The Haves and the Have-Nots: Medical Nationalism, Antibiotics, and Cold War.

The COVID-19 pandemic has created unprecedented strains on countries around the world. It has devastated populations and crippled economies. At this point, it’s difficult to see an without the development of prophylactic vaccines. This, in turn, has elevated the drug development process to the highest strata of national security. As a result, richer countries around the world have essentially pre-ordered vast amounts of vaccines for their population at the expense of poorer countries. Not only that, some countries have threatened to strategically withhold access to their vaccines while others have signaled that they would use their vaccines a geopolitical tools to cajole other countries.

This has happened before. Over 70 years ago, the discovery and, more importantly, the development of antibiotics saw the United States in control of pharmaceutical pipelines. Other countries either did not have the applied science know-how to manufacture penicillin or lacked the necessary equipment (also controlled by the United States). This turned Washington D.C. into kingmakers, granting friendly countries access to penicillin while denying adversaries.

This excerpt from the new book, Cold War Resistance: The International Struggle Over Antibiotics, documents the process by which foreign governments attempted to procure the life saving drug from Washington.

Around the world, efforts to scale up production of penicillin suffered from similar setbacks. Relying on surface fermentation methods, contamination, low yields, and questionable potency plagued the production process. Moreover, most research attempts relied on P. n otatum rather than on exploring alternative species or modifying the strains in their possession. In other words, using the same roadmap, European scientists drove full speed toward the same roadblock that had bedeviled researchers from Fleming forward. While their apparatus and setups may have been fine, the fermentation process was more an art than an exact science. An instruction manual, which is what Florey’s 1941 Lancet paper was, only communicated the basics under ideal conditions. It did not take into account the countless variables in producing penicillin. How could it?

While a number of countries submitted requests to Washington for help setting up penicillin plants of their own, the government displayed a wariness in giving the green light, whether it entailed its own agencies or private pharmaceutical firms entering partnership agreements with foreign entities. Mexico’s desire to produce the antibiotic and its subsequent approaches toward pharmaceutical industries provides some insight.

Early efforts at obtaining penicillin included the formation of the Mexican Penicillin Committee in December 1943. A presidential decree dated February 16, 1944, prioritized the manufacture, importation, and sale of penicillin in Mexico. That the U.S. government refused to grant permission for sharing information with South American countries undoubtedly played a role as well. Mexico would essentially serve as the primary supplier of the antibiotic due to its geographic proximity. It attacked the problem from various fronts.

First, the researchers attempted the obvious, researching and developing homegrown methods for the fermentation and isolation of penicillin, albeit based on the Heatley- Chain technique. One company in particular, Acidos Organicos S. A., held promise and enjoyed the confidence of the Mexican government. While the company’s progress may have been encouraging, it still needed help from someone with intricate knowledge of the penicillin production process. As a result, Acidos Organicos sought the release of technical information from the United States. The company also lobbied the U.S. Embassy in Mexico City to have Albert Elder from the War Production Board visit the firm’s plant. His observations and feedback would prove invaluable.

Ultimately, the Department of State declined the request, stating, “At the present time, the War Production Board has limited personnel concerned with the production of penicillin. It is felt that this personnel can be best utilized for the purpose of increasing penicillin production in the United States to meet military and other essential requirements. The Penicillin Program is in a critical stage, and our primary responsibility is to assist domestic producers.”

Another route entailed querying pharmaceutical companies engaged in penicillin production. In November 1943 the Mexican- American Commission for Economic Cooperation received an application from Sons de Mexico S.A., a local pharmaceutical company, that proposed a strategic partnership with E. R. Squibb & Sons. Under the terms of the agreement, Squibb would oversee the construction of a penicillin plant, presumably in exchange for a percentage of future sales. Most of the equipment would have been sourced from the United States and paid for by the company.

Again Washington declined permission, stating, “Although the American section is inclined to believe that this industry might be a desirable one for Mexico, over the longer term, it has considerable doubts as to the advisability of giving any encouragement to the project at this time. . . . No action with regard to this project will be taken until the viewpoint of our government has been received.”

The indecision regarding the transfer of technology was on full display three months later when Wyeth was granted permission to enter a strategic partnership with another Mexican company Laboratorio Stille, S. A. A senior economic analyst at the U.S. Embassy in Mexico concluded, “The Embassy believes that, unless the authorities in Washington perceive some objection, this new enterprise should be supported to the extent of supply assistance for the few items of equipment which may be necessary and for the materials needed in the production of penicillin.”

Ultimately the production of antibiotics in Mexico commenced in 1944.16 The episode captures issues that would continue to crop up for the next twenty years. Washington dc would exercise its newfound political influence to control as much of the worldwide antibiotic industry as possible. The task bedeviled American politicians and policy makers because with Florey’s publication of the Heatley- Chain process, at least one method of producing penicillin was in the public domain. Even if it lacked the efficiency of the patent- protected submerged fermentation methods developed by the osrd consortium, it still provided a foundation from which others could work.

The State Department’s unwillingness to allow American experts to consult with foreign firms eager to produce penicillin of their own foreshadowed the only strategy at its disposal. If it could not control the flow of information about the research and production of the antibiotic, it could still thwart efforts by withholding the various proprietary production techniques developed by the U.S. pharmaceutical companies, as well as the intangible know- how that could only be acquired by working with the fickle P. notatum. It also became clear that the mechanical technology necessary for the most up- to- date methods could only be acquired in the United States.

Excerpted from “Cold War Resistance: The International Struggle over Antibiotics” by Marc Landas by permission of the University of Nebraska Press. Copyright Marc Landas.

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