Africa, the Oldest and the Newest Frontier

Most people know Oliver Wendell Holmes Sr., the father of the Supreme Court Justice Oliver Wendell Holmes Jr., as a poet and a writer. Along with Longfellow and Emerson, he was a pillar of 19th century American literature.

However, Holmes was also a giant figure in medicine, and dean of the Harvard Medical School (HMS). He was one of the first doctors in America to use a stethoscope, and invented the term “anesthesia.”

In fact, one of the five academic societies (study groups) at Harvard was named after him, a great honor (at least among those of us who went to Harvard Medical School). Then in 2020, this changed.

Harvard expunged his name from the society. They renamed it after William Augustus Hinton, the first African American professor at HMS.

Holmes, it turns out, had expelled the three first African American students from the medical school (although to be fair, he had admitted them when no other school would) in response to a petition by Caucasian students. And he apparently espoused additional unacceptable beliefs about racial inequality. Basically, he believed that African Americans were inferior.

We look back with a mix of horror, angst, and puzzlement at this. How could an otherwise genius, compassionate, and in this case, sensitive and literary person believe and act as he did?

We look at the scars of our past human history and ask, how could we have tolerated slavery, colonialism, and other clear moral transgressions? How is it that so few people spoke out against it?

But perhaps when they look back at us two centuries hence, they will see us in the same light. Perhaps they will be horrified and puzzled as well.

They will see a society where some people lived as millionaires and billionaires while at the exact same time, on the exact same planet, most scratched out an existence on pennies a day. Where some patients survived because they could afford two hundred thousand dollars for a cancer drug while others — most — died because they could not.

I fear they will ask the same question we ask of our ancestors. “How could they let that happen? Why didn’t more people speak out?” I hope they will be more charitable of us than we are of our forebearers.

After decades in biotech, I am proud of the work our colleagues and I have done to advance medicine. The drugs we developed changed lives. Lucentis allowed blind to see again. Tysabri and Ocrevus saved many patients from ending up in a wheelchair. The list goes on and on. We even developed low-cost artemisin for malaria.

But still, today, over 85% of patients in the world cannot afford most of the life-saving drugs we and others have developed.

What makes this situation so much more tragic is that the modern drugs have become so good — miraculous in fact in many cases.

Fifty years ago, if you had cancer, and couldn’t afford the best drugs, you might give up a few extra weeks of life. Today, it’s different. For HER2-positive breast cancer, for example, survival rate if a patient can get the right drugs is up to 95%. HER2 positive cancer used to be the type of breast cancer people most dreaded getting because survival was so poor, sometimes as low as 10%. Now it has the best prognosis.

If you have metastatic melanoma, you now have 50% chance of a complete cure with modern drugs. Only 20 years ago, the likelihood of survival was 0%.

Is it fair that today, patients in most countries are dying of cancer that would be curable if they were born in a rich country?

We’ve always had inequalities in societies, to be sure, for as long as we’ve been human.

But the great inequalities between countries is new — it’s only been last several hundred years that the gap between rich and poor countries has become a chasm. And it’s only in the last few decades that expensive drugs that can literally mean life or death have proliferated. It’s happening on our watch — that people dying because they are penned on the other side of affordability, technology, and intellectual property barriers.

Some newer cancer drugs cost hundreds of thousands of dollars. For patients living on 30 cents a day, access to them is a dream… or a nightmare, depending on how you see it.

In some ways just as tragic, or perhaps more, are patients who could barely afford the therapies, in middle income countries, who choose to forego lifesaving drugs to avoid pauperizing their families.

I am helping my friend, Menghis Bairu, change all this.

Menghis, who grew up in Eritrea and then had to flee war and become a refugee before he became a physician and a very successful biotech executive, recently founded Bio Usawa. He was on our Board of Directors when I headed up OneWorld Health, developing low-cost small molecules for neglected diseases.

His plan is to transform affordability of monoclonal antibodies for indigent patients in Africa and other countries by manufacturing low-cost biologics in Africa.

The actual cost of production of monoclonal antibodies that are priced at hundreds of thousands of dollars is only a few hundred dollars. We can lower that even further by manufacturing in Africa.

I initially became involved in the project because of the mission. However, after we ran the numbers, it became clear that manufacturing biologics in Africa and selling them at a substantial discount to branded products is an attractive investment proposition.

The enormous size of the African market, and eventually the low and middle income country markets will mean Bio Usawa will have economies of scale that dwarfs any current biologics manufacturer.

And the cost of labor is still a substantial portion of the cost of manufacturing for biologics. It will be impossible for any other country, including China (with its rapidly rising labor costs), to compete against Bio Usawa on price.

Africa is growing and industrializing rapidly. When I was in Senegal for a recent African Oncology conference, I was struck by how more industrialized and richer Dakar was than Seoul was when I left Korea as a child. And Senegal is not even one of the more rapidly industrializing African countries. Countries like Nigeria are projected to have larger economy than countries like Germany or France within few decades. The future of the planet is Africa.

I am very excited to co-found Bio Usawa with my friend Menghis, and start on this journey to help the 85% of the world who risk dying of curable diseases because of poverty. It’s the right mission, the right continent, the right thing to do.

As Menghis says: “When patients die because there is no cure, it’s a tragedy. When patients die even when there is a cure because of the cost, it’s an injustice.”

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