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

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.