The recent announcement of additional funding for an “anti-cocaine” vaccine has raised concern across Brazilian harm reduction organisations. Experts from the region question the vaccine efficacy as well as the repercussions its implementation could bring to an already challenging context.
The calixcoca vaccine, as it’s known, has been developed and patented by the University of Minas Gerais since 2015. The vaccine essentially functions by producing antibodies that would bind to cocaine entering the body, blocking it from passing through the blood-brain barrier, and preventing its psychoactive effects from being felt by the user. With clinical trials on rodents demonstrating successful results, the University is finalising ethical approval for calixcoca’s testing on primates.
Stories of anti-drug vaccines are not uncommon: in fact, the same University first mentioned an interest in such technology in 1996. What is concerning is the interest from the local administration of São Paulo, Brazil’s and South America’s largest city. A recent press release announced an initial investment of 4 million reais (roughly $ 820,000 USD) of “unrestricted support” in the vaccine’s development in the hopes that it will soon be tested on humans. São Paulo’s Secretary of Health is now tasked with identifying which people should be targeted for its implementation.
São Paulo has long struggled with problematic drug use and crack cocaine consumption, with Cracolândia, an open-air drug market in the city centre, often being the target of public policies. The list of approaches implemented in the region range from innovative, award-winning programs focusing on social justice to responses relying on military police force and zero-tolerance strategies. Currently, drug policies seem to be aligned with the punitive side of the spectrum: São Paulo’s Mayor Ricardo Nunes has actively called for the arrest of everyone using crack in public. In such a context, the recent interest and investment in the vaccine sounded alarms across harm reduction organisations.
Speaking with researchers and organisations on the ground in Brazil, there are multiple concerns about how a crack/cocaine vaccine would be used.
TalkingDrugs and Youth RISE spoke to the Community Centre É de Lei, an organisation that houses and advocates for people who use drugs, as well as distributes harm reduction materials in São Paulo. Their Research Coordinator, Karin di Monteiro, did not seem surprised by the news, saying that it’s common to hear about such vaccines being proposed.
“A vaccine is a technology for epidemics, but in this case, it is a matter of behavioural control. It would be a ‘treatment’ that controls, or aims to control, the behaviour of a person or a certain group of people in society”, she said.
It’s still unclear how the vaccine would work on humans and how it would be used by the public health system. “[Calixcoca] isn’t clear in its effects and dosage: a person in treatment would have to re-dose the vaccine every two months.”, said Monteiro.
The vaccine’s blocking effect also means that abstinence would be the only model of cocaine recovery. “There are, in practice, many ethical implications. The lack of debate about how people use substances, who they are and how they would react to the introduction of such a technology are important issues to understand when talking about a vaccine,” she added.
It is also unclear what would happen in the case of relapse for those vaccinated with calixcoca. People could still consume large amounts of cocaine or crack to feel its psychoactive effects again.
“A drug cannot simply be neutralised, you’re just strengthening the blood-brain barrier. The drug is still acting within your body and may cause other non-psychoactive effects on other parts, such as your digestive or cardiovascular system.” While the vaccine would block the psychoactive effects of the drug, side-effects, such as cardiac arrests or blood pressure increases, may still occur, even if you’re not feeling high.
What the calixcoca development project seemed to miss is the potential displacement of drug use: people may simply use other non-cocaine-based stimulants, like methamphetamine or MDMA, to simulate the intended psychoactive effects.
“Either you develop a vaccine for all stimulants, or this technology will not work in practice,” Monteiro commented.
A weapon of social control
There are serious concerns with pathologizing problematic crack use and implementing a technology-led health approach to respond to a phenomenon that is very much a societal failure. “I’m left thinking about how this vaccine could be used as a weapon of social control. Will people have to use it if they’re in treatment?” asked Felipe Neis Araujo, Lecturer at the Criminology Department at the University of Manchester.
There were already some egregious incidents of human rights abuses of people who use drugs, done in the name of health. In 2018, a woman experiencing homelessness and drug addiction in Mococa, a small city in São Paulo state, was forcefully sterilised after receiving a sentence for drug possession.
“The Government of São Paulo promotes the idea of crack and cocaine as a pathology to be ‘cured’ with a vaccine when we know that when people are using drugs problematically, they’re using them for several social and psychological issues – things that a vaccine won’t cure,” Araujo added.
“What if this vaccine is used by ‘therapeutic communities’, which are highly problematic organisations… how will we know they will use the vaccine ethically if they choose to adopt it?” Araujo said.
Faith-based rehabilitation clinics have long been used in Brazil to “treat” drug dependency, often punishing people through forced labour or physical assault. Drug treatment centres are fuelled by Bolsonaro-era policies which facilitated the forced internment of people who use drugs and funnelled significant amounts of drug treatment funds to these evangelical and Christian institutions.
The vaccine’s support from São Paulo’s Health Secretary comes at a time when the city’s administration has systematically dismantled local harm reduction resources that provided more holistic responses to the health needs of people using drugs problematically. Calixcoca would address the surface issue of drug use but not impact the conditions that lead to problematic drug use, such as the lack of housing, community support or psychological care.
To Araujo, São Paulo’s vaccine funding announcement is an attempt to veil the city’s current criminal justice approach to drug use as a health intervention. “If a health approach is really intended, why doesn’t the government support harm reduction organisations that have experience working with these target populations?”.
“It would not be at all unrealistic for me to predict a scenario in which people who are charged with drug possession are given two options – either you are going to get the vaccine treatment, or you are going to be framed and arrested. Ultimately, there is the risk that the vaccine becomes a legal weapon, another form of violence against people’s freedom and sovereignty,” said Araujo.
Tackling the root of the problem
The development and implementation of calixcoca should be approached with caution, considering the complex social, ethical, and public health implications it entails in Brazil. Nevertheless, the vaccine has already been praised in local media as a solution to crack cocaine addiction. “The repercussions are what worries us. There are many more people accepting this news to treat the ‘cocaine disease’. These are demagogic reactions that think this [vaccine] will put an end to Cracolândia.” said Monteiro.
Brazil has a dark history of wielding drug policies for social control. Studies indicate that the current “Drug Law”, implemented in 2006 by then-president Lula, which decriminalised the personal possession of drugs, actually generated an “explosion” in the number of people imprisoned for crimes related to drug trafficking. Since the reform, rates of incarceration rose by 27%, with nearly half of all convictions for trafficking by 2015. In practice, police street-level racial profiling exacerbated the mass incarceration of black and indigenous communities with longer sentences, which particularly impacted women. And while the 2006 Drug Law will be reassessed by the Brazilian Supreme Court this month, there is a distinctly punitive historical treatment of Brazilians who use drugs.
Promoting a vaccine as the solution to crack/cocaine dependency misses the root of the issue. It would feed into the patriarchal idea that people experiencing drug addiction are sick, incapable of taking decisions, and need help, even if this help is forced and comes through involuntary hospitalisation. “We want to help these people overcome their addiction. But what happens is the reproduction of stigmas. I don’t see this vaccine as an absolute solution, I honestly see it as another problem.” said Araujo. “I hope I’m very, very wrong”.