That African bodies have been used to test drugs intended for Western markets and consumers is not fiction or conspiracy; it is a historical fact.
In many ways, COVID-19 calls into question how far we are today from the scientific ignorance of the past. The pandemic caught the world with remarkable pace, spreading in just five months to over 200 countries, and causing major disruptions to daily life in the vast majority of these. The novelty and contagiousness of COVID-19 have been compared to the 1912 flu. Its impact on the global economy and the international system overall is likely to exceed the 2009 global recession and even 9/11.
It should perhaps come as no surprise, then, that we have seen another scorned relic of our past unearthed by the novel coronavirus. This came in the form of an interview featuring Dr. Jean-Paul Mira, head of the intensive care unit at Paris’ Cochin Hospital, and Dr. Camille Locht, Research Director at the French National Institute of Health and Medical Research (Inserm), that aired on LCI, a French television channel, earlier this year in April. During the interview, Dr. Mira suggested that Inserm carry out trials on the effectiveness of the BCG vaccine, a tuberculosis drug almost a hundred years old, for the prevention of COVID-19 on Africans, who, he expanded, have ‘no masks, treatment or intensive care’, and so ‘are highly exposed and do not protect themselves’. Mira even went as far as to draw parallels between this type of trial and studies of HIV/AIDS among sex workers. Dr. Locht, in his response, agreed with this assessment, and added that Inserm had already begun to consider conducting such a study in Africa.
Both Dr. Mira in his personal capacity and Inserm as an institution have since come forward to apologize for their statements. Inserm clarified that the suggested African trials would complement ongoing research on the BCG vaccine’s effectiveness against COVID-19 in Europe and Australia. As is often the case, however, their apologies and explanation came far too late, and were given only after massive outcry on social media. An online petition calling for disciplinary action against Dr. Mira and Dr. Locht has now gathered over 25,000 signatures.
A Legacy of Empire
Whatever the context of Dr. Mira and Dr. Locht’s comments, there are many reasons that the perspectives presented in this interview sparked controversy. The premise of Dr. Mira’s view, that exploiting any group’s exposure or lack of protection for the purpose of infectious disease research could ever be ethical, is disappointing at best. However, the strongest reactions, including from Dr. Tedros Adhanom Ghebreyesus, WHO Director General, condemned the doctor’s call for COVID testing in Africa as racist.
Such reactions are not new. They stem from the history of African peoples’ exploitation for the supposed advancement of health and medical research. In fact, the enterprise of global health itself is built on the legacy of empire and colonial medicine and the needs of the imperial centre to manage disease threats from the colonial periphery. The discovery of the malaria parasite, quinine—the first antimalarial drug—and the isolation of the cholera pathogen were all landmark achievements in medicine facilitated by and pursued in the name of empire. Colonized and enslaved bodies were sometimes grossly exploited in the name of medical advancement, as may be seen in smallpox experiments carried out on slaves in the British Caribbean and the horrific physical manipulation that enslaved black women were subjected to at the hands of Dr. James Marion Sims, a nineteenth-century American heralded as the father of modern gynaecology.
While mainstream institutions of global health and medicine such as the WHO have largely moved away from this type of relationship with the formerly colonized world, corporations and other entities have, as recently as the late 20th century, persisted in the abuse of African people for financial or other gain. Pfizer’s illegal 1996 trials of trovofloxacin, an experimental meningitis drug, in Kano, are a hallmark example of this type of abuse. The pharmaceutical company conducted trials despite evidence suggesting that the new drug could cause significant, harmful side-effects in children. Pfizer even used falsified documents to indicate Nigerian approval of the study when no such approval existed. Eleven children enrolled in the trial died, which did not stop the company from later attempting to use their Kano data to apply for the drug’s approval in the United States.
Although the victims of this instance of illegal experimentation were able to bring their case to court and eventually received a $75 million settlement from Pfizer, the broader impacts of this type of abuse are even harder to address. In northern Nigeria, where Pfizer carried out the trials, distrust for Western institutions, including Western science and medicine, is profound and well-documented. This distrust sometimes boils over into outright violence, as seen with the Maitasine riots in the 1980s and the long-standing unrest by Boko Haram, ISWAP and other extremist groups around Lake Chad. The latter sometimes target health workers directly, as was the case with the 2013 killings of nine polio vaccinators working in Kano.
Such distrust is also interlinked with other significant causes of health system failure, such as poor governance, poor infrastructure and limited supplies of drugs and medical equipment. The impact of these is illustrated, for example, in Nigeria’s status as, until recently, Africa’s last polio endemic country, and the country with the world’s second highest infant death rate. And even when distrust is confined to specific geographic areas, infectious diseases that take root in these places can have serious repercussions for other countries, both in West Africa and beyond. Outbreaks of polio in Nigeria, for example, have been linked to cases of the disease in countries as far away as Sudan and Indonesia.
Persistent Ideologies of Distrust
That African bodies have been used to test drugs intended for Western markets and consumers is not fiction or conspiracy; it is a historical fact. This historical fact feeds pre-existing ideologies of distrust in the West, its institutions and its medicine, and contributes to violence and health system failures within the countries where this abuse happens. This, in turn, can have effects that reverberate throughout and even beyond the African continent. This broader context adds a deeper dimension to why Dr. Mira’s comments feel so inappropriate and irresponsible. Evidently, science and medicine are still lacking a full appreciation of history, their imperial legacies and the significance of these legacies. Sustaining this ignorance risks jeopardizing the fundamental objective of global health in avoiding humanitarian catastrophe⎈
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