Cost of hookworm treatment beyond reach of many Alabama residents

By Warren Duzak
17 January 2018

The prevention as well as the treatment of parasitic disease is beyond what working-class and poor residents in Alabama can afford to pay. In the richest country in the world, citizens in this southern US state suffer from parasite-borne scourges previously thought common only in the poorest regions of the globe.

In Butler and Lowndes counties, in the southern part of the state, it can cost half a year’s income to install a home sewage septic system to help eliminate the breeding grounds for hookworm and other intestinal parasites. As a result of poverty many residents lack adequate indoor plumbing and basic sanitation.

Once a person is infected their treatment can require thousands of dollars in over-priced, branded drugs that once sold as generics for a fraction of current costs, according to Consumer Reports magazine.

The WSWS  reported last month on the visit of UN Special Rapporteur Phillip Alston to Alabama, including to Lowndes County, the home county of US Attorney General Jeff Sessions. Alston described seeing pits of raw sewage with disease-causing parasites that a majority of Americans might have associated with Sub-Saharan Africa.

Creeping eruption of hookworm

“I think it’s very uncommon in the First World,” Alston said, “This is not a sight that one normally sees. I’d have to say that I haven’t seen this.”

As the WSWS reported, “The loamy soil and hot, humid weather that made cotton farming such a profitable endeavor in the Deep South provides a perfect breeding environment for Necator americanus, a species of hookworm that lays its eggs in the intestines of those it infects. In a place like Lowndes or Butler County, where raw sewage seeps into poorly draining soil, the eggs deposited through sewage have a warm and hospitable locale to incubate, hatch and reproduce. A person unwittingly walking through a soil where hookworms have incubated can become infected when one or more worms enters their body, usually through bare feet and exposed ankles.”

The parasite can cause stomach pain, vomiting and diarrhea.

“As infection progresses, severe anemia frequently leads to fatigue and cognitive disabilities; in some cases, particularly among the very young, the very old, and the immune-compromised, it leads to death.”

Both sanitary technology and effective drugs have long existed to eliminate hookworms and similar parasites, including pinworms.

Hookworm lifecycle

“The incidence of hookworm is clearly tied both to poverty and to blatant malfeasance on the part of local, state and federal governments,” the WSWS reported. “In Lowndes County, the annual median household makes a mere $30,225 yearly. According to the 2010 US Census, over 25 percent of county residents live below the poverty line. For a family that earns less than $2,000 a month, the cost of a new septic system—which can cost up to $15,000 to install—is prohibitively high.”

The low wages plus price-gouging pharmaceutical companies have prevented treatment relief when prevention is out of reach.

First, there are drugs available to treat hookworm. They have been around for some time and are quite effective, with cure rates of 96 percent, according to www.drugs.com.

The Centers for Disease Control recommends two drugs that were once generic and far less expensive. “Anthelminthic medications (drugs that rid the body of parasitic worms), such as albendazole and mebendazole, are the drugs of choice for treatment of hookworm infections. Infections are generally treated for 1-3 days. The recommended medications are effective and appear to have few side effects,” the CDC recommended.

But in the hands of the capitalist owners of the pharmaceutical giants, medicine becomes a tool only for increasing profit by, like the hookworm, sucking the life’s blood from the working class.

“Albendazole was relatively inexpensive until 2010, when the manufacturer stopped making it. Amedra Pharmaceuticals later acquired marketing rights to the drug in 2013 and started raising its price from $6 per pill. Amedra was subsequently acquired by Impax Laboratories in 2015,” a Consumer Reports story last year explained. “Mebendazole, meanwhile, was an inexpensive generic drug for decades, then went off the market in 2011.”

By purchasing the rights to that drug, Amedra owned the only two prescription pinworm treatments available, which were also the recommended drugs by the Centers of Disease Control (CDC) for hookworm treatment, Consumer Reports noted.

Pinworm is a less dangerous and more easily treatable worm parasite, but affects millions of Americans, mostly children between 5 and 10 years of age.

“The company was acquired by Impax Laboratories in 2015, and by January 2016 it launched a chewable version called Emverm, pricing it around $400 per pill. The inexpensive version of mebendazole is no longer available,” the magazine reported

The recommended dosage to treat hookworms with Emverm is one pill in the morning and one in the evening for three days.

A Costco pharmacy listed the price at $1,868.31 for six pills, while Rite Way showed a cost of $2,332.20 for six, according to a recent internet search.

According to www.drugs.com, the recommended treatment with Albenza (a brand name for Albendazole) can require 28 days, depending on body weight. A 28-day regimen would cost almost $3,000 for the multiple pills.

A single 200-mg pill at nine major pharmacies, including Safeway, Costco, Walgreens and Walmart , ranged in price from $382 to $399.

As the WSWS  reported in 2015, the price tag on drugs can be 10 times higher in the United States than other countries.

“The price variations bear no relation to health outcomes,” Tom Sackville, chief executive with the International Federation of Health Plans (IFHP), said at that time. “They merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases, reflect a damaging degree of market failure.

“In the case of albendazole, the answer is very simple: Most doctors have no idea that an older, off-patent drug like albendazole could cost $200 per dose,” Jeremy A. Greene, M.D., Ph.D., professor of medicine and the history of medicine at Johns Hopkins University School of Medicine, told Consumer Reports. “That is, until a patient comes back from the pharmacy in shock over the high price.”

The drugs have been around a long time, so “the average prescribing physician is conditioned to think that it must be very cheap,” Greene explained. “And they know also that it’s a drug that’s almost free in other countries. The concept that it could cost $200 per pill is unfathomable.”

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