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	After Ebola vaccine big pharma must invest in diseases of the poor by Anna Thomas, ActionAid UK Thomson Reuters Foundation   This week we learned that the trial of a vaccine for the Ebola virus run in Guinea was successful. It now looks as if there may soon be a medical tool that could vastly reduce the risk of Ebola infections and therefore deaths.   The vaccine has been developed and tested with unprecedented speed. The Ebola epidemic was declared an emergency almost exactly one year ago, and before that few members of the general public knew Ebola existed.   It comes too late for the 11,000 people who died in West Africa from the infection. That number is testament to just how quickly an infection like Ebola takes hold in a poor country lacking the infrastructure and medical provision to contain it.   There are many other diseases particularly afflicting poor people in the developing world yet to be tackled by the big pharmaceutical companies we rely on to develop vaccines. The Ebola epidemic shone a light on those serious and dangerous gaps in the world’s pharmacy, which is handsomely stocked with medicines to tackle the diseases of rich nations – pills to lower cholesterol, counter depression or treat impotence.   Until this trialled Ebola vaccine gets onto those pharmacy shelves there will remain absolutely no medical response to the infection. The vaccine would not mean there are no more cases, but it would provide an effective barrier method; governments in countries at risk will be able to routinely vaccinate all medical staff, so they could respond to cases without the risk of catching it and passing it on themselves.   ActionAid is one of the organisations which acted during the Ebola epidemic, working to educate affected communities about arresting its spread using methods including soap-and-water hand-washing and regular disinfecting. But no amount of good hygiene is better than a vaccination programme.   The problem of research into diseases of the poor is not unique to Ebola. Only 4 per cent of new therapeutic products in recent years have been for these diseases. The reasons for this are not hard to guess. Pharmaceutical research is big business, while treating poor populations is not as lucrative as treating rich populations. ActionAid’s new discussion paper After Ebola – research into medicines for diseases of poor countries looks at the options on the table.   There are two ways to encourage neglected disease research. It can be funded up front through a ‘push mechanism’, where the money to fund the research and development of medicines is provided before the work begins. Or a ‘pull mechanism’ can be used, where rewards are promised to pharmaceutical companies or partnerships for successful discoveries – for example, by an aid donor commitment to purchase a medicine once it exists.   Most existing initiatives are currently push mechanisms, and the potential for the pull type is underexplored. Push mechanisms pay out whether there is a viable medicine at the end of the process or not.   One pull mechanism in particular merits further investigation. The Health Impact Fund, a proposal co-initiated by Thomas Pogge, a Yale professor of philosophy and international affairs, would guarantee the purchase of new medicines at prices set according to the number of lives that could be saved or improved by the medicine. This would be an attractive incentive for medicines that treat or vaccinate against diseases such as Ebola.   All this needs financing. Knowledge that prevents the spread of disease benefits everybody, and the benefits must not be restricted to those who buy them. Public health, while so heavily monetised by big business, is still a public good. For this reason, much of the funding for enhanced research into diseases of the poor in the developing world will need to be public funding.   The World Health Organisation recommends that aid donors contribute 0.01 per cent of gross national income to research into neglected diseases, as part of their aid commitments. For the UK, which is already a leading donor in this field, this would mean around £160 million this year – less than half of UK spending to date on the Ebola crisis in Sierra Leone.   Backed by public money, if big pharma put more time and money into developing better responses to the other diseases that mostly affect the poor – such as tuberculosis, malaria, HIV/Aids – generations of lives would be saved. Development would have a chance to take root. The Ebola epidemic put Sierra Leone’s nascent development and emergence from civil war back by many years.   There are those who argue that diseases of the poor are not ‘our’ problem because they happen in faraway lands. They should remember that cases of Ebola did make their way onto British soil. British aid workers and medical personnel who cared for Ebola sufferers in West Africa brought the infection home. But they were fortunate to have access to world-class healthcare; they got better.   Ebola is a disease of mass communication – its spread is facilitated by the interconnectedness of our world. The global fallout of other diseases of the poor in the developing world that are still lacking a medical response is in itself an economic case governments must take seriously.   * Anna Thomas is head of advocacy at ActionAid UK. Visit the related web page
	Ireland Votes to Approve Gay Marriage by News agencies Ireland   May 2015   Ireland has become the first nation to approve same-sex marriage by a popular vote. With the final ballots of a nationwide referendum counted, the vote was 62 percent in favor of legalizing same-sex marriage, and 38 percent opposed.   The turnout was large — more than 60 percent of the 3.2 million eligible voters cast ballots, and only one district out of 43 voted the measure down.   Not long ago, the vote would have been unthinkable. Ireland decriminalized homosexuality only in 1993, the church dominates the education system, and abortion remains illegal except when a mother’s life is at risk. But the influence of the church has waned amid child abuse scandals in recent years, while attitudes, particularly among the young, have shifted.   “Today Ireland made history,” Prime Minister Enda Kenny said, adding that “in the privacy of the ballot box, the people made a public statement.”   “This decision makes every citizen equal and I believe it will strengthen the institution of marriage,” Mr. Kenny said.   Same-sex marriage is legal in 19 nations before the Irish vote and 37 American states, but almost always because of legislative or legal action. At the same time, homosexuality is illegal across much of the Middle East and gay rights are under renewed attack in Russia and parts of Africa.   The result showed wide support for a measure that had dominated public discourse in the months before the vote.   Surprising many who had predicted a generational divide, the support cut across age and gender, geography and income.   The leader of the opposition, David Quinn, director of the Iona Institute, conceded the outcome on Twitter: “Congratulations to the Yes side. Well done.”   For older activists, the moment marked a profound evolution for their country. For the world, it suggested how far the gay rights movement has come, to make such a significant step in a country with a history as a conservative religious state.   “Throughout my youth, adolescence and young adulthood, it was a criminal offense to be gay,” said David Norris, a 70-year-old Irish senator and longtime activist. He said he had faced “total isolation” as a young man.   “There was silence on the subject,” he said. “It wasn’t mentioned in the newspapers, it wasn’t mentioned in the broadcast media. Then there was a fear of criminal prosecution, of being involuntarily placed in a lunatic asylum, losing your job, being socially destroyed. It was a terrible situation.”   The referendum changes Ireland’s Constitution so that civil marriage between two people is now legal “without distinction as to their sex.”   It requires ratification by both houses of the Irish Parliament and the president. Though that is a formality.   There was support for the measure across the political spectrum, including from Prime Minister Kenny, of the center-right Fine Gael party, and his Labour coalition partner, which had pushed for the referendum. Sinn Fein, an opposition party, also expressed support.   Many placed the results in a national context, saying it pointed not only to change but also to the compassion and tolerance of the Irish people.   Alex White, the government’s minister for communications, said: “This didn’t change Ireland — it confirmed the change. We can no longer be regarded as the authoritarian state we once might have been perceived to be. This marks the true separation of church and state.”   Gay rights activists around the world had said a victory would be an important milestone.   “I think this is a moment that rebrands Ireland to a lot of folks around the world as a country not stuck in tradition but that has an inclusive tradition,” said Ty Cobb, the international director of the Human Rights Campaign, a Washington-based advocacy group.   Late in the campaign, four Catholic bishops urged parishioners to vote against the measure. But as ballot boxes were opened one by one, and paper yes and no votes stacked up in front of counters at long tables in a cavernous hall, optimism among referendum supporters grew.   Campaigning on both sides of the debate had been underway for months, with posters, billboards and commercials.   “Commentators just don’t seem to have grasped that this has been the culmination of a 10-year campaign to change attitudes in this country,” said Colm O’Gorman, chief executive of Amnesty International (Ireland) and a leading gay rights campaigner.   “The personal stories of people’s own testimonies, as to their difficulties growing up being gay certainly struck a chord with people,” said Jim Walsh, an Irish senator who opposed the marriage referendum, during a television interview.   “I would like today to not get back into the arguments that we had during the campaign but to wish them well,” he said. “But I think that going forward we will need to address issues which are going to arise.”   In a news release, the Iona Institute congratulated the yes side for “a very professional campaign that in truth began long before the official campaign started.”   But it also said “we will continue to affirm the importance of the biological ties and of motherhood and fatherhood” and urged the government to “address the concerns voters on the No side have about the implications for freedom of religion and freedom of conscience.”   Nick O’Connell, 42, from a rural area in County Kilkenny in the Irish Midlands in an interview said he had been too afraid to come out as gay until his mid-20s.   “Today I’m thinking of all those young people over the years who were bullied and committed suicide because of their sexuality. This vote was for them, too.”   He added: “This is different from other countries because it was the people who gave it to us, not a legislature.”   * Some 20 countries have already legalized same-sex marriages
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