Presidential Commission for the Study of Bioethical Issues (Updated, and errata)

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Here are the annotated slides (PDF) from my presentation this morning to the Presidential Commission for the Study of Bioethical Issues.  (Update -- A word to the wise; a "crore" is an Indian unit indicating 10,000,000.  We had an errant extra zero in our database, and I have now fixed the Indian biotech GDP number to reflect the correction.)

Now sitting in the audience, I've just heard Jim Thomas of ETC once again egregiously distort the Keasling-Amyris-malaria-artemisinin story.  As usual he is quite well-spoken and reasonable sounding, and uses rhetoric well to his ends.

It may be true, as Thomas asserts, that switching artemisinin production to fermentation will harm the economic livelihood of "a few thousand" (his words) farmers in China and Africa.  But he has left out of his calculation the 40% of the world's population that is at risk of malaria every year.  He has left out the millions of children who die annually from malaria.

Quoting from my book (pg.98 -- I've left out the references as I am liveblogging from the meeting):

The cost burden of the disease on individual families is highly regressive.  The average cost per household for treating malaria may be in the range of only 3-7 percent of income, but total and indirect costs to poor households can amount to one-third of annual income.  The disease also disproportionately affects the young. Approximately 90percent of those who are killed by the parasite are African children under the age of five; according to the World Health Organization (WHO), a child dies from malaria roughly every thirty seconds.

In addition to staggering personal costs, the disease harms whole societies by severely inhibiting economic development. In affected countries, malaria reduces GDP growth by about 1.3 percent per year. These countries, moreover, contain about 40percent of the world's population. Over the past forty years, the growth penalty has created a difference in GDP that substantially exceeds the billions in annual foreign aid they receive. In 2000 the World Health Organization estimated that eliminating this growth penalty in 1965 would have resulted in "up to $100 billion added to sub-Saharan Africa's [2000] GDP of $300 billion. This extra $100 billion would be, by comparison, nearly five times greater than all development aid provided to Africa [in 1999]."

Because there was no technical means to eliminate the parasite in the middle of the twentieth century, this is clearly a number calculated to impress or shock, but the point is that the growth penalty continues to balloon. As of 2008, the GDPs of countries in sub-Saharan Africa would be approximately 35 percent higher than they are today had malaria been eliminated in 1965. The World Health Organization reckons that malaria-free countries have a per capita GDP on average three times larger than malarious countries.  The productivity of farmers in malarious countries is cut by as much as 50 percent because of workdays lost to the disease.  The impact of producing an effective and inexpensive antimalarial drug would therefore be profound.
Improving access to other technologies, such as bed nets treated with insecticides, would also be of substantial aid in reducing the rate of infection.  Yet infected victims will still need access to cures. Prevention might be found in a vaccine, which the Gates Foundation also funds. However, even the most promising malaria vaccine candidates are only partially effective and cost even more than artemisinin. Microbial production of artemisinin would completely change the impact of malaria on billions of people worldwide.  Artemisinin is presently derived from the wormwood tree and has been used as an herbal remedy for at least two thousand years. Its antimalarial activity was first described by Chinese scientists in 1971.  The existence of the drug and its physiochemical properties were announced to the world in 1979, although its precise molecular mechanism of action is still not understood. A method for chemical synthesis was published in 1983, but it remains "long, arduous, and economically nonviable."
Because natural artemisinin is an agricultural product, it competes for arable land with food crops, is subject to seasonal variations in supply, and its production costs are in part determined by the costs of fertilizer and fuel. As a result of the work of Keasling and his collaborators, it appears that, within just a few years, biological technology may provide a more-flexible and less-expensive supply of drugs than now exists. Commercial production of artemisinin should commence in 2010, with a continuous annual production sufficient to treat the 500million malaria cases per year.
So, Mr. Thomas, what about all the people who will benefit from inexpensive malaria drugs?  It is, frankly, unconscionable and indefensible for you to continue beating this drum as you do.  The human cost of not producing inexpensive artemisinin in vats is astronomical.  If reducing the burden of malaria around the world on almost 2 billion people might harm "a few thousand" farmers, then we should make sure those farmers can make a living growing some other crop.  We can solve both problems.  Your ideological opposition to synthetic biology is is blinding you to the opportunities, and your version of reality would ignore the health and welfare of children around the world.

How's that for rhetoric?

Update:  One other thought.  Just one year of 1.3% GDP growth recovered by reducing (eliminating?) the impact of malaria would more than offset paying wormwood farmers to grow something else.  There is really no argument to do anything else.

For a "Civil Society" organization, ETC is being decidedly uncivil on this issue.  

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Hi Rob

Have a look back at what I actually said:

"i'm not saying that east african artemesia farmers will experience this fate but there will be massive dislocation as we begin making our commodities in vats of synthetic microbes not in the fields where people work"

Its only a possible scenario not a prediction and its meant as illustrative not exclusive.

Yes, dealing with malaria is an essential public health challenge ( i said that in my remarks too) for the reasons you detail and other reasons too but assuming that centralised production of pharmaceutical artemisinin combination therapies derived from synthetic artemisinin is the cheapest way of combatting malaria may be uncritically buying the hype.

For discussion: There are other (botanically based) strategies that perhaps could be employed to lower costs. For example check out the work of the CGIAR's ICRAF (agroforestry) centre and the German christian natural medicine charity Anamed, working to help malarial affected communities grow artemesia annua bushes that can be consumed as herbal teas that they claim are generally about 80-90 effective in curing malaria.

The seeds they distribute are only cents each and the teas equally cheap - so this low tech botanical approach, while not 100 percent effective, is a much cheaper and locally adapted option that could maybe compliment ACT drugs in more severe cases to lower the overall cost of combatting malaria. Incidentally such a botanical approach strikes me as a "local distributed biological approach" which I understood was the kind of thing you liked (ref: craft breweries) - its brewing too - brewing tea.

It may be you are right and that those affected would agree it is better to go the centralised synthetic production route and use the cost savings to pay the artemesia growers to enable a just transition to some other livelihood - but looking through Amyris' IPO filings I don't currently see any plans by the company to do that:

so thats all a bit theoretical as far as they are concerned



you wrote:

"Because natural artemisinin is an agricultural product, it competes for arable land with food crops, is subject to seasonal variations in supply, and its production costs are in part determined by the costs of fertilizer and fuel."

I don't follow the point of this argument. Synthetic artemisinin also requires agricultural inputs -the yeast will consume some sort of sugar and that sugar needs arable land, fertiizer, fuel etc..

What changes is the place where land is used to produce artemisinin. Doesn't it make more sense to grow artemisinin in affected communities for local use than to grow sugar somewhere else in the world, to be transported to biorefinery somewhere to be made into synthetic artemisinin then shipped to affected communities with all the associated energy and infrastructure costs?

Do we know where Amyris is locating there artemisinin production plant and where the sugar is coming from? Emeryville and Arkansas? Brazil?


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