By Matiangai Sirleaf
Two French doctors recently appeared on television and discussed using African subjects in experimental trials for an antidote to the novel coronavirus (COVID-19).
“Shouldn’t we do this study in Africa, where there are no masks, no treatment, no resuscitation, a bit like some studies on AIDS, where among prostitutes, we try things, because they are exposed, and they don’t protect themselves. What do you think?” asked Jean-Paul Mira, head of the intensive care unit at the Cochin Hospital in Paris on April 1, 2020.
“You are right,” agreed Camille Locht, research director at the French Institute of Health and Medical Research.
Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO), denounced “these kinds of racist” remarks as a “hangover from colonial mentality.” He maintained that “Africa cannot, will not, be any testing ground for any vaccine.” The fallout on social media was similarly swift, with Samuel Eto’o, a Cameroonian football legend, referring to the doctors as “Des assasins” and several others questioning the motives behind testing a vaccine on the African continent.
The dialogue between the doctors and the strong reactions to their statements reopens the wounds of Black, Indigenous, and other people of color being treated as expendable subjects.
The discussion between the doctors is revelatory in the way that medical neocolonialism is reflexively invoked. Medical neocolonialism as a concept aptly characterizes the pattern of extraction of resources from Black and other people of color for experimental clinical trials. The knowledge generated from this research is subsequently taken for the development of new treatments and drugs. However, the subjects of the research and their communities generally do not share equitably in the benefits of the new drugs or treatments. Medical neocolonialism draws on many of the characteristics of historical colonialism, in that medical neocolonialism is similarly driven by economic dependence, exploitation, and inequality. Medical neocolonialism does not exist in a vacuum. It is tied to the presumed expendability of Black life.
This presumed expendability is witnessed both domestically and internationally, from unethical medical experimentation, to the devastating racially disproportionate impact of COVID-19, to the inadequate domestic response to the COVID-19 pandemic, and the seemingly unrelenting onslaught of police violence against Black people in the United States.
Expendability manifested in such a way that over George Floyd’s brief life he encountered both systemic police violence and racialized health inequities. Derek Chauvin, a Minneapolis police officer, kneed George Floyd to death for nearly nine minutes. During this time, George Floyd told officers, “please, I can’t breathe” more than twenty times while the officer’s knee remained on his neck.
COVID-19 also sought to render him disposable. The Hennepin County’s Medical Examiner’s autopsy report notes that a nasal swab sample collected from Mr. Floyd’s body indicates that he was positive for COVID-19 at the time of his death. It also observes that he was likely asymptomatic with persistent positivity from a previous infection. Mr. Floyd’s first positive test for COVID-19 occurred on April 3, 2020, nearly eight weeks prior to when police murdered him.
The “twin pandemics” of structural racism and COVID-19 have not only made salient presumed expendability, but also resurfaced the widespread distrust of the medical establishment amongst many Black people. Thus, a week before the police killed Mr. Floyd, an Associated Press nationwide poll conducted between May 14-18, 2020, revealed that while fifty-six percent of White people were willing to take a potential COVID-19 vaccine, only thirty-seven percent of Latinx and twenty-five percent of Black people would do the same. The response from some corners has been to stress the necessity of diversity in clinical trials in ways that problematically reify biological understandings of race.
Alternatively, some have dismissed concerns as irrational in the face of a public health emergency. This was observed when the University of Oxford announced it would begin a new trial of its COVID-19 vaccine in Johannesburg, South Africa. In June of 2020, protestors gathered to challenge the trials as exploiting African people as “guinea pigs.”
The concerns of Black people, from the United States, to South Africa, about participation in COVID-19 trials is informed by the sordid history of human experimentation carried out on Black and other people of color: from J. Marion Sims conducting un-anesthetized fistula surgeries on enslaved Black women’s bodies, based on the stereotyped belief that Black people have a high tolerance for pain; to the notorious Tuskegee syphilis experiments, wherein health authorities deliberately failed to treat and misled 600 Black men about the nature of their care; to the exploitation of Henrietta Lacks in research; to present day issues with clinical trials that treat Black and other people of color as dispensable.
Infuriatingly, unethical trials on Black and other people of color continue to take place on the African continent and elsewhere. For example, in 1996, during the worst ever meningitis outbreak on the African continent, Pfizer conducted a clinical trial in which a hundred children in Nigeria were given an experimental oral antibiotic called Trovan, while an additional hundred received Ceftriaxone. Reportedly five children died on the former and six on the latter. Some children allegedly received a dose lower than recommended, leaving many children with brain damage, paralysis, or slurred speech. The parents of the children sued Pfizer for failure to obtain informed consent. Pfizer settled the suit with the drug trial victims after a protracted fifteen-year legal battle.
Additionally, early research trials conducted in Uganda for an AIDS vaccine were designed to test the safety of HIV Subtype B – a type most prevalent in Europe and the Americas. HIV has eleven major subtypes, which correspond with geographical range; Subtype D is the dominant form in East Africa. Thus, the research done in Uganda tested a vaccine designed to attack a virus not prevalent in Uganda. Boehringer Ingelheim also supported suspect clinical trials in Uganda between 1997 and 2003 that led to thousands of serious adverse effects for women taking the anti-HIV transmission drug Nevirapine. Their symptoms went unreported; testing continued and fourteen women died.
Further, during the 2014-2016 Ebola outbreak, an Italian NGO tested the heart drug Amiodarone on Ebola patients at a treatment facility in Sierra Leone. The drug is not among the fifty-three drugs listed to have an antiviral effect on Ebola. Some British medics working at the center concluded that the side effects from the drug could be contributing to the increased morbidity within the center. Certain medical staff staged a walk-out from the facility to protest the use of the drug outside of a clinical trial concomitant with the lack of informed consent obtained from patients.
Some researchers also took thousands of blood samples from Ebola patients during the 2014-2016 epidemic and now hold these samples in secretive laboratories around the world. Ebola survivors did not consent for their blood to be taken. Several African scientists accused the laboratories of “biological asset stripping” as they are unable to access the samples for their own research despite African health practitioners assuming all the risk in drawing the blood.
These incidents indicate the limitations of the World Medical Association’s Declaration of Helsinki and the WHO’s Handbook for Good Clinical Research Practice’s ability to protect the rights and welfare of Black and other people of color. Moreover, even where legal and regulatory frameworks exist on paper for study participants, the de facto policy of treating Black, Indigenous, and other people of color as expendable requires more robust mechanisms to counteract the praxis of dehumanization.
Matiangai Sirleaf is the Nathan Patz Professor of Law at the University of Maryland Law School. Her expertise includes public international law, global public health law, and international human rights law.
For further discussion see Sirleaf’s, Disposable Bodies: COVID-19, Experimental Trials & the Uprising, Colum. L. Rev. Forum (forthcoming 2020).