Malaria
is a devastating disease. The mosquito-borne parasite that
causes it has been eradicated in North America and Europe
through a combination of swamp drainage and DDT.
But slow economic development elsewhere in the world, plus
a steadily growing resistance to insecticides and to drugs
used to treat the disease, means that malaria is still a widespread
killer in Latin America, Africa, the Middle East and South
Asia.
A million children are expected to die from it next year
in Africa alone. Millions survive, but many with liver injuries
or, especially among the young, brain damage.
More people, not fewer, are suffering from malaria worldwide
than thirty years ago, perhaps because global warming is extending
the habitat of the anopheles
mosquito. More people are alive to be threatened too,
of course.
Last week the British
government announced plans
to purchase 200 million to 300 million doses of malaria vaccine.
The interesting thing about this transaction is that there
is no vaccine for malaria -- not yet, not officially anyway.
Some 80 candidates are being tested around the world, 15 or
so of special interest to development authorities.
Indeed, it was only in October that scientists and physicians
announced their most successful test to date. A vaccine given
to thousands of children in Madagascar was reported to have
protected a third of them altogether, and spared another third
the more serious consequences of the disease. The control
group -- those not inoculated -- were carefully monitored
and treated aggressively at the first signs of infection.
What the British did last week -- in concert with several
non-governmental organizations -- was to offer a prize, in
effect, to a successful developer.
To be sure, the malaria case is not like the example usually
given -- the Longitude Prize, £20,000 offered by the British
parliament early in the 18th century to the first person to
reliably measure longitude within a half degree.
Then, it was expected that better star maps and more ingenious
methods would be required. Few understood that a sufficiently
rugged and accurate sea-going clock would solve the problem
-- fewer still had any idea how to make one.
Today, most of vaccine science is in place (though doctors
have yet to conquer a complex, multi-cellular parasite like
the one that causes malaria). There are abundant new tools
and techniques, and the vaccine in question is in its final
stages of development.
Instead, the impediments have more to do with risks and rates
of return.
Vaccines are the medicine of choice against widespread diseases,
such as HIV/AIDS, malaria and tuberculosis, the three top
killer diseases in the world today. The idea is to use a little
bit of killed or weakened pathogen to cause bodies to develop
natural immunity, similar to the vaccines that have all but
eliminated smallpox, polio and a host of other diseases.
In principle, a single inoculation and occasional booster
shots thereafter may be sufficient for most people to keep
a targeted disease at bay.
Precisely for that reason, however, few if any pharmaceutical
companies are willing to pay the huge up-front research, development
and testing costs in pursuit of a successful vaccine, for
which there may or may not be a market -- and never mind the
liability in the inevitable few cases where the inoculation
goes awry.
Hence governments have recognized for years their responsibility
to step in where market mechanisms fail. Government laboratories
and cost-plus contracts to private vaccine developers are
nothing new.
Only recently, however, have governments (and the non-governmental
organizations that advise them) begun to concentrate on the
kind of mechanism that gave rise to the naval chronometer
-- "pull" methods instead of more familiar "push"
techniques, which include grants to academic investigators,
R&D tax credits, public equity investments and government
labs.
(For a lucid account of the new ideas, see Strong
Medicine: Creating Incentives for Pharmaceutical Research
on Neglected Diseases by Harvard University economist
Michael Kremer and Rachel Glennerster. Kremer is the
man who, probably more than any other, is responsible for
formulating the distinctions between push and pull approaches.
By contracting in advance to buy large numbers of doses that
meet certain standards of safety and efficacy at a particular
price, such methods insure that if vaccines are developed,
they actually reach the people who need them. Pull methods
pay for results, so that if no vaccine is developed, no public
funds are spent.
That's important, because, left to their own devices, big
pharmaceutical manufacturers are only too happy to pursue
their work on what amounts to a cost-plus basis, pursuing
long-shots and wills-o'-the-wisp longer than they would if
they were hazarding their own funds.
It's one more example of why, more than ever, governments
today need talented and sophisticated regulators. Technology
policy has become as important as monetary policy -- in some
respects, maybe more so.
The British government's largesse is surely not unrelated
to the fact that the manufacturer of the malaria vaccine it
promised to buy is GlaxoSmithKline Biologicals, a large British
pharmaceutical concern with extensive entries in other, more
lucrative markets.
The government's investment will do more than establish a
market for a commodity whose beneficiaries are too poor to
fund for themselves. It will also defray some part of
the fixed costs of maintaining GlaxoSmithKline's position
on the frontiers of pharmaceutical research.
But that's quite all right. If governments are going to favor
the locals with subsidies, how much better that the recipients
should be biotech labs and pharmaceutical firms rather than,
as it has been the case for more than the last 150 years,
weapons makers -- that the competition should among
merchants of life rather than merchants of death?