The Progressive magazine, March 2001
The numbers beat out a dirge: Twenty-two million people to
date worldwide have died from AIDS. Thirty-six million are infected.
Twenty-five million of these live in Sub-Saharan Africa. Last
year, the number of HIV positive people in Russia and Eastern
Europe nearly doubled.
In the West, for those who can afford proper medication, AIDS
is no longer a certain death sentence. In developing countries,
it usually is.
"A fifteen-year-old in South Africa has a better than
even chance of dying of AIDS," reported The New York Times
Magazine on January 28. "One in five adults is infected with
HIV. Hospitals are filled with babies so shriveled by AIDS that
nurses must shave their heads to find veins for intravenous tubes."
In Africa, "fewer than 25,000-one tenth of 1 percent-receive
the therapy that could avert their deaths," reported The
Washington Post in a remarkable four-part series in late December.
"At current levels of intervention, the number of Africans
dead of AIDS in ten years will probably surpass the population
Precious little has been done about this plague, in part because
multinational drug companies hold a patent on, and overprice,
the anti-retroviral medications that, when taken in triple combination,
could keep millions alive.
The drug companies knew they could discount the drugs drastically
for use in Africa, but they worried that a secondary market would
develop, whereby people in Africa would buy the drugs cheaply
and resell them at a mark-up in the West. The companies feared
"killing the golden goose in the United States, Canada, Germany,
France, Britain, Italy, and Japan," Post reporter Barton
Gellman wrote on December 27.
"Corporate boards and regional operating companies weighed
the costs and benefits of pricing AIDS medicines within reach
of most of the dying," wrote Gellman. "With the tacit
and sometimes explicit assent of public authorities, the companies
decided the costs were too great."
Then, in counterpoint, comes the aggressively cheerful noise
of P.R. In 1999 and 2000, Bristol-Myers Squibb-which calls itself
"a $20 billion diversified, global health and personal care
company whose mission is to extend and enhance human life"-and
four other giant pharmaceutical companies announced a series of
grants that were, among other things, supposed to make free or
greatly discounted drugs available in Africa. For instance, the
company announced a project in South Africa: "As active partners,
Bristol-Myers Squibb and the government will make a significant
impact on the lives of women and children affected by HIV/AIDS,"
said vice chairman Kenneth E. Weg, according to a company press
But the offer does much more to improve the reputations of
the drug companies than it does to save lives. "Nothing fundamental
has changed in the calculus of access to AIDS treatment,"
"If it's relatively cheap to manufacture [AIDS] drugs,
it makes no moral sense to let thirty-six million people die,"
says James Love, director of the Consumer Project on Technology,
an organization started by Ralph Nader.
Love points to one positive development: the agreement whereby
Cipla Ltd., a Bombay drug manufacturer, will make generic AIDS
drugs that it will market for $350 per year per patient to the
organization Doctors Without Borders, which will then distribute
the medications for free. At Western prices, the brand-name versions
of the drugs would sell for $10,000 to $15,000 per person per
Love's group, along with the Paris and Philadelphia chapters
of the AIDS Coalition to Unleash Power and Doctors Without Borders,
worked for six months to bring about the Cipla deal. They regard
it as "the big breakthrough," says Love, who personally
negotiated the price. "A dollar a day for a three-drug cocktail.
That's a life-or-death issue in South Africa right now."
"We've been pursuing cheaper sources for medicines now
since 1996, with the Vancouver AIDS conference, when it became
clear that the triple combination therapy was helping people with
AIDS live longer, more productive lives," says Eric Sawyer,
a founding member of the New York chapter of the AIDS Coalition
to Unleash Power. "We knew at that time that the costs being
charged for those medications were beyond the reach of poorer
people worldwide. We immediately sought a way to bring those prices
The Cipla deal works, says Love, because international trade
law allows companies to produce generic drugs against the will
of the parent company if they pay a small fee of around 5 percent,
a process called compulsory licensing.
Love and Sawyer both say that compulsory licensing is one
of several methods developing countries can use to obtain AIDS
drugs legally without paying exorbitant prices. They have launched
a campaign to draw attention to the availability of these legal
remedies. "We're continuing to try to push the envelope every
way we can," says Sawyer. "We'd like to see this type
of process go worldwide."
Without these creative ways of bringing down drug prices,
says Love, "We sit around and we beg and beg and beg the
giant companies, 'Please, please, please lower your prices.' "
But, as one current WTO case reveals, the loopholes may allow
such freedoms only temporarily. By declaring a national emergency,
Brazil has been able to manufacture generic versions of eight
of the twelve anti-retroviral AIDS drugs, which it then supplies
free. And the program works. Contrary to the warnings of the drug
companies that poor countries would not be able to administer
the drugs properly, Brazil reports that the great majority of
its patients stick to their drug regimens.
"One major reason that only Brazil offers free triple
therapy is that, until now, there was no Brazil to show that it
is possible," reported The New York Times Magazine. "A
year and a half ago, practically nobody was talking about using
triple therapy in poor countries. Today, it is rare to find a
meeting of international leaders where this idea is not discussed."
But on February 2, The Wall Street Journal reported that the
World Trade Organization had "set up a dispute panel to examine
a U.S. complaint that Brazilian patent law discriminates against
imports." The dispute could bring Brazil's drug program,
widely praised as a success, to an end.
"We've already seen companies like Bristol-Myers Squibb
challenging generic production," says Sawyer, adding that
sometimes companies threaten to sue even in countries where they
don't hold patent rights. The activists, he says, are fighting
back with demonstrations "to call attention to the outright
inhumane and genocidal practice of putting patent protections
ahead of human lives."
" I just don't see why we as a people tolerate a system
where drug company profits are placed ahead of suffering people
in developing countries," says Peter Lurie, deputy director
of Public Citizen's Health Research Group. "But we are tolerating
In the context of millions of deaths, the companies' rationale
sounds unpardonably cynical. They claim that they should not have
to pick up the tab for Africa and other poor countries, that reducing
prices for poor countries will lower prices in wealthier ones,
and that developing countries lack adequate medical facilities
and will be inclined to misuse the medications-leading to drug
"There's sort of a naysaying in the pharmaceutical industry
and among certain researchers, a resignation about people in Africa,"
says Lurie. "They are willing to write off the developing
world with facile comments." Lurie says that it is important
to establish effective programs, "not use the lack of them
as an excuse to deny people life-prolonging drugs."
"We can do this," says Lurie. "How incredible
it is that a society that can put a man on the moon throws up
its hands at a problem for which we have multiple possible solutions.
It suddenly becomes impossible when it's in Africa."
The U.S. government has nothing to be proud of. The Clinton
Administration threatened to bring trade sanctions against South
Africa for manufacturing generic versions of AIDS medications.
Only after activists raised a stink and picketed Al Gore's appearances
on the campaign trail did the Administration change course. "We
embarrassed the Clinton Administration" into issuing an Executive
Order that it would not use trade sanctions to prevent developing
countries from obtaining affordable medications, Sawyer says.
But the Clinton Administration has bulldogged other countries
on patent rights. And it has done some of its own deceptive advertising.
Last year, it announced $1 billion in funding for access to AIDS
medicines. But that money "turned out be Export-Import Bank
loans, at commercial interest rates, to buy American drugs at
market prices. There were no takers," Gellman noted.
The World Bank, for its part, "still regards anti-retroviral
drugs as 'cost-ineffective' in the Third World, and discourages
borrowers from buying them," wrote Gellman in the Post.
Now with George W. Bush, things may get worse. "There
is a danger that a more conservative, more corporate-friendly
administration like the Bush Administration-which did receive
both hard and soft money contributions, including contributions
to some of the inaugural festivities, from pharmaceutical companies-may
rescind that Executive Order or may again engage in the genocidal
practice of using the power of U.S. trade sanctions to protect
patents," says Sawyer.
The White House did not return repeated calls requesting its
policy on distribution of AIDS drugs worldwide. But the Republican
Party has some expensive favors to return. In 2000, the pharmaceutical
industry gave $24 million in contributions to both parties, according
to the Center for Responsive Politics. Most of that-nearly $17
million-went to the Republicans.
The Bush Administration's clumsy act of announcing that it
was closing both the office on AIDS policy and the office on race
relations on February 7, then hastily rescinding that decision
the same day, does not bode well-particularly since the Administration
made those announcements the day after newspapers revealed that
the AIDS rate was surging among black and Latino gay men in the
According to Sawyer, the activists' hope lies in Colin Powell,
who sees AIDS as a global security threat and wants at least to
continue the Clinton Administration policy.
But something more dramatic is needed. "The amounts of
money necessary to make an enormous difference for AIDS in Africa
are tiny fractions of what a B-2 bomber would cost," Lurie
says. "If you put it in that context, what we've been doing
for AIDS in Africa has been pitiful for years. A couple of billion
dollars would make an enormous difference in AIDS prevention there.
The last thing we need are loans with the same contingencies that
drove Africa into an enormous debt crisis in the first place."
Combating AIDS also requires liberating women from the bonds
of inferior status and power. Until women can control their bodies
and until sex becomes something they choose freely, the AIDS rate
will continue to explode. In many countries, women do not feel
they can refuse their husbands or boyfriends or ask them to wear
condoms. And many turn to prostitution out of economic desperation.
AIDS is, for this reason, directly connected to economic and social
freedom for women. It is also connected to debt relief, since
many countries pay more toward debt service than toward public
What is our moral obligation? It is to assist our neighbors
and our fellow human beings.
To attack the AIDS plague will mean debt forgiveness, massive
public funding for public health education, condom distribution,
needle exchanges, and widespread, cheap distribution of drugs
to those who are infected with HIV.
It is unthinkably cruel to consign those who already have
the virus to an early death. The drug companies should not have
the power to determine that people with AIDS in wealthy countries
will be able to live longer, more productive lives, while poorer
people in Africa, Asia, and South America have their lives drastically
A real, working solution to the global AIDS crisis will require
U.S. and European governments to put lives ahead of patent law.
It will require companies to choose human interests over financial
"In this day and age, we really have to redefine what
we mean by public health care, and we have to make sure that everyone
on the planet has access to it," says Sawyer.