Dengue on My Mind: Spending on ‘Diseases of Poverty’ Not Enough to Create Effective Vaccines

By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.

Late in July,  as I was preparing to book a diving holiday, I contacted various buddies to solicit their thoughts on my shortlist of destinations.

In passing, I asked one of them, based in the Maldives, to please pass along my best wishes to a common friend: Renee Sørensen.

I’d met Renee– a proud Norwegian– in 2015, when she’d guided me on some diving excursions, and a couple of years after she’d upended the pattern of her life. She’d travelled to the Maldives in 2013 to learn to dive– and never left.

She qualified as a dive master and then an instructor, and initially, worked as a diving guide. Later, she set up two of her own businesses: the first, a tour company, to bring Norwegian clients to the island of Maafushi– a lower-cost alternative to the typical high-priced Maldivian resorts.

As I wrote a couple of years back in The National, in Paradise done cheap: visit the Maldives without breaking the bank:

Long a favoured destination for honeymooners and high rollers, the Maldives is seeking to broaden its appeal. Once upon a time, government policy sequestered luxury tourists on separate dedicated islands, away from the local population. This is changing, as a result of then-president Mohamed Nasheed’s 2008 decision to open “local islands” to tourism.

“Since Nasheed’s reforms, there’s been an explosion of small- to medium-sized developments owned and operated by Maldivians,” says Sharafuzzaman Anees, the operator of Shark Diving School on the centrally located Maafushi Island. These new hotels, restaurants and ancillary businesses cater to budget and middle-market tourists. “On some islands, local tourism is thriving.”

Now, tourists can interact with ordinary Maldivians, sample local culture, and enjoy the balmy climate, pristine beaches, and access to marine life for which the archipelago is justly celebrated – at a fraction of the cost of luxury resorts.

After making a success of her first business, in part due to her commitment to customer service for her clients– who “get the same level of service people get at luxury resorts, at a far lower cost”– Renee became convinced that local diving companies weren’t doing enough to protect the unique Maldivian ecosystem.

So she set up a second company, an eco-diving operation, which in addition to promoting more ecologically responsible diving, launched efforts to clean up and preserve beach and reef systems, and especially, to involve local children and teach them to understand and appreciate the environment in which they live.

I include a short, inspiring video, in Norwegian with English sub-titles, for those readers who might be interested in how one woman, along with friends, the community,  colleagues, and visitors, has worked to institute better waste management practices to deal with the spike in garbage that has accompanied the spread of local tourism on Maafushi and surrounding islands. Much of this waste was either being burnt or dumped into the lagoon.

But to Renee, “the thing is that this is very easy to fix.” She knew that “In Norway we are managing the garbage well, and we are very lucky to have sorting facilities and recycling.”

The video also describes projects she helped initiate to repair coral reefs damaged by bleaching and a tsunami.

There’s also cool underwater footage on the amazing marine life that flourishes in Maldivian waters.

Rather than despairing at the threats to the island she had made her home– waste, plastic, and reef destruction caused by global warming and a tsunami– Renee focused instead on solutions, enlisting locals and visitors alike to fix these problems.

The day after conveying my best wishes, I received a reply to my message. Renee died in April– suddenly– one of the 25,000 annual casualties worldwide from dengue fever, a mosquito-borne illness, that infects nearly 400 million people each year.  Renee’s experience– and that of other friends I know in Indonesia, India, and  Thailand who’ve contracted this disease– mean that dengue is not just a disease of the poor– but of poor countries, with most victims to date having contracted the disease in tropical countries.

That’s changing, of course, as a result of global warming, which has increased the places where the Aedes aegypti mosquito can thrive. This pest is most active during the day and, according to Wikipedia, this mosquito “can spread dengue fever, chikungunya, Zika fever, Mayaro and yellow fever viruses, and other disease agents.”

Wherever the mosquito is present, the poor are of course more vulnerable to contracting the disease — and more likely to die from it, due to the conditions in which they live and their more limited access to quality medical care.

Vaccines for HIV, Malaria, TB, Dengue, and Other Neglected Diseases Unlikely

So, with Renee’s death still fresh in my mind, I was saddened to see this report in yesterday’s New York Times, Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says. This is a different type of failure of the current profit-motivated global pharmaceutical system than is often discussed at Naked Capitalism, in one form or another, but one that claims many, many victims, due to in a inability to fund in this case, necessary research to produce prophylactic vaccines:

Vaccines against H.I.V., malaria and tuberculosis — three major killers of the world’s poor — are unlikely to be produced in the foreseeable future unless vastly more money is committed to finding them, a new study has concluded.

Other worthy goals that appear out of reach for now include a hepatitis C vaccine, a combination vaccine against the four leading causes of deadly diarrhea, a rapid cure for people who have caught tuberculosis and new treatments for a dozen neglected diseases, such as leprosy, dengue fever and sleeping sickness.

To make real progress against this variety of infectious diseases by 2030, the study concluded, the world must increase research spending to nearly $9 billion a year; it now spends only about $3 billion.

Progress on developing vaccines or more effective treatments for these diseases is yet another unheralded consequence of the financial crisis, with funding slumping, except for recent emergency funding for Ebola research.

The study, Developing new health technologies for neglected diseases: a pipeline portfolio review and cost model [version 2; referees: 2 approved, 1 approved with reservations] was funded by the Gates Foundation and the Swiss Agency for Development and Cooperation and published on an open access website, Gates Open Research.

As announced by the Duke Global Health Institute in Effective TB, HIV and Malaria Vaccines Missing from Drug Development Pipeline:

“What this tells us is that the current development pipeline is not likely to give us all the pieces to fight these diseases,” said Gavin Yamey, professor of global health and public policy and director of [Duke University’s] Center for Policy Impact in Global Health. “It underscores the need to substantially scale up resources and innovative development approaches to fill those gaps.”

In the meantime, victims rich and poor alike– will continue to suffer and die from these diseases.


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