THE GIST of Editorial for UPSC Exams : 13 MARCH 2019 (The dilemma of trying out new cures for malaria

The dilemma of trying out new cures for malaria

Mains Paper 5: Health
Prelims level: World Health Report, CHIM
Mains level: Health related issues

Context

•  In 2015, the World Health Report stated that there had been 214 million cases of malaria worldwide with 438,000 deaths from it.
•  This represents an 18% decrease in cases and a 48% decrease in mortality compared to 2000.
•  However, what these figures hide is that over the past decade, there has been an alarming rise in reported cases of drug-resistant malaria all over South-East Asia from Vietnam to

Myanmar and in Pakistan.

•  Given this geographical spread, it is inevitable that drug-resistant malaria will come to India sooner rather than later.
•  There is, therefore, an urgent need for us to develop new treatment regimes for this disease.

Concerns for India

•  The trouble with using therapies developed in the West on Indian populations, particularly in the case of vector-borne diseases such as malaria, is that the host-pathogen relationships in those countries could vary significantly when compared with India.
•  Given our genetics, history of infections, co-infections, immune status and even environmental factors, it is more than likely that treatments that work well on European populations will be somewhat less effective in Asia.
•  What we need to do is to find ways to effectively test new therapies on the Indian population to identify remedies that best address the risk drug-resistant malaria poses to us.

Highlighting the CHIM studies

•  Controlled human infection model (CHIM) studies offer a means by which this can be done.
•  A CHIM study calls for the infection of perfectly healthy adult volunteers with a carefully selected strain of a disease.
•  This allows researchers to observe the progress of the infection, its response to treatment and the efficacy of both naturally acquired as well as vaccine-induced immune responses.
•   Everything, from the strain of the pathogen to the timing, route and dose of infection, is carefully controlled to avoid causing harm to the volunteers and to allow researchers to make accurate observations of the disease that they would otherwise have been unable to do.
•  The benefit of this method is that it makes results available in far shorter time frames than would have been possible with traditional clinical trials, resulting in considerable reductions in the cost of drug discovery.
•  As far fewer participants are exposed to experimental therapies, it puts a much smaller proportion of the population at risk.

Problems with CHIM studies

•  CHIM studies throw up several ethical issues that need to be addressed before we proceed.
•  In the first place, the basic premise of a CHIM study requires doctors to intentionally infect previously healthy human beings with a disease.
•  This approach bears an uncomfortable resemblance to the experiments that Nazis conducted on prisoners in concentration camps, making it impossible to even consider without dealing with the revulsion that such images invoke.
•  In addition, the doctors and medical researchers who conduct these studies will have to consider for themselves how the act of intentionally making a healthy person ill sits with their Hippocratic obligation to do no harm.

Steps needed to be taken

•  Though all CHIM studies obtain, as a pre-condition, the informed consent of volunteers before proceeding.
•  There is understandable scepticism as to whether, in the Indian context, those who participate in these studies will actually understand the many known, unknown, and potential risks of these experiments.
•  This is further exacerbated by the poor reputation of the Indian research community with clinical trials in general particularly following the death of seven girls who participated in Human

Papillomavirus Vaccine trials in 2009.

•  Among poorer sections of society, financial incentives have the effect of being coercive, impairing the consent they provide.
•  One way to address this could be to stipulate that CHIM studies in India should not offer any financial incentives whatsoever, other than covering the cost of treatment during the study and beyond in case of complications.
•  This will ensure that anyone who takes part only does so altruistically with no interest other than to further the scientific understanding of the disease.

Conclusion

•  Above all, the government needs to quickly establish a robust regulatory framework within which any such study should proceed, with strict punishments prescribed for anyone attempting to conduct rogue trials.
•  Only research institutions with impeccable credentials should be granted a licence to conduct CHIM studies and should, throughout the process, be subject to the supervision of an independent ethics board.'
•  CHIM studies offer many benefits. However, before we take advantage of them, we need to address the many ethical challenges they pose.

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General Studies Pre. Cum Mains Study Materials

Prelims Questions:

Q.1) 'Dual or double government' in the context of the East India Company’s rule in Bengal refers to a system where:
(a) the company had the power to collect the revenue while the Nizam of Bengal controlled the nizamat.
(b) the company collected the revenue and enjoyed the control over the nizamat.
(c) the nizam collected the revenue while the police and the judicial system was controlled by the company.
(d) the powers to collect the revenue and the power to control the police and the judicial system was shared between the Nizam and the East India Company

Answer: B

Mains Questions:
Q.1) What are the major highlights in accordance with CHIM studies published by WHO?