Reading list: June 2021

Global medicine and GMO foods

Starved for Science: How Biotechnology Is Being Kept Out of Africa (Robert Paarlberg, 2008)

This is a shorter (190 pages) book challenging the international development community to invest in agricultural technology and GMOs for Africa.

From the title I was imagining a picture of a GMO-friendly future. Instead much of the book was about US consumer awareness of GMOs, or tracking spending by USAID, NGOs, and African governments on conventional agricultural research. These figures were highly relevant and depressing.
If I reorganized this book, the main question is, why are African farms having lower yields and less productivity, and why have they not copied the successes of the Green Revolution (which changed farming and generational poverty in Asia, mentioned in a previous read), or the common practices of American farms (fertilizers, tractors, GMOs which resist pests, herbicides, and drought).

Paarlberg blames the US and EU for a newly developed distaste for agricultural technology. We have plenty of choice for food and can avoid GMO foods if we want (though they are already common in the US). We are ignorant about food and most of our jobs are unaffected by productivity gains on farms. Our leaders have been reducing investments in agricultural tech and land grant universities since 1980. Our nonprofits go around the world warning about environmental dangers of chemical fertilizers and monocrop farms, and see Africa as an opportunity to promote less-productive organic farms. The elite of Africa adopt these attitudes without considering that (in the book’s view) the Global North is being irrational and most people in the Global South cannot afford that.

The book is sharply critical of fears about factory farming, GMOs leaking into the wild, terminator genes and Monsanto, the Green Revolution, runoff, etc. The logic behind this was failing at times (Americans accept medicines derived from GMOs so genetics is not our core issue; less chemical spraying is needed when farms plan for GMOs; small family farms benefit from agricultural technology [so long as productivity and prices change in a particular way]).
The book even debunks a fringe environmentalist who believes that plants need soil with a life force which cannot be replicated by chemistry.

There were two points which I wish had been explored more seriously:

• Productivity as the key to a food crisis — Famines are often studied as manmade, political disasters. Greenpeace’s Dr. Doug Parr is quoted in this book as saying “There is no direct relationship between the amount of food a country produces and the number of hungry people who live there”. The author makes a good case that this is less true in Africa, where so many subsistence farmers live precariously on the production of their small plot of land.
• EU import colonialism — When African farmers do export their crops, the EU is a major buyer. This led to fears that should an African country plant any GMOs, even locally-consumed food crops, all of their cocoa, coffee, tea, etc. might be rejected by the EU market. The author gives examples of the US having lost export business over GMOs, and South Africa having kept trade going. This was a more compelling story than the ‘NGO brainwashing’ and ‘organic farms holding meetings during UN/FAO conference’ angle which the book tread over multiple times.

I gotta admit, I did like the questions raised and answered, and its role as a pro-agribusiness counterpoint to the books Uncertain Harvest and The Government of Beans which I read last year.

Unfortunately this book is already 13–15 years old.
I was frequently wondering if organic farming was still so small an industry in the US, or whether relevant new GMOs had been approved. One example Paarlberg gives were biosafety regulators in Nigeria, who had accepted millions from USAID and toured farms in Missouri yet failed to approve any GMO crops. Progress has been slow, but in 2019 Nigeria approved a GMO cowpea [black-eyed pea] developed by the African Agricultural Technology Foundation based in Nairobi, and as of 2021 there are now 27 other brands of cotton, maize, and soybean with regulatory approval.

Here’s a collection of newer sources on the topic:

• I found a database on the International Service for the Acquisition of Agri-biotech Applications (ISAAA) which lists GMO approval ‘events’ by country. This is the best, most frequently updated source that I could find.
  isaaa.org/gmapprovaldatabase/countrylist/default.asp
  Unfortunately this won’t tell you whether they are being planted at scale.
• Info on Wikipedia is severely limited and outdated (statistics from 2014)
  Genetically_modified_food_in_Africa
  List_of_genetically_modified_crops
• Most GMO crops are only modified to make plants more resilient or more productive. After 20 years, nutrient-rich Golden Rice is approved and on the way to deployment in the Philippines. There are government social media channels promoting the launch and future public availability.
• Paarlberg has a new book this year advocating against organic farming, titled Resetting the Table: Straight Talk about the Food We Grow and Eat (interview with IFPRI).
• In 2018, a former activist published Seeds of Science: Why We Got It So Wrong On GMOs about what changed his mind to support GMOs.

A History of Global Health: Interventions into the Lives of Other Peoples (Randall M. Packard, 2016)

Packard, a professor of medical history at Johns Hopkins, gives a critical examination of how ‘colonial’ and ‘tropical’ medicine became a respected field, and then evolved into ‘global health’ organizations and foundations. It’s somewhere between a Zinn-esque People’s History and an epidemiology course textbook.

We open with the outbreak of Ebola at the end of 2013. By the time doctors who were trained to identify Ebola had received a patient, the virus has been spreading rapidly for weeks to months. The international media and foreign health orgs tended to criticize West Africans for not listening to doctors and guidelines, and for continuing to hold traditional practices which spread the disease further. I read this part pre-Covid, and flashed back to it many times.
Packard was not writing about this as a warning, but to advocate for stronger local primary care facilities and health institutions. He explains that the Gates Foundation, PEPFAR, and other foreign initiatives tend to build their own infrastructure around specific diseases (malaria, HIV/AIDS) or specific solutions (condoms, bed nets), but few stepped up to educate local health workers, or build up lasting, locally-trusted institutions. The real problems and attrition of poor healthcare are not attractive enough or solve-able enough for a foundation or rich country to stake a claim. Packard recommends Partners in Health and Last Mile Health as two orgs which are more focused on the long-term.

Then we flash back to the early days of colonial/tropical medicine. In 1881, scientists started to understand that mosquitos spread malaria. If they could control the mosquitos, then it would be possible for Americans to live comfortably in Cuba, complete the Panama Canal, and similar benefits for the other colonial governments in Europe. There was not one rulebook to how this worked — as an example Packard tracks the history of William Gorgas. His process included strict measures to inspect houses and spoil any standing water which could support mosquito larvae. A contemporary wrote:

results such as were obtained in Havana in the suppression of yellow fever during the American occupation cannot be obtained elsewhere, where the disease is widely spread, without the undisputed authority […] These powers in reality amounted to martial law.

When put in charge of protecting Panama Canal workers from mosquitos, Gorgas changed his focus to poverty, building infrastructure for Panamanian cities and giving workers individual apartments over bunkhouses. These two competing philosophies (tech interventions vs. public wellbeing) emerged for how leaders understood global health issues. Other philosophies included: ‘civilizing’ people with shoes and new hygienic practices, or specifics of nutrition (food variety, stability, and pricing). You could imagine another reality where ‘global health’ evolved as an international farmer insurance and food price regulator (though I don’t know how differently this mindset could approach smallpox or HIV/AIDS?). Instead public health was a product of its time — new colonies, Kipling, new understanding of bacteria and other vectors, and the invention of DDT.

Packard compares the WHO’s two founding initiatives: eradicating malaria and smallpox. Malaria was the larger-scale and better-funded program, getting early success with DDT in some countries, yet it was the smallpox program which achieved their goal of eradication.
The takeaways from this are muddled. The author makes a case that the malaria program was too rigidly organized, and smallpox program flexible enough to adapt to each country, to allow whatever strategy or local partnership could reach people. As acknowledged here and in an earlier read (House on Fire), smallpox patients were bedridden / always visibly sick, and the invention of a portable vaccine and jet injector needle meant that vaccinators could act one time on each person and move quickly. The malaria program had no similar advantages, relying on regular visits to spray pesticides indoors (found to be less effective on mud walls). Their work could be undone by war, or outdoor sleeping, or asymptomatic travelers.
And if the management was the true key difference, then would we expect new management to affect malaria over the past decades?

There was also a lot about the Rockefeller Foundation being the precursor to international organizations eventually leading to the WHO, which makes me wonder if the Gates Foundation is intentionally following the Rockefellers?

Then there are sections about reproductive health, family planning, population control, drug patents, and World Bank financial controls through a People’s History-type lens. Maybe this is because I’m in the book without the context of the author’s course, but it seemed like the overall message was public health was heavily directed by Malthusians whose family planning programs were racist and coercive and the World Bank dismantled public health access over debt, with true evidence, but what is the takeaway for a health professional or a patient today? If there is no hope, only contempt, it is tonally distinct from other parts of the book.