The World Cup and Research Ethics: Legacies

You may wonder why I’m blogging about the World Cup on the Research Ethics Blog. Call it an unfortunate coincidence arising out of a legacy of poor treatment towards those who are already socioeconomically disadvantaged.

Critics of the World Cup organizers are claiming that local poor vendors and entrepreneurs (known there as “hawkers”) in Soweto are being prevented from selling their wares and services or setting up their booths anywhere near to the events, within the official World Cup “zone”. With an unemployment rate of 40%, “hawking” wares and selling a wide variety of services is a deeply embedded part of the local culture. Before the games even began, promises were made to the locals that the World Cup would, in fact, benefit them in a number of ways. Local craftspeople would be able to sell their wares to the large crowds. Money generated from hosting the games would hopefully go into local projects which might include establishing and updating plumbing and roads in the surrounding areas. These promises have yet to come to fruition and many of the locals, according to one CBC report, are fearing that the World Cup will “parachute in” and leave the locals in the exact same situations that there were in before the games. Certainly not better off. Perhaps even worse off. Demoralized for sure. Still poor.

The report from CBC states that inside the World Cup areas, there are only “official” sponsors selling their wares. Large corporations, such as McDonald’s and Coca-Cola, dominate the markets, the stadium billboards, the food and drink booths and as a result, smaller local merchants aren’t able to even access the area around the stadiums. The perception, for many, is that the perceived benefits or opportunities, which might have arisen out of hosting the World Cup, simply aren’t going to happen. While the projected profit from the World Cup is estimated to be approximately 21 billion, much of that has been used to upgrade stadiums, enhance transportation to the stadiums and building a new international airport. All good things but not likely things that will, in any tangible way, really benefit the local craftspeople in Soweto. The CBC reporter notes that few to none of the local entrepreneurs could afford permits to work during the World Cup zone in stadiums meters from their own houses, in which they used to sell their wares before they were renovated for the event.

Here is the audio report from CBC (Sorry, you likely can only gain access to listen if you are in Canada): The World Cup Economy

This kind of “practice” isn’t new. The idea of richer Western countries using poorer countries in ways which will benefit only the rich and not those in the developing world is something that we’ve already seen in other contexts. Health research that is “exported” to the developing world is a prime example of this skewed harm/benefit situation. We often refer to this as “parachute research” In a now-famous 1996 Nigerian meningitis study, Pfizer researchers from the US came to Nigeria in the middle of an outbreak and left soon after (with their samples and data about the effectiveness of the drug Trovaflaxacin in treating bacterial meningitis) before the outbreak had even begun to resolve. They left behind inadequate records and local physicians had difficulty even determining which children had been diagnosed with meningitis. Few families even knew that their child had ever been enrolled in any kind of research study.

Sometimes this kind of problematic research hasn’t even been “exported” out of the country. In the Tuskegee Syphilis Study (1932-1972), nearly 400 poor illiterate African American migrant farm workers were used, without their informed consent, to study the natural course of the disease (without treatment) in black males. The study continued long after a cure was readily and cheaply available (which it was in the 1940s when penicillin was confirmed to be effective in treating syphilis).

There are few studies being conducted in developing countries on diseases and health conditions related to the complex social problems that are faced by those living there: poverty, famine, civil unrest, living with refugee status, economic unrest, sanctions. Many research studies being conducted in these countries are on what we might call first world diseases: obesity, elevated cholesterol, high blood pressure, etc. Sure, plenty of trials on HIV and AIDS were and are carried out in Africa (as of the end of 2008, there were 22.4 million persons in sub-Saharan Africa living with HIV and AIDS), but many of these trials have raised other contentious research ethics issues including standard of care and whether or not participants in trials in the developing world have a right to the same standard of care as a patient in an HIV clinic in Manhattan. We have, of course, supplanted the notion of local standard of care with “universal standard of care” but there are still marked differences between living with HIV in Botswana compared to living with HIV in Boston.

It may seem like a stretch to compare, even in an informal way, the World Cup and health research. They have significantly different goals. While health research should be aimed at benefiting persons, and improving health states, the World Cup has no such obligation. However, according to the CBC story, the hopes of the locals included the possibility to see even some marginal improvement in their daily lives by hosting the games in Soweto.

While the world grows ever smaller according to some, the discrepancy between rich and poor apparently continues to strive in a variety of contexts. In the medical labs and even now in the soccer stadiums.

~ by Nancy Walton on June 14, 2010.

2 Responses to “The World Cup and Research Ethics: Legacies”

  1. Nancy I must take exception to your criticisms of the World Cup and then tenuously connecting the “legacy of poor treatment towards those who are already socioeconomically disadvantaged.” with questionable conduct by major Pharmas.
    You failed to point out the infrastructure investment that has already taken place ahead of the World Cup, including:
    6 new stadia
    20 billion Rand in Airports to boost tourism capacity
    96 billion Rand on Roads
    18 billion Rand Railways
    30 new hotels
    This massive investment resulted in jobs for many many thousands of people who would have otherwise have no employment. This type of investment is only possible if large corporations are given exclusive marketing rights for an event of this magnitude. Without it the event could not be staged. Perhaps you can report on what being “disadvantaged” would have been like in South Africa without the World Cup.
    There is absolutely no possible connection to the actions of possibly unscrupulous Pharmas. Surely you would agree that the massive infrastructure investment that has ALREADY taken place must have a positive impact on all aspects of public welfare in South Africa.
    Balance please.

  2. Hi Ian, Thanks for your comment. You do make some very good points. I did say it was rather a stretch in some ways. And you’re right, there has been tremendous contribution to infrastructure in the region with the building of those facilities and the short term employment boosts that have resulted. Absolutely. However, I’m also thinking about the many abandoned Olympic villages that exist all over and the possibility of real, long term positive outcomes or local improvements that will or won’t result from The World Cup. After the event is over, will those hotels be able to sustain employment for local persons once they empty out significantly? Will the infrastructure set up to enhance tourism capacity really be able to be sustained by that amount of expected tourism? I’m not sure.

    Of course no event like this, as you note, could be possible without the involvement of large corporations such as McDonalds or Coca-Cola. And as I noted, in my entry, they’re not to blame. But the local people felt that they were, according to the report I linked to, coerced in a way to support the event being held in their area by promises of being able to profit or benefit individually. With prohibitively high priced permits to hawk wares or services, this is not possible.

    I’m not saying that there is a direct connection between “parachute” health research (as you’ve called it, Pharma – but I didn’t limit it to that) and this kind of situation. But it does make one reflect on these kinds of events and the tremendous profits and whether or not locals “really” do benefit from something like this.

    Thanks for your helpful perspective,
    Nancy

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