nutrition, which requires that governments change laws and policies in favor of businesses in exchange for greater investment from the more than 220 companies involved in the initiative.

But perhaps the most resonant criticism came from those who took issue with the “parade of autocrats from the continent that descended on D.C. for the event” – a group that included at least six African presidents who have been in power for decades thanks to questionable election victories, along with several who have atrocious human rights records. Responding to these concerns, Obama made a case for engagement: “We find that in some cases, engaging a country that generally is a good partner but is not performing optimally when it comes to all the various categories of human rights, that we can be effective in working with them on certain areas [while] criticizing them and trying to elicit improvements in other areas.”

To be fair, the president really can’t win on most of these issues. Political realities prevent him from passing ambitious aid packages like PEPFAR, leaving market solutions as his primary option. But major corporations won’t invest in emerging markets unless they have confidence that their public policy is sufficiently business friendly. And refusing to do business with autocratic governments would put the U.S. even further behind competitors like China, who don’t share our scruples. (And to be honest, those scruples have historically tended to take a back seat to global realpolitik anyway.) Should the president do nothing, or should he use what seem to be the only tools available to him to support Africa’s development? Are the ethical downsides worth the benefit – for both Africa and the U.S. – that will likely come from these initiatives? Though reasonable people may disagree, I’d prefer action to inaction on this front.

And speaking of ethical dilemmas … another big U.S.-Africa story this week threatened to overshadow the White House summit. As you’ve likely heard, two American missionaries contracted the highly lethal Ebola virus and – with their deaths apparently imminent – were given an experimental drug which seems to have saved their lives.

Immediately after the news broke, questions and criticism began to swirl: Why wasn’t the drug’s existence made public earlier, when it could have potentially saved some of the hundreds who’ve died so far from the disease? Are white Americans’ lives more valuable than black Africans’? And what comes next? Will the medicine be made available in the countries that are currently in the grip of the disease – and will it happen in time to make a difference?

Answers soon emerged to the questions about the drug’s previous unavailability. As Arthur L. Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center’s Department of Population Health explained in the Washington Post:

“The medical missionaries got the experimental drug because the evangelical Christian International Relief organization they work for, Samaritan’s Purse, reached out to the CDC and the NIH to find out if there was any drug to give to them. They were referred to Mapp Pharmaceuticals and evidently struck some kind of deal to get the drug to their employees who were in Africa at the time. (Technically, African health ministries could make a similar request.) The FDA has little oversight over what goes on abroad, and the federal government has no program to consider appeals for use – much less payment – of experimental drugs that have only been tried on animals. Without an organization pushing, no one might have received access to any sort of treatment.”

As for questions about whether it may be available in Africa – Caplan (writing on Wednesday) sounded less than optimistic: “The chance of a poor African getting an experimental drug is about the same as Donald Trump contracting Ebola.” The drug requires refrigeration and careful handling, he explained, along with close monitoring by experienced doctors and scientists. It’s expensive to make, still untested and in very short supply. And while the American Ebola patients gave their consent – as would, presumably, most Africans – a company may still withhold a drug from willing volunteers for fear that it will fail, reducing investor interest or increasing the probability of legal action. “This Ebola outbreak has taught us two things,” Caplan wrote. “We need to act quickly to shut down emerging epidemics wherever they occur, and it is long past time to have a transparent public policy about what to do when not everyone gets a chance to live.”

However, on Thursday, the company that makes the drug, Tekmira Pharmaceuticals, announced that the U.S. Food and Drug Administration had allowed its potential use to treat those infected with the virus. We’ll be watching this fast-developing story closely.

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