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In high-income countries, pharmaceutical research is highly regulated, while in low-income countries there is often a lack of clear ethical regulations.

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Financially vulnerable people fall victim to the pharmaceutical companies' tests

The Corona pandemic has sparked discussions about whether new vaccines and medicines should be tested in low-income countries. It is a historical trend that drug research is carried out on economically disadvantaged people, while it is the richer people who ultimately have access to the medicines.

During a televised debate in early April suggested a French doctor that a new corona vaccine should be tested in Africa, in addition to where it is already being tested, despite relatively few reported cases on the continent. His argument was that there is a lack of protective equipment and good care against the virus in Africa, and that it would therefore be a more credible result of the study there.

The statement created outrageous accusations of racism, including from the head of the World Health Organization, Tedros Ghebreyesus, who said that the hangover from the colonial mentality must stop. What Ghebreyesus was referring to was the fact that many large pharmaceutical companies perform clinical trials in low-income countries instead of in the country where the largest share of sales is likely to take place. 

One may ask why the French doctor thought that tests should be performed on a population that currently does not benefit much from it, due to the low reporting of corona falls in Africa. For example, it would be more difficult and less effective to test malaria drugs in Europe because there are fewer infected people there than in Africa. 

The statements regarding drug testing are linked to a discussion on "medical colonialism”, Where international pharmaceutical companies use vulnerable groups to test drugs in exchange for care. These tests often take place in low-income countries that have lower quality healthcare. 

For several generations, there has been an exploitation of populations that have suffered from life-threatening diseases, poverty and poor access to health care. Structural poverty contributes to exploitation, as participation in clinical trials may be the only chance for care for a person in that position. At the same time, many drugs are very expensive, and may be out of reach for many people in the countries where they are tested. 

Poor African Americans were exploited for syphilis research

One of the most notorious cases of exploitation of the poor in research is the so-called Tuskegee Syphilis Experiment which took place between 1932 and 1972. The purpose of the study was to study the development of untreated syphilis. Six hundred poor African-American men participated in the experiment in which two-thirds of the participants had the disease. 

The experiment was performed without the participants' informed consent. The participants did not know that it was syphilis they were suffering from, but instead thought that they were treated for 'bad blood' - a local expression for several different diseases where syphilis is included. In exchange for participating in the study, patients received free medical examinations, treatment, meals and funeral insurance. 

The researchers did not provide participants with complete information during the experiment. For example, they thought the experiment would last for 6 months, instead of the 40 years it actually lasted. Even when penicillin was discovered as a cure for the disease, it was not offered by the researchers. Thus, participants continued to be studied for their disease, even long after a cure was available. 

Ethics laws are weaker in low-income countries

The revelations about the Tuskegee study led to legislation in the United States that tightened the criteria for ethical studies, among other things by requiring well-informed consent. But this type of legislation does not exist in all countries. It is most often lacking in low-income countries where the state is weak. 

According to a report written by Katrin Weigmann Strict legislation in many rich countries makes it difficult for pharmaceutical companies to recruit participants. Then they turn instead to low-income countries where authorities set lower requirements or have less capacity to monitor experiments. 

In corrupt states, the authorities are even more likely to accept bribes. The researcher in bioethics Ames Dhai tells The Guardian that research in low-income countries is becoming less demanding and an attractive choice for pharmaceutical companies. The reason is that the ethical review in poorer countries is often less strict, that the side effects of the tests are often underreported and that the risk of legal disputes is less. In addition, there are low operating costs in low-income countries. 

The researcher Sheriff M. Shehata claims in a study that the pharmaceutical companies' research is not adequately controlled - or that many authorities simply seem reluctant to deal with unethical drug tests.

Nigeria sued pharmaceutical company for child death

Year 2007 sued the Nigerian state pharmaceutical company Pfizer after a test study of the antibiotic Trovan against meningitis. The drug tests resulted in 50 deaths of a total of 200 participating children. In addition to the deaths, many of the other participants developed physical deformities, such as joint disease, abnormal cartilage growth and liver damage. 

The Nigerian state claimed that Pfizer had not received approval from the authorities to carry out the study. Pfizer, for its part, claimed that they had received verbal consent from the parents of the children. The validity of verbal consent can be questioned in such a situation, especially given that it is difficult to know how informed the consent is. 

The case of Pfizer in Nigeria proves that medical experiments can pose real health risks to participants, as the side effects of the drugs or vaccines being tested are not yet fully known. Journalist Sonia Shah, who wrote the book The Body Hunters, talks about the power that the public and the media have to hold pharmaceutical companies responsible for ethical violations in clinical trials. But she also writes that that power is more difficult to use when the tests take place in low-income countries with poorer media coverage and poorer legal systems. This will make it easier for companies to get away with unethical tests. Sonia Shah also addresses the fact that poverty is often linked to lower education, and that it can be exploited by pharmaceutical companies. 

These examples do not mean that all clinical trials in low-income countries are poor. Researchers say that a distinction must be made between clinical trials of vulnerable people that will benefit people in richer countries, and studies that can contribute to a higher quality of care in the low-income country. Hence the anger directed at statements that covid-19 vaccine should be tested in Africa, the continent with the least reported cases. In response to the French doctor's statement, Tedros Ghebreyesus said it was against solidarity, and that the WHO would follow all the rules and protocols for testing all vaccines around the world.

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