We’ll get to Chagas disease in a bit, but first let’s talk about the Trans-Pacific Partnership (TPP) agreement. This is a trade agreement that is being negotiated in secret, and which will then be presented to the Congress for an up-or-down vote. Because it’s been labelled a ‘free trade‘ agreement–even though only five of the twenty-six sections dwell on tariffs (and, at this point, most tariffs among the signatory nations are pretty negligible anyway)–the Very Serious People are touting the TPP sight unseen.

Don’t ask those bozos for advice when making a large, important purchase.

Anyway, how do Chagas disease and the TPP agreement tie together? First, let’s review exactly what Chagas disease is, other than the quiet killer you’ve probably never heard of. Chagas disease is found in the Southern U.S., Central and South America. In terms of disability-adjusted life years lost, in the Americas, it ranks third behind HIV/AIDS and tuberculosis, and blows past malaria. It’s a protozoal disease transmitted by ‘kissing bugs.’ After infection, there can be acute symptoms, but the real problem is that, when left untreated, it’s a ticking time bomb: twenty to thirty percent of those infected will, years later, develop severe colon or heart disease, often leading to death. Asymptomatic carriers are at risk for these potentially deadly complications if their immune system is weakened, either by disease or medical immunosuppression.

Ok, this sucks, but what the hell does it have to do with a trade agreement? Well, parts of this secret agreement dealing with drug patenting have been leaked, and, as you might guess, they’re pretty odious (boldface mine):

The partial draft of the TPP agreement on IP and health contains this provision.

“Article QQ.A.5: {Understandings Regarding Certain Public Health Measures7}

The Parties have reached the following understandings regarding this Chapter:

The obligations of this Chapter do not and should not prevent a Party from taking measures to protect public health by promoting access to medicines for all, in particular concerning cases such as HIV/AIDS, tuberculosis, malaria, [US oppose: chagas] and other epidemics as well as circumstances of extreme urgency or national emergency. Accordingly, while reiterating their commitment to this Chapter, the Parties affirm that this Chapter can and should be interpreted and implemented in a manner supportive of each Party’s right to protect public health and, in particular, to promote access to medicines for all.”

The “US oppose[s]” adding “chagas” to this list of exceptions…

It appears that the current state of the TPP draft is that the other nations included Chagas but it was excluded from this clause due to the sole opposition of the U.S. The provision of “access to medicines for all” is particularly vital in the case of Chagas disease because early drug treatments of infected newborns are extremely effective in eliminating the disease in newborns who were infected maternally….

The Obama administration’s effort to block governments from providing medicine to the victims of Chagas disease represents the intersection of callousness and stupidity at their respective maxima. The heads of state of Chile, Mexico, and Peru have disgraced their office by failing to denounce the U.S. position on Chagas, to make public the TPP documents, and to withdraw from the treaty negotiations.

It’s worth noting that a Chagas disease drug, unlike many antibiotics, could be quite profitable: there’s a large non-human reservoir of parasites. This disease is not going away any time soon. Unlike many bacterial diseases, human-to-human transmission is rare, so resistance, even if evolves within a person will be difficult to transmit (one exception is from infected mothers to newborns via breast milk). There’s a potentially large market with few effective alternatives–even if caught during the acute phase, treatment is only 60 – 80 percent effective, meaning a significant fraction of treated patients are at risk for severe complications.

If any country were to manufacture a generic version of a Chagas disease drug to save its own citizens’ lives, they could be hit with economic sanctions if the U.S. version of the TPP were passed.

This is shameful. Something to keep in mind the next time you hear the phrase ‘free trade.’

Full disclosure: I have colleagues who are attempting to screen compounds for potential anti-Chagas drugs–I personally receive no funding or support from this work. My views are my own and do not reflect theirs.