By Elham Kazemi, CIHA Editorial Assistant and PhD Candidate, University of California, Irvine
Today’s post delves further into the video that was aired on LCI (La Chaîne Info) in April and caused a great deal of backlash on social media. To recap: the video shows a conversation between two French doctors in which one of them, Dr. Mira, asks his colleague whether they should test the effectiveness of the BCG tuberculosis vaccine on COVID-19 first in Africa, “where there are no masks, treatment or intensive care, a little bit like it’s done, by the way, for certain AIDS studies or with prostitutes?” Dr. Locht, the research director at France’s National Institute of Health and Medical Research (Inserm), agrees: “You are right. And by the way, we are thinking of in parallel about a study in Africa using this same approach.” This interaction was met with immediate condemnation on the part of a wide spectrum of people, from the Ivorian soccer player Didier Drogba to Olivier Faure, member of the French National Assembly from the France’s Socialist Party. The French anti-racism group SOS-Racisme called on the Superior Council of the Audiovisual to formally condemn the remarks, but the Council did not denounce the statements. Twitter users from the continent also started the hashtag #WeAreNotLabRats in response. Although Dr. Mira apologized a few days later following the outcry, Inserm counteracted by arguing that the video was being “misinterpreted” while accompanying its statement with the hashtag #FakeNews on Twitter. The WHO director also condemned the comments as racist and a hangover from the “colonial mentality.”
In addition, both the statements and the reactions to them caused concerns among scientists in Africa that clinical research on COVID-19 might now be delayed or compromised because of the lack of trust on the part of African populations. For example, false claims about the death of children as a result of receiving COVID-19 vaccine circulated in Senegal as well as a false claim that the UN was planning to test vaccines in Africa. For our purposes, however, there are additional issues that need unmasking (pun intended), and that connect with previous work done here on the CIHA Blog. First, let’s take the interaction between the two doctors and discuss the problematic assumptions underlying their statements and the historical context within which such statements gain meaning.
First, Dr. Mira points out that there are no masks or treatment available in “Africa.” This statement clearly neglects the wide variation that exists among different African countries. When I first arrived in Mali in February 2020, I noticed that many Malians were wearing homemade masks and it was even before COVID-19 had found a way into the country. Upon my conversation with other “guests” in Mali, I realized that in several West African countries, wearing a mask was part of the culture and recommended in order to protect people from the dust and sand coming from the Sahara Desert. Further, as the figure below from the WHO report shows, the consolidated health system performance score – driven from four indices of access, quality of care, demand, and resilience – varies greatly in the continent ranging from 0.26 to 0.7, with countries in green having the highest scores.
It should also be noted that some countries in Africa, including South Africa and Senegal, have been at the forefront of medical research on COVID-19 in close cooperation with other countries. The tendency to portray Africa as a homogenous region while neglecting the differences between the 54 countries of Africa, and to underrate the capacities that exist in the continent, even if limited, is highly problematic and is rooted in Western imaginaries of Africa in relation to other spheres of global power. Second, let’s not forget that in terms of infections with coronavirus, African countries are still far behind some of the Western countries.
Third and most importantly, the suggestion that experimentation can be conducted in Africa as it is done on “prostitutes” is not only based on the assumption that there are certain groups of people who lack agency and therefore, not subject to the requirements of informed consent like other “subject groups” of study, and whose lives are therefore more disposable, but also ignores the efforts of sex workers themselves to take control of the research process – see especially the CIHA Blog post on how some sex workers in Nairobi challenged such assumptions by calling for an indigenous research ethics against exploitative research. A long history of dehumanization and prevalent racism has made such assumptions both possible and natural as way of “how things are and should be.” It should not be surprising, then, that medical experimentation has a long history in colonized Africa. As Hellen Tilly, the author of Africa as a Living Laboratory, argues, in most cases, establishing medical services went hand in hand with research programs and experimentation in colonial Africa. During the colonial era, no ethical code governing research on “human subjects” existed. It was only after the horrors of Holocaust and the Second World War when the ethical codes governing medical ethics were enacted. The Nuremberg Code (1947) and the Declaration of Helsinki (1964) are two of the most well-known documents on medical ethics. But even the existence of such documents did not prevent the repetition of harmful medical practices in post-colonial Africa, this time mostly by private pharmaceutical companies. One case that got a lot of attention, especially in the US, was when Pfizer used Trovan in a clinical trial in Kano, Nigeria without authorization from the government or consent from the legal guardians of its “subjects” who were children (for a comprehensive study of “fake” drug trade in Nigeria, see Speculative Markets: Drug Circuits and Derivative Life in Nigeria by Kristin Peterson). Following four rounds of lawsuit against the company in the US, Pfizer finally settled the case out of court. But one can just imagine that this is one of a few success cases of enforcing corporate accountability.
Such discourse also tends to deny or at best overlook the accountability of colonial powers for the failure of health systems in post-colonial Africa. The end of colonial era came with a withdrawal of medical personnel and cut in the funding for health services while the imposed neoliberal policies following the independence ensured the breakdown of health systems in various countries in Africa as well as other areas of the world – see the CIHA blog post by China Scherz as well as others in our blog series on Ebola. The answer is not excluding the continent from ongoing research. Clinical trials can be done ethically and under the supervision of ethics review boards in the continent itself. It is time for Europe and the US to let go of their old colonial imaginaries of Africa and instead include African nations as equal partners in forging global policies to fight problems that are transnational and global in nature. We do not need a laboratory in “Africa,” what we need is to hear the voices of people across the world and develop a solution that free us not only from this pandemic, but also from other global issues such as climate change whose impact goes beyond borders of one country.
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* Featured image: © WHO/Kabambi E.