Pneumococcal vaccine complexity

Hey there bathhousers,

Wow, haven’t done one of these for a while but I just learnt something and feel the urge to share. I’ve been reading about how vaccines work and also about the geographical variation of disease.

This brings me to today’s post which as sciency as it gets round here so hold on to your autoclaves and let’s get stuck in.

Invasive pneumococcal disease kills over 1.5 million children each year according to the World Health Organization (WHO), Ninety percent of these deaths occur in the developing world. [1][2]

You might think that if a vaccine is available in Europe and the US then it should be made available in the developing world too. One of the main vaccines for Pneumococcal disease is called Prenvar. Prevnar is among Wyeth’s top revenue producers, with sales in 2005 of $1.5 billion. [3]

So on the face of it there is an effective vaccine used in Europe and the US that should be rolled out across Africa, seems like a straight forward case where the drugs exist, Pharma has recouped their investment from Western consumers, so there is a moral imperative to bring this drug to the people that need it. Perhaps, within our current system of IP as long as the rich world needs the same drugs then they can pay for the R&D costs and everyone can get the benefit, assuming the minefield of international IP law can be negotiated.

Unfortunately it’s not as simple as that. There are around 90 different bacteria (serotypes) which cause pneumococcal disease. Prenvar is formulated to prevent 7 of those strains. Unfortunately the prevalence of different strains varies geographically. The table below shows the results of a study to determine the relative prevalence in descending order for the developed and developing world [4]. Bear in mind that ‘developed’ and ‘developing’ represent huge areas so there is likely to be a large amount of additional variation between regions. (the number represents serotype number)

Developed 14 6 19 18 9 23 7 4 1 15
Developing 6 14 8 5 1 19 9 23 18 15 7

The table below shows the 7 serotypes present in Prenvar and a new GSK drug Synflorix.

Prenvar 14 6 19 18 9 23
Synflorix (GSK) 14 6 19 18 9 23 1 5 7

You’ll notice that the Prenvar vaccine is designed to prevent the most common strains in the developed world, as you might expect. Unfortunately the 3rd, 4th and 5th most common forms of the disease in the developing world are not covered by this vaccine.

This example illustrates why even if access to drugs developed for the developed world could be assured, in some cases, the efficacy wouldn’t be the same. Furthermore, If you’re going to go to the trouble to run a mass vaccination for a disease that kills millions, you’d at least want a drug that treated most of the common strains in your country, otherwise it could be expensive and ineffective.

Also in the table you can see another drug developed by GSK.  Synflorix, which as you can see covers two of the missing serotypes and is therefore  likely to add to the overall effectiveness significantly in the developing world. But if the missing serotypes aren’t prevalent in the developed world why did GSK develop this drug?

It was possible because of an advanced market commitment from Gavi [5] (the Global Alliance for Vaccines and Immunisation). This means that Gavi have committed to buying up to 300 million doses over 10 years and in return for this GSK have developed the drug.

In conclusion, in some cases the developing world will need drugs developed specifically for their own needs. Where there aren’t rich consumers with insurance companies and government funded healthcare, innovative financing mechanisms like advanced market commitments or perhaps publicly developed and owned IP will be needed to ensure that drugs get developed.


[2] (


[ 4] (Pediatric Infectious Disease Journal
Volume 14, Issue 6



Israel, the Holocaust, National Identity

Below are some of my thoughts and opinions on what it means to be Israeli. The subject requires many chapters rather than a few paragraphs. However I’ve done my best and feel it is important to post something on this left-leaning (please excuse the categorisation) blog. I am aware that the subjects I touch on are sensitive and apologise for any offence caused by my rather sweeping statements. I would welcome criticism in such cases.

Before I commence, I would like to point Bathhouse readers in the direction of an article by a Marxist named Werner Bonefeld. Bonefeld attacks left-wing apologists for the anti-Semitic politics of current Middle Eastern liberation movements. I believe Bathhouse readers will find it valuable:

I am a Londoner, and have been raised with an awareness of different cultures and the problems caused by state discrimination. Fighting against state imposed discrimination is very important and for many in the international community the aggression by Israel against Palestinians and its neighbours is clear and apparent due to the obvious imbalance of economic, military and political power between the combatant sides. We witness state directed violence being conducted against non-state actors (PLO, Hamas, Palestinian civilians) and we cannot help but be astonished at the irony behind such an obvious parallel with the Jewish people’s own past. I have always wondered how this irony can fail to be recognised by Israelis. My time in Israel has given me some insights that I feel may answer this question. I will expound on these in the next few paragraphs.

The past few weeks have been very interesting for me. Israelis have recently marked Holocaust day and Commemoration day (for all their lost soldiers who almost always teenagers due to conscription) and on Wednesday I visited Yad Vashem which is the Israeli Holocaust Museum. It really is very important that people staying in this area make the time to visit the museum. At the age of seventeen, all Israeli school children are given the option to visit Poland, which most do, where they tour Auschwitz and talk with death-camp survivors. Taking these practices into account, one begins to understand how the history of anti-Semitism in Europe, culminating with the Holocaust is fundamentally and deeply imbedded within the Israeli national identity.

The Holocaust was the only time in history where the bureaucratic and industrial apparatus of a modern state had been directed toward wiping out a specific segment of its population. It is unique in this regard and the state of Israel emerging “out of the ashes of Auschwitz” is imbued with the conceptual survival of the Jewish race. In this sense, any attack on the new Israeli homeland or any question regarding the legitimacy of Israel is regarded directly as an attack on the Jewish race. Most Israelis today still feel as though Israel is fighting for survival.

For us in Europe, the 30s and 40s plays just as important a part in the creation of our national identity as it does to Israelis. We can understand the films, documentaries, national curriculum etc as an ongoing project to forge a national conception of the democratic west struggling against and eventually winning out over tyranny. It is to us a period of the triumph of western democratic values and free-market governance. We study the period with a focus on alternative models of the industrial state and understand anti-Semitism, culminating in the Holocaust, as an inevitable outcome of ultra-nationalism.

Israelis view the period from a different perspective. Visiting Yad Vashem enables an outsider to better understand this perspective and it places the Holocaust at the centre of the 30s and 40s. For example, the launch of operation Barbarossa by Hitler against the Russians is significant, not because he is now fighting on two fronts (as with British education), but because Jews have been linked with Communism by the Nazis and now that Communists are the enemy Jews too become fair game in the war of annihilation in the east. It is an important psychological step toward enabling the Holocaust to take place.

Many in contemporary Europe have moved onto new social causes in the fight against discrimination and injustice. I myself gave very little thought to anti-Semitism other than as resulting in a horrific and tragic episode in history that, although unique, was part of a wider period of horror. So blind am I to Jewishness as a distinct racial/cultural/religious identity, I understand my colleagues and friends here in Israel just as Israeli. Their Jewishness, or lack thereof, never enters my head. When I mention this, I am met with expressions of surprise. Without exception those I speak with understand themselves as Israeli first and Jewish second. In the UK the typical identity path I encounter of secular whites is British first followed by the person’s home town.

Israel is a full scale national project and people are connected with it at a far deeper and intricate level than in the UK. I am amazed at how connected those who live here are with the history, politics and economics of their local region. They know the families that originally settled in the area, its main agricultural product, which famous Israelis have come from their specific locale, the role of the locale in various of Israel’s conflicts. An intimate knowledge of Israel’s smallest areas and their contribution to Israel is commonplace at grassroots level. Israeli history is social and embodied in family lines and living relatives. In contrast, UK historical sites are empty of life but full of relics which visitors come to see; otherwise they are occupied by a family disconnected from the original famous inhabitants through many changes of ownership over the centuries. I point this out to try and give a feel for how connected Israelis are to their nationality not as a criticism of the UK. In Israel the history remains alive.

Being comfortable and free from fear to express Jewishness (whatever this may be) is central to Israel’s nationality. There seems to be a regular pattern of holidays marking this, that, or the other Jewish celebration, suggesting religious and cultural homogeneity, although prejudice exists within Jewish Israeli society. For instance, some Israelis consider the Hassidic Jews to be parasites on the state since they contribute nothing to its economy and are paid to study the Torah. In addition, many Hassidic Jews establish settlements in the West Bank and this is perceived by some Israelis to drain state resources by forcing Israel to protect these settlements.  Also, you will find racial prejudice existing amongst the Jewish community between Eastern Jews, North African Jews, Ethiopian Jews and European Jews as well as classist terms such “Frecher” and “Arsim” which denote something equivalent to the UK’s Chav and Pikie.

The centuries of anti-Semitism culminating in the Holocaust catalysed the creation of Israel making this event fully and deeply part of Israeli national identity. Israel is understood as the only place on earth where Jews can live this identity without fear of persecution or annihilation. This is an ongoing project (like all national identities) and for me, it is understandable given the ravages the 2nd World War dealt on Jews. But the national project seems to permeate almost every level of Israeli society as Israelis living their day-to-day lives (having babies, developing agriculture, educating themselves, serving their time in the army, working in the high-tech industry) understand this in terms of contributing to the ongoing maintenance of the Israeli state and therefore the Jewish people. The result is that any physical attack on Israel, however minor, or any questioning of its legitimacy and right to exist is met with a hard-line stance from the vast majority of Israelis who see this as a direct threat to their lives and the lives, the lives of their families, and the lives of Jews everywhere.

We in Europe may see Israelis as blind to the obvious ironies that can be drawn between state violence directed toward Jews and state violence directed toward Palestinians. The specific historical circumstances of Israel’s creation and it’s uniquely Jewish identity mean that no irony exists for Israelis. Rather, attacks against them can only be considered in the terms of their ongoing fight for survival against a world hostile to Jews.

I hope in this piece to have drawn attention to the fundamental link between Israel’s policy choices and the Holocaust. I hope I have given some insights into the unique nature of Israel as a national project and provided a route toward understanding how the Israeli perception of its policies toward Palestinians differs so markedly from many onlookers in Europe.

Water politics

Take a look at this really neat animation crafted by Isobel Foulsham on water access and privatisation.

It’s really interesting to think about the extent to which safe water is understood as a commodity, rather than as an equally accessible resource or as a human right. There’s a lot to be said for the ways in which corporations are increasingly commodifying and branding ‘health’, such as Unilever’s Lifebuoy campaign, which seeks massive profits through social missions which target the handwashing practices of millions of people living in poverty, encouraging them to buy Unilever’s branded antibacterial soap. I’ve been meaning to post on this for ages, there’s plenty to be said… Alongside the many issues the water rights animation raises, it’s awful to assume that this kind of health-and-hygiene-right commodification could happen with branded water too. Er, is it?

Prostitution in Bangladesh

The Guardian posted a really fantastic piece of journalism today, though I should perhaps use that word warningly. It’s, I think, looking at the political economy of prostitution – how the role of pharmacies, prostitutes, contraceptives, relationships, poverty, trade, love, drivers, gender, sadness and security are all tangled up together and implicate each other, told through the stories of women and men working and using a legal brothel. Brilliant, sensitive, and avoids sentimentalism. Definitely take a look at the accompanying video.

Elizabeth Pisani sounds off about why HIV treatment is a bad thing

Hi bathousers,

Sorry for not posting for a while but to make up for it here here’s a quick post about an article written by Pisani, in which she provides anyone wanting an excuse for not funding ARVs in Africa. Brilliant.

In this article, as ever, Pisani seeks media attention by making a point in an inflammatory and simplistic way.

This is in response to another story, in which some researchers have suggested that screening and in some cases blanket prescription of ARVs could prove effective.

In this case her argument runs like this:
1.) The AIDS mafia want treatment to replace prevention in Africa because they think that people on ARVs are less infectious, therefore reducing the spread of HIV.
2.) What the fools don’t realise is that people are most infectious soon after having contracted HIV so the screening is unlikely to help identify people in time
3.) Availability of treatment makes people less worried about HIV and so indulge in more risky behaviours
4.) Treatment is bad and people who think it is a good idea are optimistic simpletons

This ignores several important factors. Firstly the scientific argument, obviously there will be a decrease in inflections if everyone who needs drugs gets them as viral load is reduced, but this effect will not help those infections that take place before people have received treatment. Clearly then, the balance between effectiveness and screening interval needs to be considered. Annual screening could reduce all infections which aren’t caused by newly HIV+ people. No doubt this is still a significant chunk, though this is not the most risky time. It will also catch a good amount, though by no means all, people while they are at their most infectious. Assuming people are at their most infectious for several months you will find 8.3% (100/12months) of people in their first month and 25% of people within their first three months. This is still a big reduction. To increase this rate further you could increase screening intervals, perhaps of ‘at risk’ groups to achieve greater success.

As the true effectiveness of the idea will depend on loads of diverse factors, the only way to really know how well this will work is to do a trial. This is actually what is being proposed, so the whole thing sounds very sensible to me.

Secondly, the moral argument. You really can’t just go letting people die preventable deaths. If it costs money to bring the new infections and deaths under control in a way that rich counties have, then that is money well spent.

Once we acknowledge that it is morally right to reduce the spread of HIV the interesting question, and the one the researchers will set out to answer is “is screening and increased access to ARVs more effective, cost effective and practical than other forms of prevention?” That question won’t be answered by misrepresenting the augment as if the researchers have made a basic error in understanding the virus.

A Lost Soul in Israel

Cor Blimey my fellow Bathhousers,

You have been busy this last week. I’ve been based in Israel for a little while now and have been struggling for a way of bringing my experience to this website – it’s so damn complex out here. Other than the fact that the Palestinians are getting shat on, that is.

Anyhow, I think I have something for you. Let me contextualise: I work for a left-wing college that specialises in training citizens from developing countries in key management and structural areas (typically USAID and World Bank funded). It also runs a Summer Programme for western students who want a reflective look at the land of Israel and Palestine. The programme is not without its faults, but as Israelis and their dogma go, it’s at the top end of the intelligence and pro-humanity spectrum.

Marketing this course to UK university professors I received a response. The ensuing email exchange I think should be 0f interest. I have deleted names or replaced with generic functions in brackets where necessary to protect anonymity. The first email is the response to the marketing email from a university professor at an international development institute (I have italicized his words):

Dear …………………

 As I understand it from Ha’aretz newspaper and various colleagues the Government of Israel is currently engaged in efforts to prevent foreign NGO employees from working with the Palestinians and, in particular, for overseas academics from spending periods of time at Palestinian universities. This constitutes a direct affront to academic and professional freedom. In light of such actions I have decided not to accept invitations from Israeli academic institutions, even those opposed to the actions of their government. Furthermore, I shall be encouraging colleagues and students in the UK to do likewise. 



 Dear ………………,

 Thank you for your forthright response. You must do what you see fit to work towards ending a dire situation.

 (Israeli Educational Organisation) has a history of cooperation with Palestinians and this has been brought to a halt since the actions of the IDF in Gaza a year ago.

Due to the difficulties of maintaining official cooperation between Israeli and Palestinian institutions in the present climate, we currently keep in touch with our alumni individually through email.

 I am sorry for the polarisation of people in this region, and the growing polarisation of academia as a result of this conflict.

Best regards


 Dear ………………..

 I appreciate your comments. I would only add that, having lived and worked in both Israel and the oPt over a period of more than forty years, I have come to see that this is not, as conventionally conveyed, ‘a conflict’. Rather it is a situation of ongoing colonisation and ethnic cleansing. However, few of my many ‘leftist’ Israeli friends seem to grasp this basic point and continue to talk about ‘conflict’ as if there were two more or less equal partners to a dispute. It truly baffles me that such a misleading term continues to be used in this way.




I want to respond to you but to do so on the email account of the organisation I work for would be unprofessional. I trust you will forgive my shift to my personal account.

 You’ll be pleased to know that you have made me think and that you have made me feel sad. I do not disagree with you one iota with regards to your view of what is happening here and your objection to the use of the word ‘conflict’.

 I do not pretend to have your experience of the region – though I have been here quite a bit and spent a brief period in West Bank. I am deeply curious at how said “Israeli friends” continue to view the situation in the light of a conflict as between two independent people. We’re talking one power structure here. But how does it function?

 I take you to David Campbell “Writing Security” and “National (de)construction” as one means of reading the use of the term ‘conflict’. Psychological mutual dependence? Maybe. But as a political economist, I believe it goes further. Unfortunately for the Palestinian people at large, since the erection of the wall, Israel has unshackled its economic dependence on its occupied population with the introduction of a far eastern labour pool – things look bleak from the perspective of the Palestinians.

From the perspective of Israel, I guess it is the bad luck of this state to be brought into existence at a time when human rights have become vogue – otherwise maybe they could have sold the native population some diseased blankets and created the necessary living space (dodgy term I know) in that manner! I mean this seriously – guilt for human rights abuses exists in almost modern nation building exercises.

 On the part of (Israeli Educational Organisation) – it’s a self reflective organisation and a good deal of time is given in its curriculum to bringing a voice to those other than Jews who live in this area. (Specific Left Wing Israeli Lecturer) gives a brilliant lecture, highlighting the alternative narratives that exist regarding the creation of Israel etc.

I guess I’m here because I have been involved on and off with the Free Palestine campaign feel that most of the people I have met fall into the same trap of homogenisation that the Israelis themselves are guitly of. I believe that there is a place for this form of campaigning. However, I believe that there exists a place for forging connections within Israeli society whereby a common platform of dialogue can be achieved with the international community. As we both agree, this is one power structure, and the Israelis hold the cards. Somehow we need to work with elements within Israel because out here there exists one big bad victim complex.

 Anyhow – I waffle.

 All the Best



I appreciate you taking the time to respond.

I am a more than a little tired with the Israeli left-wing obsession with ‘voice’, ‘alternative narratives’ and ‘dialogue’: been there, done that. It seems to serve no greater purpose than to sop the consciences of a few well-meaning lefties. It certainly doesn’t impress the vast majority of my Palestinian friends who have long since given up on this schtick.

There is downright evil being perpetrated in the name of world Jewry (of which I am a member by the way), and all the intellectualizing and hand-wringing is not going to stop it. Serious political and economic pressure of the sort not yet even remotely implemented just might. It helped in South Africa where ‘voice’, ‘alternative narratives’ and ‘dialogue’ counted for little or nothing.



I took myself to be dismissed at this final comment. Those who know me may laugh at the thought of me as a “hand-wringing leftie” – Oh Thatcher, where are you my queen???!!! hahaha (sorry mum).

Jokes aside: I wonder if this correspondence stirs anything in you lot.

Peace and Love

Failure to Fathom

Intellectual property and climate change

Bear with me on this post. It spans intellectual property, green energy, other bloggers and UK energy policy .

Yesterday, I attended the Regen South West Renewable futures conference. You can read about what was said here. I even get a quote!

One of the speakers on the event was a guy called John Geesman who is an American who had a startling grasp of UK energy policy. He also has a blog called “Green Energy War

He’s just written a post called “Free Trade, Global Warming, and Beliefs of Elites”, sounds great doesn’t it? In it discusses (briefly) the role of trade and IP relating to clean energy tech and developing countries. Arguing that the US hardline on IP damages the ability of countries to mitigate or adapt to climate change.

He also draws attention to an excellent report from Third World Network on the fact that through the “Foreign Relations Authorization Act” the US have established a policy that they will “oppose any global climate change treaty that weakens the IPRs of American green technology”

This seems to offer a new front on the IP rights vs human rights debate. The argument has been well rehearsed in between the pharmaceutical industry and developing country health campaigners. But at Copenhagen we may see the same debate between clean tech companies and environmental groups. As if to underline the point General Electric borrowed pharma’s script and told congress:

“Such measures would be counterproductive from the point of view of combating climate change because they would deter innovation and technology deployment. In addition, they would be severely detrimental to US export interests … Companies will be careful to avoid licensing technology or even selling products to customers in countries where those customers could reverse engineer, take and use the intellectual property rights.”

So this begs the question, are patents and IP rights a desirable way to incentivise things that need be deployed for a global good?