Politics & Policy

When Regulation Kills

An electron microscope view of the Ebola virus (CDC)
Release the experimental Ebola drugs.

When you are infected with Ebola, you are not very much worried about the possibility that you might get sick — you are sick, horrifyingly so, and mortally so in more than half of all cases. Worrying that your health might take an additional turn for the worse after you’ve been infected with Ebola is like noticing that your car’s check-engine light has come on a half-second after you’ve driven it over the rim of the Grand Canyon. And so the controversy over giving experimental Ebola drugs to two American aid workers, Kent Brantly and Nancy Writebol, and whether to extend the same option to dying people in Africa, is a strange one.

Of course the drugs should be released, but the World Health Organization is hearing none of it. The experimental Ebola serum, which has shown promise in tests on monkeys but has not been through human trials, may very well have saved the two aid workers’ lives. The serum, called ZMapp, is a project of Mapp Pharmaceutical of San Diego — one of those wicked pharmaceutical companies that are a favorite whipping-boy of health-care reformers while they are quietly working to save the world — in collaboration with Dreyfus Inc. and U.S. and Canadian health agencies.

Mapp seems ready and willing to get moving: “Mapp and its partners are cooperating with appropriate government agencies to increase production as quickly as possible,” the firm said in a statement. But use of ZMapp remains “under the regulatory guidelines of the FDA.”

An American firm with a potentially life-saving drug is allowed to administer it to two Americans, while 1,600 or more Africans are denied: Needless to say, the reaction to this has not been especially celebratory in Africa. Critics in Africa denounced the United States as “wicked and selfish,” and one asked: “So the secret serum used to cure two Americans from Ebola is too secret to reach Africans dying like flies?” WHO is a creature of the United Nations, not the United States, but it is certainly the case that American institutions could — and should — be taking the lead instead of waiting around for the bureaucracies to rouse themselves. We aren’t talking here about another endless and expensive national crusade, another open-ended effort to try to right the world’s wrongs, but rather about a very discrete, focused effort to head off a plague before it becomes an epidemic. It’s a chance for the planet’s most powerful nation to get off its butt and remind the world that our ability to shock and awe is not limited to the battlefield.

But that requires leadership, which we are a bit short on just now.

George W. Bush won the United States a tremendous amount of goodwill in Africa and elsewhere with his assertive approach to the continent’s HIV crisis. Barack Obama, on the other hand, remains committed to at least one campaign promise: He’s going to undo what Bush did to America’s standing in the world — though perhaps not in the way he intended. Not in Africa, anyway.

While this crisis is unfolding, President Obama and Bill Clinton were in Washington using Africans as props in their campaign to save the Export-Import Bank, a venerable, Roosevelt-era corporate-welfare program, the net economic effect of which would be indistinguishable from simply sending a large check every year to Boeing, General Electric, and Caterpillar. The argument the Democrats put forward at the U.S.-Africa Leaders Summit was, in effect, that financing subsidies for U.S. exporters is essential for Africa’s economic development. That’s a pretty dodgy argument: The benefits of Ex-Im are heavily concentrated on a very small number of American companies and their overseas customers. General Electric’s 2013 revenue was more than the GDPs of several sub-Saharan African nations combined. How much greasing U.S.-based multinationals really need to be investing in Africa’s expanding markets is far from obvious, but dressing up corporate welfare as African aid is good politics: Dead Africans write no campaign checks.

It isn’t just Africa, of course. Every year, Americans in the late stages of terminal illnesses are denied access to experimental treatments by the FDA, on the theory that untested drugs might make these dying people sick. The agency’s “compassionate use” program, which gives some leeway in the use of unapproved drugs, is cumbrous and narrow, and, like most regulatory programs, is much more oriented toward the FDA’s institutional interests than those of the sick and dying people the program allegedly is there to serve. The FDA is not there to look after Americans’ health; the FDA is there to look after the FDA.

There are, of course, times when experimental treatments must for prudential reasons be kept out of use: For example, an experimental vaccine that might lead to an outbreak would be too dangerous to use without further study. But that is not what is keeping ZMapp away from those who might benefit from it. The roadblock here is the usual one: bureaucratic inertia.

Ebola experts including Peter Piot, the discoverer of the virus, argue that African doctors and patients should be given the same choice that was given to Kent Brantly and Nancy Writebol. He’s right. And if Barack Obama had ever figured out that there is more to being the most powerful man in the world than giving speeches, he’d also figure out that sick Africans need American pharmaceuticals far more than they need American corporate welfare. Instead, he’s at the African summit tweaking congressional Republicans over the Export-Import Bank, an agency he himself denounced as an exemplar of “corporate welfare” within recent memory.

If an African government were looking to buy a Boeing airplane to ship Ebola medicine to sick people abroad, the U.S. government has a program to finance that. But getting ahead of a terrifying plague? No such luck. 

— Kevin D. Williamson is a roving correspondent for National Review and the author of The End Is Near and It’s Going to Be Awesome.


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