Building trust just as vital as producing vaccines

 Emeritus Professor Tan Sri Dato' Dzulkifli Abdul Razak
Opinion - New Straits Times
June 30, 2021

A LARGE United States pharmaceutical company, Johnson & Johnson (J&J), is the third to have its vaccine (a first, single-dose product) authorised by the US Food and Drug Administration for "emergency" use in preventing Covid-19 in the US.

It is a different type from the vaccines used there. As a single-dose vaccine, it has the advantage of speeding up the vaccination rate, thereby reducing hospitalisation and deaths. It is also said to be effective against some of the viral variants.

In April, the rollout of J&J vaccines was paused due to rare but serious blood clots that were experienced by those who had the shots, found in the large blood vessels of the brain or other parts of the body and were associated with a low platelet count termed as thrombosis with thrombocytopenia syndrome (TTS).

Just when the people are about to build trust with pharmaceutical companies after the many anomalies related to the processes involving the vaccines, J&J hit the headlines last week. It had nothing to do with vaccines, but was equally troubling — an opioid scandal.

Opioids are a class of powerful drugs found in opium poppies that can be used to block pain signals between the brain and the body. They can be legally used as prescription medications but they can also be used illegally, leading to drug abuse.

The subtext in the United Kingdom's Guardian headline reads: "Whether the pharmaceutical giant jumped or was pushed, its New York deal is a significant sign of the way the wind is blowing," that is, in the direction as "its accusers describe as cynicism and greed in creating an epidemic of addiction to prescription painkillers and illicit opioids, such as heroin, that has killed more than 600,000 since 1999 and caused misery for millions more".

For that, J&J has to pay a US$230 million settlement to settle a lawsuit brought by the attorney-general of New York over the opioid crisis. Reportedly, together with other opioid makers, pharmaceutical chains and some of the largest US drug distributors, revelations about their business practices are said to be "shocking".

According to the attorney-general in a press release: "The opioid epidemic has wreaked havoc on countless communities across New York state and the rest of the nation, leaving millions still addicted to dangerous and deadly opioids."

Overall, drug companies and distributors were implicated across the US in promoting the prescription of powerful opioid painkillers beyond medically necessary levels, prompting the addicted to seek out heroin and illicitly-made fentanyl.

This was substantiated by the US Centers for Disease Control and Prevention which highlighted that from 1999 to 2019, almost 500,000 people died from an overdose involving any opioid, including prescription and illicit drugs.

In 2010, there was a dramatic increase in overdose deaths involving heroin, whereas in 2013, there was a surge in fatal overdoses involving synthetic opioids, especially illegally manufactured fentanyl.

It was only last year that J&J said it decided to "discontinue all of its prescription pain medications in the US".

Allegedly, consultants hired by J&J recommended its sales force to focus on increasing sales by looking to "target high abuse-risk patients (e.g. males under 40)". In a 2019 judgment, J&J was reportedly asked to pay US$465 million after it was found that it "deceptively and aggressively pushed false claims that its powerful opioid painkillers were safer and more effective than they were".

The company allegedly made "substantial payments of money" to front organisations to resist curbs on prescribing.

Against this development, the New York case is likely to further threaten the public image of J&J as a company that is now struggling to up its reputation in the context of the pandemic.

Not to say of its other scandals, including over contaminated baby powder to which Newsweek (March 9) reported: "Hundreds of social media posts have linked the Covid-19 vaccine with allegations the company's talc could cause cancer."

Those who spoke to Newsweek said they wanted to be inoculated but would refuse J&J's vaccine if offered, specifically because of the talc lawsuits, of which there have been more than 15,000.

Most of the lawsuits alleged that the company failed to warn customers that its talcum powder contained tiny amounts of asbestos, a cancer-causing material.

Sadly, we are back to the issues of trust (or the lack of it) whenever the parties involved choose to (mis)behave which could cause a further widening of trust-deficit situations among the lay public!

The writer, an NST columnist for more than 20 years, is International Islamic University Malaysia rector