March
2000
Editorial:
Moving to Where the Resources Are
AIDS and the Global Politics of Wellness
By Catherine Clyne
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For the next fiscal year, the National Institutes
of Health (NIH) has designated nearly $2 billion for HIV/AIDS research
alone (including an aggressive campaign to ensure access to the preferred
animal model—the Indian Rhesus macaque, but that’s another
story). Perhaps this reflects what the public is demanding. Throwing
money at research makes people feel as if they are doing something about
AIDS, even if it may not be the most appropriate or effective use of
resources. This observation is not meant to belittle the necessity of
producing drugs for people with AIDS, nor should the quest for a vaccine
be dismissed. However, it underscores an American "not-in-my backyard,"
provincial mentality. It is taken for granted that HIV positive Americans
should have access to life-enhancing and life-prolonging drugs. There
is absolutely no argument there. But do we really have our priorities
straight? Millions of HIV positive poor people and children in developing
countries do not even have access to the treatment and drugs currently
available in the West; thus they are condemned to a death sentence of
AIDS. The quests to discover a vaccine are meaningless when a large
portion of the world’s population are not benefiting from the treatments
now available and may not from a vaccine—if one emerges. Demands
for coffins are mushrooming, creating a growing industry in Africa.
It doesn’t have to be this way.
The numbers speak clearly for themselves: $2 billion from the NIH for
scientists conducting research; and the Clinton/Gore administration
is requesting $150 million this year from Congress for vaccine research
and prevention programs in African countries. This is like tossing a
band-aid at a massive and fatal flesh wound. In February, Clinton defended
the administration’s Africa policy with hyperbole: "We have
seen thousands of triumphs, large and small. In this world, we can be
indifferent or we can make a difference. America must choose, when it
comes to Africa, to make a difference." But what difference is
that exactly?
Behind the scenes, the U.S. government protects the interests of pharmaceutical
companies by threatening economic sanctions against those countries
that have the audacity to attempt to generate affordable generic drugs
to make them available to their people. Case in point: by law, the World
Trade Organization (WTO) allows a country to call for compulsive drug
licensing should a national health crisis emerge. South Africa considers
the threat of HIV/AIDS to be of epidemic proportions, and in 1997 passed
a law to license the local production of generic HIV/AIDS drugs. However,
for nearly three years the South African government has been paralyzed—by
the threat of U.S. sanctions and by a massive lawsuit. Some 40 drug
companies are contesting the legality of South Africa to invoke compulsive
licensing and have the situation tied up in court. Their complaint is
that they dump all sorts of money into research that produces only a
few effective drugs, and if they allow every country to manufacture
generic, affordable versions, they will lose millions, perhaps billions
of dollars each year. It is barely acknowledged that the South African
government is offering to pay royalties for the use of patented formulas.
An article in the January/February Mother Jones estimates that during
the squabbling over the right to produce generic drugs, 300,000 South
Africans have died of AIDS. 300,000 souls that may have had longer,
healthier lives if they had had access to treatment.
There is no denying that drug companies put money into research, but
if we ask ourselves why the NIH has such an enormous research budget,
things get murky. The fact is that a lion’s share of successful
treatments and drugs for HIV/AIDS are created on the government’s
dime—our tax money—via grants given by various agencies to
researchers. Then the patents for promising drugs are sold to pharmaceutical
companies while the Food and Drug Administration accelerates the process
to approve these drugs for market. Toss on top of that the fact that
the pharmaceutical industry was one of the top ten profit-making industries
in the world last year, and we must ask, who is the real loser here?
Vice President Al Gore Chairs the Bi-national Commission on South Africa
and has considerable power over this situation. Why would the U.S.,
a country that is a member of the WTO, the World Health Organization
and a world leader in the treatment of diseases, attack the governments
of other countries, preventing them from producing life-saving drugs?
There are murmurs that Al Gore has close ties with the pharmaceutical
industry—it is reported that Gore has received over a million dollars
from drug companies for his presidential campaign. It is also suspected
that drug companies are aware that if the public knew the actual cost
of the production of anti-AIDS drugs, they would be subject to severe
public outrage. An AIDS activist recently reported that AZT can be purchased
in bulk for 42 cents per capsule from worldwide suppliers, while the
exact same drug retails in the corner pharmacy for $5.82 per capsule.
It hardly merits comment that the discrepancy in price points solely
to profit making, and that the cry that production costs are prohibitive
is a smoke-screen, let alone insulting and inhumane.
In January, the Nobel peace prize winner Medecins Sans Frontieres (MSF—Doctors
Without Borders) weighed in, releasing a statement accusing the U.S.
of restricting poor nations’ access to AIDS drugs in order to protect
the interests of big business. The statement comments: "Every day
MSF doctors and their local counterparts in Africa, Asia and Latin America...are
forced to tell their patients that treatment is too expensive to consider."
In 1996, the Immigration and Naturalization Service (INS) granted asylum
to an HIV positive African computer engineer on the grounds that he
would not have been able to get a job or have access to medical treatment
had he been returned home. How many people in this world can claim the
same circumstances, where infection with HIV equals certain death? In
western countries life-enhancing drugs are available, while people in
poor countries have no access to resources that could extend their lives.
Babies are denied therapies that could allow them to live longer, healthier
lives. Here is an idea or a choice even: given the reality that drugs
will not be available to numerous people anytime soon, what if everyone
who is HIV positive—with no access to medical treatment and unable
to get a job—were to petition the U.S. government for asylum? Who
are we to say no? If they cannot get them in their home country, why
don’t they come to where the resources are?
Admittedly, Africa and the rest of the world seems very far away, and
as Mia MacDonald’s piece emphasizes,
the numbers of people dying of AIDS are entirely overwhelming, and growing
at a staggering rate. Can we push beyond hyperbole and take Clinton’s
words truly to heart? "In this world, we can be indifferent or
we can make a difference. America must choose." Can we be generous
and compassionate enough to choose to share?
