A New Chapter in the AIDS Controversy

A meeting last week in Johannesburg between African health ministers and executives of major pharmaceutical companies along with frank words last month by U.S. Secretary of State Colin Powell during a recent African tour both signal an opportunity to open a constructive a new chapter in the global battle against AIDS.

The meeting in Johannesburg, brokered by the United Nations, brought health ministers and drug companies together to work on stemming the alarming rise in the number of people infected with HIV, especially in sub-Saharan Africa. This was an important step in ending the destructive blame game that has put pharmaceutical companies in the cross-hairs of public opinion and perpetuated the delusion the drugs alone would be enough end the crisis.

Both the companies and the countries know that the solution is much more complicated than loading boxes of medicines onto an airplane. While modern medicines can perform near miracles, even the newest and best drugs alone aren’t enough for a crisis as serious and widespread as the tragedy of AIDS in Africa.

The problem is much deeper, rooted in poverty and culture. Taking and monitoring the combined AIDS therapies can be a full-time occupation that requires close medical supervision and regular testing. Poor African nations lack the public-health infrastructure to even distribute, much less monitor, drug treatments for even a fraction of the tens of millions of people believed to be infected. Further, many African leaders have perpetuated a code of silence about the disease, denying it exists and therefore refusing the initiate even the most rudimentary public education efforts about how the virus is spread.

Secretary Powell, the first African-American U.S. Secretary of State, delivered a powerful message during his recent trip to Africa, telling leaders they must “stand up and speak out about the practices that cause AIDS to be transmitted?to teach young people the danger that is inherent in practicing sex indiscriminately?that prevention is key.”

This frank talk about the importance of prevention is a huge leap forward and infinitely more helpful than blaming pharmaceutical companies. Ever since the first AIDS treatments became available in the late 1980s, the companies that developed the drugs have been under attack for their high cost. The industry had become the target of activist groups claiming the drug companies could solve the problem if only they gave their drugs free to the millions of victims.

The battles reached a crisis point this spring when drug companies confronted the South African government in the courts over a law passed in 1997 allowing the country to ignore intellectual property rights to make and buy cheap copies of patented AIDS drugs.

Outside the courtroom, companies had offered to provide deep discounts on AIDS drugs, selling them at pennies above manufacturing costs in return for maintaining critical patent protection. Other companies offered to give away their drugs.

But that wasn’t enough. Faced with the global outcry of public opinion and isolated even from government support for intellectual property protection, the companies were forced to back down and settle the case.

But as soon as the ink was dry on the court papers, the truth of the AIDS crisis was revealed. The South African government almost immediately said it had no intention of massively importing drugs at rock-bottom prices.

The problem: The cost of the drugs is only the tip of the iceberg in the AIDS pandemic. Drugs alone aren’t enough. The finger pointing at the pharmaceutical industry had actually hampered the ability of African governments to do what they can do and must do to begin the reverse the spread of the HIV virus.

President George W. Bush has created a task force at the highest level of the U.S. government and has established a trust fund to begin to collect money that can be distributed to relief agencies that can begin to help.

But unless the pharmaceutical industry becomes actively engaged in this new effort, they may well find themselves again the subject of global derision.

This is global politics with life and death consequences. The companies have a short intermission from the beating they have been taking, and it is imperative that they take advantage of the opportunity to reshape and reframe the debate.

Job one is to become an active participant in change by attending and initiating meetings with political leaders and even activist groups to develop and implement education and treatment programs.

Job two is to do a much better job than they have of making sure that the public understands the connection between effort and reward. Companies made a huge investment in research to come up with the treatments in the first place and continued research could lead to a vaccine if the research continues.

But it won’t continue if the companies believe that the results of their collective billions of dollars in research will be confiscated by governments that wantonly disregard their intellectual property rights. One of the most important advantages that the United States provides to research industries is strong patent protection.

Public education efforts are an important part of progress, both in Africa and around the world.

While European nations deride the U.S. health care system, they should look at their own cultures of cost containment that keep prices and utilization artificially low and force other countries to pay more than their share for research and development. Yes, the United States can afford to pay more, but so can many other countries and they should share the burden.

U.S. consumers already are subsidizing the development of new drugs that help alleviate the suffering of patients in the lesser-developed countries; if they didn’t pay the prices that permit the research to continue, the world would have fewer new miracle drugs.

Infectious disease around the globe is among the gravest threats to both U.S. national security interests at home and to its economic, political and humanitarian interests abroad, according to a recent report from the Council on Foreign Relations. This is true for all developed nations.

This new conversation has begun. For the next century’s medical miracles to be discovered, the private research industry must muster the backbone to explain why profits translate into products and that, as valuable as new drugs are, they alone can’t solve crises as complex and multi-faceted as AIDS in Africa.

Grace-Marie Turner is president of the Galen Institute, a not-for-profit health policy organization in Alexandria, VA, in the U.S., which provides public education on free-market health reform ideas.

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