National Nurses United

narrowly conceived understanding of health as a product of technological interventions divorced from econom- ic, social and political contexts." A number of PPP advocates argue that reducing the disease burden on the Third World will be an important ingredient toward lifting populations out of poverty. But the link between poverty and disease is a complex and tangled one. Shortly after World War II, on a grant from the Rockefeller Founda- tion, anthropologist Peter Brown examined what effect eliminating malaria in Sardinia would have on poverty. Very little, it turned out. Brown found that while malaria con- sumed 4.6 percent of its victim's caloric intake, landlords swallowed up 62 percent of the island's calories. Regardless of the critiques, howev- er, PPPs appear to be one of the few games in town. "PPPs are the result of people realizing that returns on investment isn't going to be the model that drives forward the development of needed vaccines," Dr. David Olson, medical advisor of Doctors Without Borders/Medicins Sans Frontieres, told Revolution. "PPPs are seeking a way to bring together scientists, donors and industry to focus on particular problems. They also keep someone responsible for keeping their eye on the ball." Even those who are leery of PPPs admit that creating alternatives is, as Sidel puts it, a "long-term" project. For warriors like Francis, battling AIDS, polio and diseases that are little heard of in the First World but extract a deadly toll in the Third, "long-term" is a luxury. "Time is money in the private sector, but in vaccines, time is death and suffering. For every day we don't have vaccine 'Y,' so many people die," says Francis. Global Shortfalls sidel agrees that, in the short run, Francis is probably cor- rect about PPPs, but the long-term project of building a public-sector vaccine industry, where profit is not the bottom line, needs to be done. "And insofar as [PPPs] delay the buildup of a public sector," they can be problematic, he says. Tuft's Robbins says there is a long history of successful government intervention to solve problems, "like landing people on the moon. No one thought the private sector would do that, the government did it." There is certainly a precedent for government intervention in health. Popular campaigns in India, Thailand and China forced governments to man- ufacture cheap generics to treat HIV. A similar movement in Brazil pushed the government to withdraw from the World Trade Organization because of its objections to patenting generic anti-viral drugs. Not only were the Brazilian generics five to six times cheaper, but also, under market pres- sure, Merck dropped the price of the antivirals Indiarvir by 65 percent and Rfavirencz by 59 percent. From 1996 to 2001, AIDS treatment costs in Brazil fell 73 percent, as catalogued in the book "Winning the War on AIDS, Brazil Style." Olson argues that governments need to see that just because disease is somewhere else, doesn't mean it shouldn't be their concern. "Take, for instance, Botswana, where there is a possibility that the existence of the country is at stake, that the AIDS crisis could get so large as to make the country non-functional." He says that possibility should be seen as a "security concern," and that governments need to realize "that their countries will be affected in the long run – if not the short run." While drug companies argue that profit has been the driving force behind vaccine creation, profit has not always been the motive, even in the most successful vaccine campaigns. Jonas Salk and Albert Sabin refused to patent their polio vaccines, and Alexander Fleming rejected patenting penicillin. The discoverer of insulin handed his patent over to the University of Toronto for $1. Relying on drug companies to find cures for "neglected diseases" in the Third World has not worked very well, although PPPs have helped make progress in this area. Ultimately, however the bottom line for drug companies is profit. "The private sector is not much concerned with countries or people without disposable income," Robbins points out. Indeed, when it comes to vaccines, profit may be part of the prob- lem. "Vaccines are almost treated like orphan drugs," Francie Wise, RN, MPH, the Contra Costa County director of public nursing and an expert on communicable diseases, told Revolution. "There is not enough profit in them." 16 C A L I F O R N I A N U R S E W W W . C A L N U R S E S . O R G A P R I L 2 0 0 6 JONAS SALK GIVES THE VACCINE TO A CHILD AS PART OF A FIELD TRIAL AT A PITTSBURGH ELEMENTARY SCHOOL. DR. KAY BAILEY IS BEHIND HIM. (DATE LIKELY FEB. 1954) © UNIVERSITY OF PITTSBURGH Salk and Sabin refused to patent their polio vaccines, and Fleming rejected patenting penicillin. The discoverer of insulin handed his patent over to the University of Toronto for $1.

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