Bioethics Blogs

Manufacturing neglect: What happens to drugs once the epidemic has passed? by Jeremy Greene

We like to think that drugs help put an end to disease, although in the aggregate this is seldom the case. However many individual infections and infestations might have been cured by timely doses of antibiotics, antifungals, antiparasitics, or antivirals, very few diseases have been eradicated because of biomedical therapeutics. Yaws, a chronic treponemal disease now limited to 14 countries in West Africa and Southeast Asia, is a rare exception of a malady whose displacement has been driven by antibiotics. More often, diseases are controlled by surveillance, prophylaxis, and other preventive measures than by specific treatments. The limited successes of malaria eradication came more from vector control than antimalarials, polio and diphtheria are no longer scourges of childhood in North America and Europe because of widespread vaccination. If early 20th century debates over the management of the HIV/AIDS and MDRTB pandemics have rightly challenged any facile dichotomy between treatment and prevention as public health strategies, the relationship between the two remains an uneasy site of intersection between medicine and public health. More recently, a subtler antagonism between prevention and treatment has become apparent: the paradoxical influence of successful prevention on the availability of efficacious treatments.

Take, for example, the displacement of hookworm from the southern United States, widely remembered as a successful local eradication effort that owed more to the development of sanitation systems and social uplift than the deployment of antiparasitic drugs. While hookworm remains one of the most common nematode infestations of humans worldwide, the website of the US Centers for Disease Control (CDC) discusses the American subtype, Necator americanus, exclusively in the past tense: a parasite which “was widespread in the Southeastern United States until the early 20th century.” Although hookworm was once widespread, the CDC continues, “improvements in living have greatly reduced hookworm infections.”

These “improvements in living” were part of a coordinated regional campaign by the Rockefeller Foundation that would ultimately launch the foundation to the forefront of international public health interventions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.