Nurses wearing protective suits escort a man infected with the ebola virus to a hospital in Monrovia, Liberia, 25 August. Photo: Getty
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Why releasing untested ebola drugs was the right thing to do

Drug trials rarely tell the whole story as many drugs have side effects that emerge only after deployment in the population at large. Yet unexpected effects can sometimes be surprisingly good.

Scientists do the best they can, but no drug is properly tested until it is fully deployed. And sometimes the result is better than anyone could have hoped.

In all the hand-wringing over whether it was right to release untested drugs to treat ebola victims, an important truth has gone largely unreported: even when completed, drug trials rarely tell the whole story. Many drugs have side effects that emerge only after deployment in the population at large. If you want proof, look at the millions of reports of adverse effects on the US Food and Drug Administration’s new OpenFDA website.

It’s worth noting, however, that unexpected effects can sometimes be surprisingly good. Take BCG. The Bacillus Calmette-Guérin vaccination was designed to protect against tuberculosis but it does far more. It stimulates an immune reaction against bladder cancer, for instance – the vaccine, delivered directly into the bladder, is now a standard treatment for this disease. It has also been used to fight multiple sclerosis and diabetes. No one knows exactly why this immunity-boosting effect takes place.

Other vaccines also have unexpected protective effects. Studies have shown that, when deployed in Africa, the measles vaccine cuts deaths from diseases other than measles by a third. The way it stimulates the immune system seems to enhance the body’s defence against infections. As a result, pneumonia, sepsis and diarrhoea – the most common causes of death in developing countries – are reduced by vaccinating against a completely unrelated disease.

We have known this for a while. In the early 20th century a physician logged the survival rates of children when vaccination was introduced to Sweden. Even though tuberculosis mostly kills older children, the vaccination had an effect on babies, too: those who had received it stood a much higher chance of reaching their first birthday. Follow-up trials in the US and UK in the 1940s and 1950s suggested that BCG-vaccinated children had a 25 per cent lower death rate from diseases unconnected to tuberculosis.

More recent studies have shown that vaccines for both smallpox and BCG can reduce susceptibility to lymphoma, leukaemia and asthma. Some researchers suggest that the rise in allergies and asthma in developed countries might be linked to the phasing out of the BCG vaccines.

There are still improvements to be made. This year, the World Health Organisation (WHO) has announced that it is looking into tweaking the sequence in which certain vaccines are administered in developing countries, after a team of experts concluded that the way they interact might be having an adverse effect on girls’ health.

It is not the first time that gender-specific effects have been noted after vaccination. In 1992, WHO withdrew a high-dose measles vaccine that had been shown to increase girls’ susceptibility to infection. No one is advocating that we drop any vaccinations – they save far more lives than they put at risk. But just changing the order in which they are given might help them save even more lives.

In the messy world of pharmaceuticals, nothing is ever certain. Whatever the outcome, releasing the untested ebola drugs was the right thing to do. In a crisis, we sometimes have to jump and hope for the best. Or maybe even better. 

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 20 August 2014 issue of the New Statesman, What the Beatles did for Britain

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The Prevent strategy needs a rethink, not a rebrand

A bad policy by any other name is still a bad policy.

Yesterday the Home Affairs Select Committee published its report on radicalization in the UK. While the focus of the coverage has been on its claim that social media companies like Facebook, Twitter and YouTube are “consciously failing” to combat the promotion of terrorism and extremism, it also reported on Prevent. The report rightly engages with criticism of Prevent, acknowledging how it has affected the Muslim community and calling for it to become more transparent:

“The concerns about Prevent amongst the communities most affected by it must be addressed. Otherwise it will continue to be viewed with suspicion by many, and by some as “toxic”… The government must be more transparent about what it is doing on the Prevent strategy, including by publicising its engagement activities, and providing updates on outcomes, through an easily accessible online portal.”

While this acknowledgement is good news, it is hard to see how real change will occur. As I have written previously, as Prevent has become more entrenched in British society, it has also become more secretive. For example, in August 2013, I lodged FOI requests to designated Prevent priority areas, asking for the most up-to-date Prevent funding information, including what projects received funding and details of any project engaging specifically with far-right extremism. I lodged almost identical requests between 2008 and 2009, all of which were successful. All but one of the 2013 requests were denied.

This denial is significant. Before the 2011 review, the Prevent strategy distributed money to help local authorities fight violent extremism and in doing so identified priority areas based solely on demographics. Any local authority with a Muslim population of at least five per cent was automatically given Prevent funding. The 2011 review pledged to end this. It further promised to expand Prevent to include far-right extremism and stop its use in community cohesion projects. Through these FOI requests I was trying to find out whether or not the 2011 pledges had been met. But with the blanket denial of information, I was left in the dark.

It is telling that the report’s concerns with Prevent are not new and have in fact been highlighted in several reports by the same Home Affairs Select Committee, as well as numerous reports by NGOs. But nothing has changed. In fact, the only change proposed by the report is to give Prevent a new name: Engage. But the problem was never the name. Prevent relies on the premise that terrorism and extremism are inherently connected with Islam, and until this is changed, it will continue to be at best counter-productive, and at worst, deeply discriminatory.

In his evidence to the committee, David Anderson, the independent ombudsman of terrorism legislation, has called for an independent review of the Prevent strategy. This would be a start. However, more is required. What is needed is a radical new approach to counter-terrorism and counter-extremism, one that targets all forms of extremism and that does not stigmatise or stereotype those affected.

Such an approach has been pioneered in the Danish town of Aarhus. Faced with increased numbers of youngsters leaving Aarhus for Syria, police officers made it clear that those who had travelled to Syria were welcome to come home, where they would receive help with going back to school, finding a place to live and whatever else was necessary for them to find their way back to Danish society.  Known as the ‘Aarhus model’, this approach focuses on inclusion, mentorship and non-criminalisation. It is the opposite of Prevent, which has from its very start framed British Muslims as a particularly deviant suspect community.

We need to change the narrative of counter-terrorism in the UK, but a narrative is not changed by a new title. Just as a rose by any other name would smell as sweet, a bad policy by any other name is still a bad policy. While the Home Affairs Select Committee concern about Prevent is welcomed, real action is needed. This will involve actually engaging with the Muslim community, listening to their concerns and not dismissing them as misunderstandings. It will require serious investigation of the damages caused by new Prevent statutory duty, something which the report does acknowledge as a concern.  Finally, real action on Prevent in particular, but extremism in general, will require developing a wide-ranging counter-extremism strategy that directly engages with far-right extremism. This has been notably absent from today’s report, even though far-right extremism is on the rise. After all, far-right extremists make up half of all counter-radicalization referrals in Yorkshire, and 30 per cent of the caseload in the east Midlands.

It will also require changing the way we think about those who are radicalized. The Aarhus model proves that such a change is possible. Radicalization is indeed a real problem, one imagines it will be even more so considering the country’s flagship counter-radicalization strategy remains problematic and ineffective. In the end, Prevent may be renamed a thousand times, but unless real effort is put in actually changing the strategy, it will remain toxic. 

Dr Maria Norris works at London School of Economics and Political Science. She tweets as @MariaWNorris.