The Shackled Continent

by Robert Guest

  Of course all this milling took time and money. In November 2002, I asked Judith Lewis, the World Food Programme’s personable director for eastern and southern Africa, about it. “This issue totally came out of left field for us,” she said. “I mean, we’ve been handing out GM food aid for seven years, all over the world. There were no problems until now. But now, in Zambia, we’re seeing just a drip of food aid going in. We have 100,000 tons of American maize [corn] sitting in nearby ports like Durban, Maputo, and Beira, just waiting to go. But we have to send samples to South Africa to test them. This takes ten days. Then we have to get the GM maize to a mill, mill it, and put it back on the road to wherever it was supposed to be going. That can take up to two or three weeks.”

  All the while, people were dying. The most spare milling capacity, Lewis told me, was in Zimbabwe, where many mills had been mothballed. But the Zimbabwean government refused to let the WFP either grind GM corn on its territory or even transport it along Zimbabwean roads. The reason cited was “biosafety,” but this may have been a pretext. Robert Mugabe’s regime used its monopoly of grain distribution to reward its supporters and punish dissidents. It did not want Western charities to start handing out food to members of the opposition party.

  Technology cannot solve all problems. Famines are usually caused by the interplay of bad weather and bad government, with war and pestilence often lending a helping claw. Biotechnology offers no cure for the likes of Robert Mugabe. But it does offer the prospect of more and better food, and in the long term there are few more important goals than that. The world’s population is swelling while the area of cultivable land is not. Somehow, farmers will have to continue squeezing more calories out of each hectare.

  Past predictions that overpopulation would cause mass starvation have always proven wrong, because people have found ingenious ways to raise agricultural productivity. The techniques of the “green revolution” of the 1960s and 70s – high-yielding hybrid seeds, chemical fertilizers, pesticides, and weedkillers – worked wonders in India and China and saved, by one estimate, a billion people from starving.1

  Africa was slow to embrace the green revolution. In Asia by 1998 an impressive 86 percent of wheat fields were sown with modern hybrid seeds, as were 65 percent of rice paddies, 70 percent of corn fields, and 78 percent of millet fields. For Africa the figures were 52 percent, 40 percent, 17 percent, and 14 percent.2 Partly, this reflects the fact that some of these seeds were not suitable for African soil. But it also reflects a reluctance or inability on the part of African governments to promote new technologies and a reluctance among many Africans to embrace them.

  Among the very poor, such reluctance is rational. All change carries risks, and when you live perpetually on the brink of starvation, all unquantifiable risks are terrifying. If a peasant with no safety net tries a new hybrid seed and his crop fails, his family may starve. But governments have no such excuse. Official technophobia seems especially perverse when you consider the benefits that technology has brought to people’s lives in the past century.

  Getting better all the time

  I once spent a piteous morning interviewing Angolans who had trodden on landmines. It was easy to imagine, as I glanced uncomfortably at their stumps, that twentieth-century technology has done more harm than good in Africa. Cluster bombs shred limbs. Helicopter-gunships keep evil men in power.

  But even in Angola, the country UNICEF rated in 1999 to be the worst place on earth, people are living nearly twice as long as their great-grandparents. A life expectancy of forty-five sounds awful by Western standards. But a century ago, Angolans, like most people throughout human history, survived for an average of only twenty-five years.3

  The main reason for this improvement is modern medicine. Even the sad souls in Luanda’s refugee camps have access to drugs. Antibiotics clear up infections that would previously have been fatal. Vaccines prevent countless children from dying before they can walk. In Angola as a whole, two thirds of one-year-olds are immunized against tuberculosis. This is one of the lowest rates on earth, but it is a vast improvement on nobody 100 years ago.

  The conventional wisdom is that as rich countries innovate with ever-increasing speed, the poor are left behind. This is not true. Technology certainly makes the rich richer, but it also makes the poor less poor, not to mention healthier, better-fed, longer-lived, and supplied with a wider variety of entertainment.

  Consider the most basic (and least falsifiable) indicator of well-being: staying alive. Angus Maddison, an economic historian, estimates that life expectancy in 1900 in what we now call the developing world – roughly speaking, everywhere apart from Western Europe, North America, Australasia, and Japan – was twenty-six. In the West it was forty-six, about the same as in Angola today.

  Westerners now live 70 percent longer than they did a century ago, to an average of seventy-eight. People from developing countries have done better: they can expect to live two and a half times longer than in 1900, to sixty-four. These figures are astonishing. In the millennium before 1900, lifespans in Asia, Africa, and Latin America barely budged. But then again, medicine has improved more in the past 100 years than in the previous million.

  Brains v. bugs

  Imagine a hospital where the water is dirty, where tuberculosis is rife, and where the doctors are so ignorant that a patient has only a fifty-fifty chance of benefiting from a consultation. Imagine, too, that most of the drugs are useless, and some are poisonous. This is a fair description of what health care was like in America a century ago. One in four children died before the age of fourteen, mostly from infectious diseases. In the early twentieth century, Oliver Wendell Holmes, an American wit, declared that if all the medicines of his day were tossed into the ocean, it would be better for mankind and worse for the fish.4

  Health care in poor countries today is rather better than that. Poor people are living longer, not because the natural human lifespan has increased, but because many of the horrors that prevent people from reaching old age are being tamed. A child born in the developing world today can expect to live eight years longer than one born thirty years ago. Even in the forty poorest countries, infant mortality fell by a third between 1970 and 1999. A recent World Bank study concluded that technical progress was the biggest single cause of reductions in mortality, accounting for 40–50 percent of the improvement between 1960 and 1990.

  Vaccines, for example, have had a startling effect. Influenza, which killed between 20 and 100 million people in 1918–19, is now largely under control. Smallpox has been eradicated and measles, whooping cough, rubella, diptheria, tetanus, and tuberculosis have been curbed by vaccination. In recent decades, technology has made vaccines easier to deliver in poor countries. A droplet of polio vaccine can be swallowed – no need for needles. More heat-stable vaccines have been created which do not need refrigeration. Combination vaccines can be delivered in a single shot.

  Antibiotics have been a great blessing, too. Penicillin was discovered in 1928, but it was only during the Second World War that a way to mass-produce it was invented. Infections that used to be fatal can now be quickly cured.

  One of the simplest and most effective medicines ever is oral rehydration therapy (ORT), which was developed in Bangladesh and has saved millions of babies from dying of diarrhea. Take a mixture of sugar and salt, dissolve it in water, and give it to the ailing child. It prevents dehydration and so keeps her alive. Before ORT, the standard treatment was an intravenous drip, at a cost of $50 per baby. Packets of oral rehydration salts were mass-produced in the 1980s: they cost less than 10 cents each.

  Despite all these advances, people in poor countries, and Africans in particular, are much sicker than they need be. Technology has conspicuously failed to conquer AIDS, which, by scuppering people’s immune systems, has allowed diseases that were retreating, such as tuberculosis, to rally and attack once more. In much of eastern and southern Africa, life expectancies have actually fallen in the last decade, often quite dram
atically, because of AIDS.

  How can Africans fight back? Better logistics would help. Existing medical technology is not nearly as widely used as it should be. In Ethiopia and Burkina Faso, for example, under 20 percent of those who need ORT receive it.

  One problem that Africans are almost powerless to solve, at least in the short term, is that most medical research is done in rich countries for the benefit of rich people. The fattest profits are to be made tackling chronic conditions that affect lots of Westerners, such as heart disease and cancer. The ills of the poor are neglected: of the 1,223 drugs introduced between 1975 and 1996, only thirteen were aimed at tropical diseases. In 1998, the world spent $70 billion on health research, but only $300 million of this was directed at developing an AIDS vaccine, and a mere $100 million was devoted to fighting malaria.

  When drug firms do produce pills that might help the poor, their patents allow them to charge monopoly prices which the poor cannot pay. The patented drugs that have curbed AIDS in rich countries used to cost $10,000 a year. For most Africans this is an outlandish sum. AIDS activists have gone so far as to claim that “patents kill.”

  This is unfair. Without patents, there would be no incentive for private companies to invent new medicines. Drugs firms spend $300–$500 million creating a single pill. They could never recoup this investment if others were allowed to copy their drugs and sell them at a thin margin over what they cost to manufacture.

  Patent protection is temporary and conditional. To win it, an invention must be original, useful, and non-obvious. The inventor must reveal how his invention works, and this information is made public. The inventor is then typically granted the sole right to sell it for seventeen to twenty years from the time the patent application was filed. For drugs, the effective monopoly period is shorter. It can take a decade for a drug firm to develop, test, and bring to market a patented molecule. This leaves only seven to ten years for the firm to cover its research costs and turn a profit.

  Abolishing patents would more or less halt progress in pharmacology. But there is a strong argument for pricing drugs differently in poor countries. A treaty that most countries signed in 1994 allows governments to override patent protection during a national emergency. AIDS in Africa obviously qualifies as such an emergency.

  Several drug firms, partly because of international pressure and partly because they noticed that they were not generating significant profits in Africa anyway, have started to offer AIDS drugs to Africans for less than a tenth of their normal price. This gesture has certainly prolonged some lives, but the drugs are still too expensive for most Africans, and some have been bought up by corrupt officials, shipped back to Europe, and sold, illegally, at a huge profit.

  Differential pricing will not, in any case, address the other problem, that drug firms’ research concentrates on problems that affect rich people. Only public money can fill the gap. As I mentioned earlier, foreign aid would lift more people out of poverty if it bankrolled vaccine research instead of dodgy governments.

  Some donors see this. In 2001, the UN announced the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, asking rich countries to chip in $7–$10 billion. In the first year, it raised $2.1 billion, which is a start. Another organization, the International AIDS Vaccine Initiative, launched by the Rockefeller Foundation, which brings together states, academics, and drug firms, started clinical trials of its first vaccine candidate in Kenya in January 2001.

  The more that developing countries themselves contribute to these efforts, the more likely they are to succeed. No African country, except South Africa, can plausibly handle the whole process of drug discovery, development, testing, and marketing. But several have pockets of unique expertise or a wide variety of potentially medicinal plants.

  Turning biodiversity into medicine is not easy, however. Vietnamese scientists extracted an effective malaria drug from a tree long used in traditional medicine, but there are only a handful of other recent triumphs. Congo’s jungles may well hide a cure for heart disease, but no one has found it yet. The trouble is that countries with rainforests tend to lack pharmacological expertise, while the big drug firms that have the know-how are all based in countries without rainforests.

  Unscrupulous Western researchers sometimes solve the problem by stealing plants from poor countries. Some firms have learned about the healing properties of plants from locals, taken this information, and patented the plant’s active ingredient without acknowledging the locals’ contribution or rewarding them for it. Two cancer drugs, for example, were developed using a rose periwinkle plant found in Madagascar, but Madagascar received no benefit. Stopping “biopiracy” is tricky; bacteria are easy to smuggle. But multinationals hate bad publicity, so many are striking fairer deals. The Brazilian government, for example, receives royalties from Novartis, a Swiss drug firm, for providing it with micro-organisms. Monsanto, another multinational biotech firm, is working with the Kenyan Agricultural Research Institute to create virus-resistant sweet potatoes.

  Some day, biotechnology may allow scientists to modify the insects that spread disease: perhaps to create a mosquito that cannot carry malaria. Using a more basic technology, irradiation, health workers managed to eradicate sleeping sickness, a horribly debilitating disease that hits both people and their cows, from the island of Zanzibar, off the coast of Tanzania. Tsetse flies, which carry the disease, were sterilized with radiation and then released. The sterile flies mated with fertile ones, producing no offspring but convincing the fertile flies that they did not need to mate again. Eventually, the island’s tsetses died out. I spoke to John Kabayo, a doctor who was trying to organize a similar feat in Ethiopia. This was clearly going to be harder as Ethiopia is not surrounded by water. But Dr. Kabayo seemed confident. “Sleeping sickness is a poor man’s disease; no one is going to develop a vaccine for it,” he told me, “So we’re just going to have to wipe out the tsetse flies that carry it.”5

  Fishermen on the Net

  Working as a journalist in Africa, I find myself using Internet cafes a lot. Television crews need their own satellite link-ups to whizz pictures home in time for the six o’clock news, but a scribe on a weekly paper can get by with much less fancy equipment. A humble laptop with a floppy drive is all I usually carry. When I have to send a story home, I save it onto a disk, walk into a cyber-cafe, order a strong black coffee, log on, and buzz the piece to London. It’s cheap and more reliable than you might think. These days, even small African towns have Web access. Sitting at a terminal in Antananarivo, the capital of Madagascar, I’ve looked up facts about the history of an island that has not yet been properly mapped.

  The Internet has been so loudly hyped that I hesitate to add to the noise. Africans need food and medicine before they need Google. But information and communication technology (ICT) could help them lay hands on both of these more easily.

  While surfing in Tanzania, I’ve overheard locals using Internet telephony to bypass the price-gouging state phone company, call Hong Kong, and sell hand-carved elephants for hard currency. In Niger, weather forecasts are downloaded from the Internet, relayed to local radio stations, and broadcast to cattle-herders with wind-up radios. This tells the herders where to herd their cows for the best grazing, crucial information in a country that is mostly desert.6

  Communication, as you may have heard, is getting cheaper. Any task that can be digitized can now be done at a distance. Dial a helpline for a British bank, and you may find yourself talking to someone in South Africa. It’s in roughly the same time zone and has adequate telephone lines and a lot of English-speakers who will work for a quarter of the going rate in England. The operators are glad to have jobs (staff turnover is much lower at South African call centers than at British ones), British banks save money, and their customers enjoy slightly lower bank charges as a result. In Ghana, a firm called ACS employs 1,000 locals to process American health insurance claims and bounce them back to Kentucky via satellite. None of this
remotely compares with what is going on India, where the software industry employs 400,000 people. But you have to start somewhere.

  Accurate, timely information is useful in almost every field. Take health care. The Internet is the quickest and cheapest way yet devised of disseminating medical research. African doctors with Web access can read journals online that they could not afford to have mailed to them. In Gambia, nurses in remote villages use digital cameras to download images of symptoms on to a PC and email them to doctors in the capital for diagnosis. Throughout Africa, outbreaks of meningitis are tracked over the Internet so that epidemics can be stopped early.

  Information and communication technology could make government more efficient and accountable. Email creates an unshreddable paper trail for decisions. In Madhya Pradesh, in India, an experimental government intranet service allowed ordinary people to get hold of official documents (farmers, for example, might want land title deeds) for as little as 10 cents. Previously, such documents were only available if the farmers bribed corrupt officials to dig them up, which could cost as much as $100. And academics find the Internet invaluable. A decade ago if a researcher in Nairobi wanted to bounce ideas off lots of other experts each day, he probably had to move to Boston. Now, he simply logs on. Cheaper communications mean more North–South collaboration and indeed more South–South collaboration. Between 1995 and 1997, Kenyan scientists coauthored papers with colleagues from eighty-one other nations.

  As I write, most Africans have still never made a telephone call. But by the time you read this book, that may no longer be true. Landlines are still expensive and unreliable, but mobile telephones are spreading throughout the continent with the pace and annoying chirrups of a swarm of locusts. In 1998, only 2 million Africans had cellphones. Four years later, 30 million did.7