Miraculous medicines are always more myth than reality: Pandemics, prophylactics and pice packets

Miraculous medicines are always more myth than reality: Pandemics, prophylactics and pice packets

Every epidemic has its cult drug. Doctors may advise caution and governments warn against panic buying, but this simply convinces people that it is the secret, miraculous cure they are being denied, and they frantically start searching for it and even self-medicating.

Oseltamivir was that drug during bird flu several years back, and hydroxychloroquine (HCQ) is the drug today. President Trump’s demands for a quick solution, and refusal to listen to medical experts, caused soaring demand and pressure put on India, which has stocks, to supply the US, even as concerns rise about our own supply. And now other countries are also asking India for HCQ.

As many have noted, HCQ links back to the original cult drug. It was created in the 1950s as a less toxic form of the anti-malarial drug chloroquine, whichitself wascreatedin 1934 as asynthetic analogue of quinine. This was an extract of cinchona tree bark used in its native Peru as a muscle relaxant to stop extreme fever shivers.

Jesuits priests brought cinchona extract back to Europe where it was seen as a wonder cure. By 1820 quinine had been extracted as the essential medicine, and was seen, as Rohan Deb Roy writes in his book, Malarial Subjects, as a cure for “dysentery, sore throat, alarming head symptoms, impotence, and toothache.”

Quinine, it was claimed, could have changed history, by saving conquerors like Alexander the Great from malarial death.

Such claims were a calculated attempt to link quinine with British imperial expansion; malaria need not halt British colonial expansion in tropical, mosquito ridden lands as long as quinine could be provided. Clements Markham, a writer and explorer who was working in the India office of the British government decided travelled to Peru to procure seeds.

Cinchona was planted in the Nilgiris and the hilly areas of Bengal and Burma. It took a while for the delicate trees to grow in sufficient numbers to start manufacturing quinine, but then the question was how to distribute it. One well known way was to combine the very bitter drug with sugar in tonic water, but this was always quite minor. For all the mythology of gin and tonic being an essential part of the Raj, it was mainly a drink for box-wallahs, the British business community in larger towns where both tonic and imported gin was easily available.

The real challenge was to get quinine to the Indian masses. One basic debate for mercantile imperialists was whether to sell it commercially or supply it as charitable need. The compromise was to supply it, on the grounds that controlling malaria enabled wider colonial exploitation.

The solution was the ‘pice packet system’ in which tiny packets containing five grains of quinine were priced at just one pice and distributed through the Indian postal system.

Packing was done by juvenile delinquents and convicts in jails in Calcutta and Hazaribagh (now in Jharkhand) and dispatched to post offices across India and Burma.

Apart from achieving wide distribution, the idea was that Indians were more likely to take quinine if persuaded by their peers, rather than commanded by the British. Roy explains that postmasters got an incentive “initially fixed at one anna for every sale amounting to one rupee.” Other local influencers like headmen and schoolmasters were also roped in.

It was the forerunner of the sachet distribution of products like shampoo and hair oil today.

And just as with these products, there were different packings for those who could afford it – glass vials of quinine tablets that were less bitter to swallow. It was a remarkable attempt to persuade a vast population to stop a disease.

Yet by the 1930s the limits of the pice packet scheme were evident. As droughts devastated many areas the cost of the packets was beyond the reach of the really poor. In a public health dilemma we see playing out today, given a choice between stopping hunger or stopping a disease people naturally put food first.

Demand for free distribution of quinine grew and, as the British dragged their feet, so did their quinine stocks. In 1934 the Times of India reported that the British was even considering selling stocks to the Kina Bureau, an Amsterdam based organisation that tried to control global quinine supply, like OPEC and oil. The discovery of chloroquine promised to undercut even this, though the extreme toxicity of the drug delayed its widespread use.

This is why the discovery of HCQ, as a more useable version, was a breakthrough. It was soon followed by the discovery of DDT, as a mosquito killing insecticide. For a while the world seemed poised to stop malaria, but in time mosquitoes and malaria parasites became resistant, and the disease has recurred.

The miraculous medicine is always more myth than reality with epidemics, and never a substitute for careful and comprehensive public health planning.

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