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Al-Ahram Weekly 6 - 12 July 2000 Issue No. 489 
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Published in Cairo by AL-AHRAM established in 1875 |
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Al-Ahram Weekly 6 - 12 July 2000 Issue No. 489
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| Published in Cairo by AL-AHRAM established in 1875 |
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Egypt Region Focus International Economy Opinion Culture Features Travel Living Sports Profile People Time Out Chronicles Cartoons Letters Identifying the killer
By Gamal Nkrumah
"Is a free market free if it is dominated by the rich?" thundered a visibly enraged Malaysian Prime Minister Mahathir Mohamed. The question sounded more like the utterances of a veteran Marxist than a wisecrack from one of the most vociferous proponents of Asian capitalism.
The business of doctoring Acquired Immune Deficiency Syndrome (AIDS) patients is a very large and lucrative one, but millions of people in the developing world are denied access to miracle drugs because the high costs of patented drugs and the protectionist policies of the North.
The scale of the AIDS pandemic in Africa is blood-curdling and necessitates radical decisions that override the interests of large Western pharmaceutical companies. An estimated 11 million Africans have perished so far -- some two million last year alone -- and the exorbitant cost of treatment has placed it squarely beyond the reach of most Africans diagnosed with the virus. Of the 13 million children orphaned by AIDS, 95 per cent are in Africa. By 2005, life expectancy is expected to plummet to an all-time low of 45 years.
According to a recently released United Nations Development Programme report, some 1.2 billion people subsist on less than a dollar a day. Over half of them live in Africa. Meanwhile, the world's 200 richest people have a combined wealth of over $1 trillion. The organisation Doctors Without Borders -- better known by its French acronym MSF (Medecins Sans Frontiers) -- recently published a scathing criticism in the British medical journal The Lancet attacking Western nations for forcing poor countries to buy expensive patented AIDS drugs. Contrary to received thinking, drugs are far more expensive in poor Africa than they are in the rich West.
South Africa, among the world's most AIDS-ravaged countries, will play host next week to the 13th International AIDS Conference from 9 to 14 July. South African President Thabo Mbeki has been perhaps the most vociferous African leader in denouncing Western protectionist policies. Mbeki recently declared that Africans cannot apply Western solutions to combat AIDS. "As Africans we have to deal with this uniquely African catastrophe," he claimed, warning that the "superimposition of Western experience on African reality" is not only unacceptable, but counter-productive.
The AIDS conference will take place in Durban, the capital of KwaZulu-Natal, South Africa's second largest and fastest growing city, in the region hardest hit by the AIDS pandemic. The statistics from this nation alone are deeply disturbing: 4 million South Africans are HIV positive; 22 per cent of all pregnant women in the country are HIV positive; 20 per cent of skilled workers in South Africa will have AIDS by 2015. In KwaZulu-Natal, South Africa's most populous province, one out of every three residents is HIV positive and half of those infected are in their 20s.
One of the issues that is bound to raise some heated debate is that of AIDS research and the connection between the human immunodeficiency virus (HIV) and full-blown AIDS. Barely a week before the Durban conference, some 5,000 scientists from 50 countries signed a document published in the scientific journal Nature stressing that HIV is the indisputable cause of AIDS. But a few scientists, most notably American biologist Peter Duesburg, dispute the HIV-AIDS link and attribute AIDS to malnutrition and drug abuse.
It is an issue close to Mbeki's heart. Last year the United States and South Africa were embroiled in a trade dispute over patented drugs. Mbeki did not make himself any more popular this year when during a tour of the US he courted scientists, including Duesburg, who believe that AIDS is not necessarily linked to HIV. What no one can dispute is that the rapid spread of AIDS is inextricably intertwined with abject and pervasive poverty and poor health services.
The AIDS pandemic took South Africa by surprise. Barely a decade ago, as the country battled the last vestiges of apartheid, AIDS was hardly South Africa's most pressing problem. But ill-health goes hand in hand with poverty and joblessness, explains Frank Mdlalose, South Africa's ambassador to Egypt. Formerly minister of health in KwaZulu-Natal, and later chief minister of the province, Mdlalose ran a private medical practice in KwaZulu-Natal for nearly two decades years before entering politics.
During his term in office, Mdlalose often raised the question of AIDS at political meetings, public rallies, and among the nurses, doctors and staff employees of KwaZulu-Natal's health department, but it is only now that AIDS has come to top the province's -- and South Africa's -- political agenda.
Mdlalose pointed out that the endemic presence of malaria and tuberculosis has likely facilitated the rapid spread of AIDS. Both malaria and tuberculosis weaken the body's natural immune system and are especially prevalent in rural KwaZulu-Natal. Poverty, malnutrition and joblessness are all factors that could explain the higher incidence of AIDS in KwaZulu-Natal, he said.
"During my private practice, I never heard of, let alone come across, a single case of AIDS," Mdlalose told Al-Ahram Weekly. "It was only after I held the health portfolio, and especially around 1987-89, that I was first alerted to the presence of the disease in our midst. The incidence of HIV/AIDS was, however, insignificantly low in those days," he recalls.
But within a short span of time, the situation worsened considerably. Poverty and poor health services led many victims to resort to quack-healers who claimed quick cures. "Many people claim that they can cure AIDS. These unsubstantiated claims are difficult to prove or disprove," Mdlalose says. But here he treads carefully. "Traditional herbalists might be effective in curing some other endemic diseases, but their battle with AIDS has been proven ineffective. The South African government appreciates the role traditional healers play in combatting certain diseases and officially recognises traditional healing systems. However, as far as fighting AIDS is concerned, traditional healing methods have failed to find a cure."
The UN joint programme on HIV/AIDS (UNAIDS) is another international programme raising funds for Africa's AIDS victims. "We are going into societies where there are more people in their 60s and 70s than there are in their 40s and 30s," explained Peter Piot, executive director of UNAIDS. "It is really important the money becomes available now. The longer we wait the higher the bill will be, not only because this is for prevention and basic care, but the care will become dramatically bigger," he said.
All such well-meaning declarations dance around the vital issue that Western pharmaceutical companies' unbridled quest for profit is killing Africans by the million. The sick and dying will not be cured by conference documents and final communiqués. Mere words won't stop the spread of AIDS. Cheaper and more easily available drugs will. Africa commands a prodigious reservoir of goodwill from international do-gooders, but the continent cannot seem to muster enough political clout to drive the point home about cheaper drugs.
AIDS is a leviathan that threatens to ruin already bankrupt African economies, but those who could stifle its virulence remain conspicuously out of the fray. The international media displays a morbid fascination with Africa's ills, but makes no attempt to highlight the role played by Western pharmaceutical companies in compounding the problem of AIDS in Africa.
One rare exception was a recent New York Times article highlighting the results of a study undertaken by African-based Norwegian researcher Kirsten Myhr, who has previously organised medical distribution centres in Botswana, another African country rife with AIDS. Myhr accuses the Western pharmaceutical industry of putting profit maximisation far above the widespread suffering of Africans. Her study revealed that malaria medicine in Botswana was 50 per cent more expensive than in her native Norway. Nevirapine, a drug used for the prevention of mother to child transmission of HIV/AIDS, costs $430 per 100 units in Norway and a $874 in Kenya.
As if this is not bad enough, now traditional healers and irresponsible physicians are getting in on the act and seem to be cashing in on people's pain and paranoia. One such doctor, Jeremiah Abalaka, was found to be injecting his patients in Nigeria with a vaccine he claims cures AIDS at $259 a shot before his arrest this week. "Dr Abalaka has not subjected his 'vaccines' to any objective immunological or other scientific evaluations," said Anya Anya, president of the Nigerian Academy of Sciences, the country's highest scientific body. "[The vaccines] have not been subjected to any controlled clinical trial."
HIV/AIDS victims had been flocking to Abalaka's clinic in desperation because of the exorbitant cost of medicine in Nigeria. Currently, some 100 medical practitioners and traditional healers claim to have found a cure for AIDS. Last Tuesday the Nigerian government announced that it has set up a new 15-member technical committee to investigate these claims. Similar investigations are also being launched in several other African countries. As long as drugs are out of the reach of the poor, the quacks will continue to make money out of people's misery.
Some African governments are desperately fighting the odds to cope with the AIDS crisis. Tough anti-AIDS campaigns in Africa, most notably in Uganda, have achieved commendable results. "There was social mobilisation, in which all sectors were expected to have HIV/AIDS components in their programmes," explained Ugandan doctor Samuel Ikwaras at the 11th International Conference on AIDS and STDs in Africa, held in Zambia last year. He praised political leaders and the informal sector for getting involved in Uganda's awareness campaign and stressed the importance of monitoring programmes.
At the Zambian AIDS conference, Zambian Finance Minister Katele Kalumba urged rich nations to write-off Africa's debts. The cancellation of the continent's debts would free resources for investment in activities that will control the spread of HIV/AIDS, but invariably Africa's pleas fall on deaf ears. Leaders have become wary, if not cynical. Zambia's Health Minister Nkandu Luo cautioned delegates against being naively optimistic about the World Bank's $3 billion pledge for the AIDS control programme in Africa.
Lombe Chibesokunda, chair of Zambia's Permanent Human Rights Commission (PHRC), identified poverty and underdevelopment as "perfect breeding grounds for HIV/AIDS". The international community, she said, "has recognised that the promotion and protection of human rights is necessary in fighting the HIV/AIDS scourge."
So if anything good can come of this tragedy of continental proportions, perhaps it will be a more sympathetic attitude toward the production of cheaper generic drugs. This calls into question the role of pharmaceutical companies and WTO regulations on "intellectual property" rights in aggravating the AIDS crisis in Africa. Doctors Without Borders and other poverty-conscious groups must be commended for spearheading the campaign to uncover the injustices of the new international economic order and give Western pharmaceutical companies a run for their money. As World Health Organisation regional officer Sam Muziki noted, why should a course of first-line TB treatment cost a Swiss worker one hour's worth of wages, and an African labourer 500 hours?
Clearly, the hand-wringing approach is not working. The culpability and flagrant profit-seeking of Western pharmaceutical companies must be universally condemned for its role in this painful crisis. It makes a mockery of grim African realities when US officials preach democracy and urge the democratisation of Africa while the policies adopted at international trade gatherings turn a blind eye to Africans' right to health and a fair treatment. It is these very same officials who make sure that world trade agreements refuse permission for poor countries to produce generic drugs, even though they can ill-afford the patented versions. They throw their hands up in horror at Africa's woes, but cannot condemn pharmaceutical companies for lining their pockets with ill-begotten profits.
