Godfrey Tangwa AKA "Rotcod Gobata"

TWO PUBLICATIONS AND AN AWARD

I am happy to draw the attention of Gobata blog readers to two books freshly out of the press and to an award conferred on yours truly by the Global Emerging Pathogens Treatment (GET) Consortium in August 2019.

The West African Ebola epidemic (2014-2016) witnessed the emergency formation of the GET within which I was charged with constituting and leading the Cultural, Anthropological, Social and Economics (CASE) Workgroup. Ab initio, I worked with Akin Abayomi and Nchangwi S. Munung in forming the group and one of the already delivered deliverables of the workgroup is the book Socio-cultural Dimensions of Emerging Infectious Diseases in Africa: An Indigenous Response to Deadly Epidemics  edited by Akin Abayomi, Samuel J. Ujewe, Nchangwi Syntia and Godfrey B. Tangwa.

The second book, African Perspectives on some Contemporary Bioethics Problems which has come out of the press at the same time is my second collection of bioethics articles

To crown it all, the GET Consortium gave me an award during its 5^th annual conference in Abuja, Nigeria, 7-10 August 2019.

 

CHIMAMANDA AND FEMINISM

Feminism may be defined as the advocacy of women’s rights on the ground of the equality of the sexes (male and female). Feminism is a reaction to gender. As a biological fact, human beings are born as either of the male or female sex. But maleness or femaleness considered not merely as a biological fact but with reference to socio-cultural functions, norms and attitudes, is what is meant by gender.

Feminism means different things to different people. Chimamanda Ngozi Adichie is a feminist, but not a feminist in the Western connotation of the term. Western Feminism [paradigmized in such works as: Kate Millett, Sexual Politics (1969); Griffin et al., STIRRING IT: Challenges for Feminism (1994)] cannot accommodate Chimamanda’s unpacking of her feminism (she is an African feminist who likes men). Western feminism is about a war of the sexes. Chimamanda cannot be admitted into this war because she is a happy African feminist who wears lip gloss and high heels for herself and does not hate men.

Chimamanda, when you read her carefully, is rather a humanist, passionate about equality and fairness between the sexes, between men and women. This passion underlies her much-celebrated novel Americanah in every detail and is epitomized in the main character and heroine, Ifemelu, who outmatches the co-main character, Obinzi, in her strength of character and self-assertiveness. Ifemelu comes over as an unapologetic serial polyandrist, more than equal to any putative serial polygamist. She is a veritable shero and female Casanova.

Men and women endowed with physical beauty, intellectual strength and material wherewithal, have a natural tendency towards sampling attractive members of the opposite sex, thereby often ending up in random sexual experimentations. The only problem being that the sexual philandering of the men is accepted, excused, taken for granted or even encouraged by society at large, especially within some cultures such as African culture, while that of the women is severely abhorred and tabooed.

Equals ought to be treated equally. This is the first principle of human rights. But equality does not mean uniformity. However, if open expression of sexuality, let alone sexual adventurism, is permitted, tolerated or even encouraged for men, a clearly convincing reason is needed to forbid the same for women. A human being is a human being simply by being a human being and not for any other reason. When we talk of human rights, therefore, like the right to life, the right to self-expression, the right to pursue happiness, the right to not be treated unfairly, etc., we are talking about rights that must apply equally and equitably to all human beings, male, female or genderless. Beyond and above her very fascinating art, Chimamanda is a passionate crusader for equality, equity and fairness among human beings as human beings.

PROSPECT OF SUSTAINABLE WORLD PEACE

The 13th World Congress of the International Association of Bioethics (IAB) recently took place in Edinburg, Scotland, United Kingdom, from 14-17 June 2016, under the general theme: INDIVIDUALS, PUBLIC INTERESTS AND PUBLIC GOODS: WHAT IS THE CONTRIBUTION OF BIOETHICS? For that occasion, I made a poster presentation on the prospect of sustainable world peace in the era of globalization. Herewith a gist of the poster for your critical reflection.

 

POSTER 110

PAPER NUMBER 68

Globalization and world peace: is sustainable world peace an achievable goal?

Tangwa G1

1Cameroon Bioethics Initiative / University of Yaounde

FROM PALPABLE OBSERVATION

We live in an era of unprecedented violence and loss of human life on a massive scale. Terrorism seems to rule the world: Boko Haram, Al Shabab, Al Caeda, ISIS etc. Both terrorism and counter-terrorism have continued to send many innocent human beings to their untimely deaths on a more or less massive scale. Leisure activities like sports, cinema, musicals, and huge gatherings like in Churches, Mosques or Airports have become high risk events because of the lurking terrorist. Then there are intractable wars and civil wars around the globe, making it evident that we are living in a world of unprecedented human-made violence.

Furthermore, there are natural causes of untimely human deaths – epidemics, tsunamis, typhoons, hurricanes, earthquakes, sundry accidents, etc. We seem to be living in a world more dangerous than has ever been the case at any other period in the history of our world.

HUMAN RATIONALITY AND AGENCY IN THE WORLD

And yet human beings remain those creatures on earth endowed with purposive thinking and action, the capacity to anticipate problems, to reflect on them and to solve them. The prospect of a globalizing world in one of its positive aspects has held the promise of a world evolving towards democracy, good governance, health, peace, prosperity and abundance. What has happened to such optimistic human dreams and how may they be realized even partially?

YES, SUSTAINABLE WORLD PEACE IS ACHIEVABLE!

Sustainable world peace is the indispensable condition for the realization of optimistic human dreams. It is realizable and this is how it can and will be realized: first, by transcending the traumas and mind-set of war, second, by enhancing and strengthening the United Nations Organization (UNO) as the only global organization capable of transforming into a benevolent global government, third, by waging a relentless struggle against madness, especially power-induced madness, against the manufacture, sale, distribution and use of weapons, all weapons, against racism, colonization, exploitation, subjugation, discrimination, segregation, enslavement. .

WHO DONE IT AGAIN!

The World Health Organization (WHO) is perhaps the most important agency of the United Nations with a global mandate whose importance is evident and acknowledged by all and sundry.  All around the world, ministries of public health, healthcare providers and medical researchers listen to the WHO and sometimes obey its recommendations like dummies. For these reasons, the WHO needs to be not only highly professional in its actions and pronouncements but also transparently fair to all the different global communities and competing interests in global health.  

Since the outbreak of the Ebola virus disease (EVD) in parts of West Africa in December 2013, the WHO has shown appropriate concern and involvement in saving the lives of victims, bringing the spread under control and finding a solution to the disease, even if some of its actions had been a little tardy. Two important releases of the WHO on Ebola had caught my attention, the first of which I applauded and the second of which I critiqued.

On 12 August 2014, the WHO had released a short statement captioned “Ethical considerations for use of unregistered interventions for Ebola virus disease (EVD): Summary of the panel discussion” which generally was well received and appreciated around the world.  The consultation panel had reached the consensus that, “in the particular circumstances of this outbreak, and provided certain conditions are met”…, “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention”. This recommendation was justifiable by the fact and to the extent that the situation in question was that of a deadly and highly infectious epidemic with no known, let alone available, cure. The context was a purely therapeutic one with all efforts directed at saving human lives in imminent danger of death. We applauded this WHO release and the Cameroon Bioethics Initiative (CAMBIN) which I chair posted a statement on its website (www.cambin.org) on 29 September to that effect.

Subsequently, the WHO published another release, 29-30 September, 2014 [http://www.who.int/immunization/diseases/ebola/WHO_consultation_ebola_sep2014/en/] “WHO Consultation on Phase 2 clinical trials for Ebola”, being the result of “an expert consultation to assess the state of the art work to test and eventually license candidate Ebola vaccines” in which “more than 70 experts, including many from affected countries in West Africa… Ebola virus disease (experts), manufacturers, regulators from Africa, Europe and USA, those with expertise in vaccine science, clinical trials and clinical management of patients” took part. This panel considered and apparently approved urgently carrying out clinical tests on humans of some candidate Ebola vaccines in the development pipeline, including Chimpanzee adenovirus serotype 3 (Chad 3) by Glaxo Smith Kline + others and Recombinant vesicular stomatitis virus (rVSV) vaccine by a consortium involving Canadian Public Health plus others.

We expressed our concerns against this development in the same statement referenced above and attempted to propose conditions under which, in our view, clinical trials could be carried out on the Ebola virus in the following words. “It is evident that, in the current situation in West Africa, any attempted testing of an investigative substance would be up against an insurmountable therapeutic misconception and illusion. Besides, one of the proposed candidate vaccines to be tested belongs to a powerful pharmaceutical company with a reputation for controversial drug trials involving a legion of unethical practices. Also, no mention is made in the WHO statement of post trial access to any successful vaccine or treatment that may eventually result from the trial, from which it can be deduced, in the light of past experience, that whatever vaccine or medicine results from the trials will be priced beyond the means of those who helped to make it possible.

“The WHO got it right the first time regarding the use of unproven interventions in attempt to save lives,…but, this time around, regarding clinical testing of experimental substances, CAMBIN is unable to endorse the WHO release.

“If clinical tests on any candidate vaccine or medicine for Ebola are to be carried out, after the current epidemic has been brought under reasonable control, … (in Nigeria it has been brought under control without the use of any medicine beside oral hydration) the following would seem recommendable:

1. Let the Phase 1 and 2 of such trials (expedited or not) be carried out on well-informed volunteers from amongst research scientists, members of ethics review committees, medical personnel including doctors, nurses, laboratory technicians etc., personnel of pharmaceutical companies, civil servants especially in the Ministries of Health and Scientific Research, University teachers, government ministers, members of parliament, experts in all domains. In my layman’s view, these initial two phases of the trial would not last less than 12-18 months.  For to take such a putative experimental substance which has previously only been tested in non-human animals requires appropriate caution. One cannot start celebrating safety and efficacy only a couple of weeks after surviving the test and not contracting the Ebola virus whose incubation period is said to be three weeks. There is need to observe possible effects for at least a couple of months.

 

1. Phase 3 and 4 can then go “straight into very vulnerable people in African countries” as envisaged by the WHO and its expert consultants, while every effort is made to avoid exploiting the desperately poor, ignorant or ill who have been the guinea pigs of medical research, the unacknowledged heroes/heroines of the great advancement of Allopathic Western medicine in the past century.

 

Now on July 31 2015, a ground-breaking publication [“Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial”] was made in the very influential journal, THE LANCET (www.thelancet.com) , copyrighted by the WHO, with some of its high officials as co-principal investigators/co-authors. The announcement of this publication in newspapers, radio and television was accompanied by hyperbole quite uncharacteristic of the scientific domain: “spectacular”, “first time ever”, “100% effective”, “game changer”.

 

The successful molecule, hurriedly tested on Africans in Guinea, had originally not been developed or prepared against the Ebola virus but rather as an anti-bioterrorism product for North Americans, which had been subjected to non-human animal tests but not yet human tests. The following preliminary questions thus naturally arise:

1. Was the WHO statement on clinical trials for Ebola of September 2014 tailor-made to ensure tests in humans of this particular candidate vaccine?
2. Was this not an opportunistic trial reminiscent of the TROVAN trials in northern Nigeria in 1996?
3. As an agency of the United Nations with oversight for global health, is it right for the WHO itself to engage directly in commercial drug discovery, development and clinical tests, while at the same time issuing guidelines and directives on how these should properly and ethically be done?

 

Gobata

(Yaounde 07/09/2015)

Ebola Epidemic: the WHO gets it right, then wrong

The EBOLA virus epidemic (EVE) has continued ravaging West Africa, with nearly 4,000 deaths already as of October 2014, and is threatening to migrate to other regions of the world. Shortly after the outbreak of the epidemic, the World Health Organization (WHO) convened a consultation meeting of ethicists, other experts and stakeholders, on 11 August 2014, “to consider and assess the ethical implications for clinical decision-making of the potential use of unregistered interventions”. On 12 August 2014, the WHO released a short statement captioned “Ethical considerations for use of unregistered interventions for Ebola virus disease (EVD): Summary of the panel discussion” which generally was well received and appreciated around the world.  The consultation panel had reached the consensus that, “in the particular circumstances of this outbreak, and provided certain conditions are met”…, “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention”. This recommendation is justifiable by the fact and to the extent that the situation in question is that of a deadly and highly infectious epidemic with no known, let alone available, cure. The context is a purely therapeutic one with all efforts directed at saving human lives in imminent periculo mortis.

Subsequently, the WHO has published another release, 29-30 September, 2014 [http://www.who.int/immunization/diseases/ebola/WHO_consultation_ebola_sep2014/en/] “WHO Consultation on Phase 2 clinical trials for Ebola”, being the result of “an expert consultation to assess the state of the art work to test and eventually license candidate Ebola vaccines” in which “more than 70 experts, including many from affected countries in West Africa… Ebola virus disease (experts), manufacturers, regulators from Africa, Europe and USA, those with expertise in vaccine science, clinical trials and clinical management of patients” took part. This panel considered and apparently approved urgently carrying out clinical tests on humans of some candidate Ebola vaccines in the development pipeline, including Chimpanzee adenovirus serotype 3 (Chad 3) by Glaxo Smith Kline + others and Recombinant vesicular stomatitis virus (rVSV) vaccine by a consortium involving Canadian Public Health plus others.

Biomedical clinical trials would normally pass through 4 distinct phases:  Phase 1 trials (on 20-80 people) to evaluate safety and dosage; Phase 2 (several hundreds of people) to determine efficacy and further evaluate safety; then Phase 3 (several thousands of people) to investigate efficacy by comparison with other standard experimental interventions as well as to monitor adverse effects; and finally Phase 4, conducted after the intervention has been marketed, to monitor effectiveness in the general population and to collect information about adverse effects associated with widespread use. But in this case of the Ebola disease, it is envisaged by the expert consultants and WHO, “before going straight into very vulnerable people in African countries” to test “in a few hundred volunteers” whether it is safe and induces antibodies. It is hoped to have these results before the end of 2014 and, ceteris paribus, to “start using the intervention in affected countries in January 2015”.

This is a highly ambitious project, maybe consistent with the challenge at hand. But it is not an ethically justifiable proposal. The Ebola virus epidemic (EVE) as distinguished from the Ebola virus disease (EVD) as such is still raging unabated and threatening to migrate from its epicenter in West Africa to other regions of the world. All reports coming out from West Africa describe an overwhelmingly desperate and chaotic situation. How would anybody go there with an aim and intention, let alone with a clinical research project, whose immediate purpose is anything other than containing the spread of the epidemic and helping to save the lives of those in imminent danger of death? How would one go about asking for, let alone obtaining, the informed consent of participants in such a research project? It should be recalled that the problem with the TROVAN trial by Pfizer in northern Nigeria about two decades ago now was not that such an experimental intervention should not have been tested but that Pfizer chose opportunistically to conduct the test during a meningitis epidemic and, moreover, with forged informed consent forms, which was another but different issue.

It is evident that, in the current situation in West Africa, any attempted testing of an investigative substance would be up against an insurmountable therapeutic misconception and illusion. Besides, one of the proposed candidate vaccines to be tested belongs to a powerful pharmaceutical company with a reputation for controversial drug trials involving a legion of unethical practices. Also, no mention is made in the WHO statement of post trial access to any successful vaccine or treatment that may eventually result from the trial, from which it can be deduced, in the light of past experience, that whatever vaccine or medicine results from the trials will be priced beyond the means of those who helped to make it possible.

The WHO got it right the first time regarding the use of unproven interventions in attempt to save lives, and the Cameroon Bioethics Initiative (CAMBIN) which I lead endorsed the WHO position in a statement published on its website (www.cambin.org) on 29 September 2014 but, this time around, regarding clinical testing of experimental substances, CAMBIN is unable to endorse the WHO release.

If clinical tests on any candidate vaccine or medicine for Ebola are to be carried out, after the current epidemic has been brought under reasonable control, of course, (in Nigeria it has been brought under control without the use of any medicine beside oral hydration) the following would seem recommendable:

1. Let the Phase 1 and 2 of such trials (expedited or not) be carried out on well-informed volunteers from amongst research scientists, members of ethics review committees, medical personnel including doctors, nurses, laboratory technicians etc., personnel of pharmaceutical companies, civil servants especially in the Ministries of Health and Scientific Research, University teachers, government ministers, members of parliament, experts in all domains. In my layman’s view, these initial two phases of the trial would not last less than 12-18 months.  For to take such a putative experimental substance which has previously only been tested in non-human animals requires appropriate caution. One cannot start celebrating safety and efficacy only a couple of weeks after surviving the test and not contracting the Ebola virus whose incubation period is said to be three weeks. There is need to observe possible effects for at least a couple of months.

 

1. Phase 3 and 4 can then go “straight into very vulnerable people in African countries” as envisaged by the WHO and its expert consultants, while every effort is made to avoid exploiting the desperately poor, ignorant or ill who have been the guinea pigs of medical research, the unacknowledged heroes/heroines of the great advancement of Allopathic Western medicine in the past century.

 

Godfrey B. Tangwa, PhD (aka GOBATA)

(Philosopher and Bioethicist)

Yaounde, 09/10/2014

GUIDANCE AND LEGISLATION FOR THE GLOBAL COMMUNITY: AFRICA’S INVOLVEMENT

The GOBATA blog has been dormant since my last posting in December 2013 on Nelson Mandela. This has been owing to two reasons: my partial paralysis as a writer in the face of so many overwhelming events around the globe that require tearful comment and the fact that, by the time I summoned the energy to write, the generous hosts of this blog, Emil Mondua and Dibussi Tande, had napped a bit and someone else had taken over the website and I found myself unable to access my own blog! I am so happy that they have fought so hard and restored the status quo ante and I can now make this posting with the promise never to stop writing as long as I can still write.

On the global landscape, Africa is badly off in many respects but not in all respects. Some human values have been better preserved and respected in African cultures than in any other culture. As the world continues to evolve in the process of globalization towards closer shared and more unified values, it is important that human values preserved and practiced within African cultures be not thrown in the garbage cans and replaced with the values, practices and preferences of the powerful, predatory, proselytizing cultures of the world. That would be a great loss and a pity for humanity as a whole. International legislation and regulation will increasingly regulate human behaviours and practices in many domains around the globe and it is critically important that all cultural perspectives be taken into consideration in formulating such laws and regulations so that we may not end up with a system whose ‘globality’ and ‘internationality’ are mere euphemisms for the arbitrary will and idiosyncratic preferences of erstwhile or current colonial masters.

I have earlier related on this site about the 30th International Congress on Occupational Health in Cancun, Mexico, in March 2012 and the work of revising and updating the Code of the International Commission on Occupational Health (ICOH), in which an Africa working group, committed to making the African voice heard and an African perspective taken into consideration, has been involved. Kindly find here attached, a first publication of that group in the journal Occupational Health Southern Africa of September/October 2013, Volume 19, Number 5. Download LL_AfricanGrp_PW_AfricanPerspectivesEthicalCode_Publ1015

Gobata, Yaounde, Cameroon, 07/05/2014

GLANCING BACKWARD 4

Two giant steps backward from the CANTAM Workshop of 27 September to 01 October, 2010, take me first to the CAMBIN General Assembly which took place at the University of Buea in the South West Region of Cameroon on 17 July 2010. CAMBIN is the Cameroon Chapter of the Pan African Bioethics Initiative (PABIN) whose creation (CAMBIN’s that is) I initiated in 2005. It is a non-profit, non-governmental, non-political, non-discriminatory, multidisciplinary association whose official seat is in Yaounde.

GLANCING BACKWARD 3

Some 3 weeks or so before the 17th (ordinary) session of the International Bioethics Committee (IBC) in Paris, scheduled on 26 and 27 October 2010, to which I was invited to make a presentation on the Ethics of traditional medicine, I had been involved, as the chairperson of the Cameroon Bioethics Initiative (CAMBIN), as coordinator of the African Malaria Network Trust (AMANET) Sub-Hub (ASH) in Yaounde nestled in CAMBIN, and as an expert in my own right, in the organization and facilitation of a workshop on Health Research Ethics for Members of Ethics Review Committees and National Regulatory Authorities of Central Africa.

Book Review: Ethics and AIDS in Africa: The Challenge to our Thinking

Anton A. van Niekerk, Loretta M. Kopelman (eds). Ethics and AIDS in Africa: The Challenge to our Thinking. Johannesburg: New Africa Books, 2005. [ISBN: 0-86486-673-9]

The devastating AIDS pandemic in Africa poses daunting medical, social, and economic challenges, placing local, regional, national, and international communities at a moral crossroads. This book, the first to systematically examine the ethical implications of the AIDS pandemic for Africa, examines such pressing questions as:

How do we deal with the uncertainties surrounding AIDS statistics?
Is it really too costly to provide people highly active antiretroviral therapies in Africa? What is the relationship between AIDS and poverty?
Is the political leadership in South Africa doing what is right and prudent to meet the challenge of AIDS?

The HIV/AIDS pandemic, African traditional values and the search for a vaccine in Africa

By Godfrey Tangwa

Culled from Anton A. van Niekerk, Loretta M. Kopelman (eds). Johannesburg: New Africa Books, 2005. ISBN: 0-86486-673-9(Chapter 11, pp. 179 - 189)

Traditional African values have a lot to offer in an approach towards fighting HIV/AIDS. In this chapter Godfrey B. Tangwa argues that values such as empathy and unpaid assistance for those in genuine need will do more to curb the pandemic than the first world's market-driven, profit-oriented practices have done. He also outlines what he believes to be some encouraging research done in Africa towards an AIDS vaccine.

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