Is it right to put a price tag on survival? South Africa’s government thinks not. It wants to bypass Western pharmaceutical firms and produce AIDS drugs on its own, or to import them at the cheapest possible cost–perhaps from so-called patent-pirate countries. That, in turn, has whipped up emotions in Washington, where trade officials and corporate lobbyists are determined to protect intellectual-property rights. AIDS activists have taken up the South African cause: protesters from ACT UP, the confrontational AIDS lobby group, are now dogging the campaign of Al Gore, casting him as the leading villain in the dispute.
This is not a narrow bilateral issue, nor is it a simple one. Ninety percent of the world’s 33 million HIV/AIDS cases are in Africa, Latin America and Asia. The vast majority of infected people in those areas can’t afford the cocktails of miracle drugs that can make AIDS a chronic disease rather than a death sentence. Those cocktails usually include protease inhibitors such as Crixivan, produced by Merck, and other antiretrovirals, such as AZT, produced by Glaxo Wellcome. In the United States, the combination can cost $750 a month, a fortune in a country like South Africa, where 8 percent of the country’s 38 million people are infected with AIDS–and the annual per capita income is $6,000.
In late 1997 South Africa decided to take action. It passed legislation that would empower the government to secure cheap, effective drugs. Theoretically, the law would allow small local companies to produce their own versions of drugs patented by the pharmaceutical giants–perhaps at much lower costs. The government would also be allowed to import AIDS drugs from other countries, such as India and Argentina, that don’t enforce intellectual-property rights.
The law was condemned by the South African drug industry, which is largely made up of subsidiaries of Western drug multinationals. The companies quickly took the government to court, arguing that the South African legislation threatens their patents–and with them, the revenues needed to fund the costly development of such drugs in the first place. Besides, the companies contend, complex AIDS treatments are unlikely to be administered effectively in South Africa. “It’s much more complicated than getting pills to people,” says Tom Bombelles of the Pharmaceutical Research and Manufacturers of America, an industry trade group. The AIDS drug regimens need to be closely monitored, he says. Yet in South Africa, “the whole health system is in a shambles.”
U.S. officials initially hoped that quiet diplomacy might resolve the dispute. Gore, who heads the U.S.-South Africa Binational Commission, told Pretoria last August that the law was too vague and had to comply with international trade regulations. (South Africa insists that it does, and points out that Western countries take the same measures when it suits them.) Apparently that wasn’t tough enough for Rodney Frelinghuysen, a Republican congressman from New Jersey whose district includes several drug companies. He attached a provision to last year’s budget that blocked U.S. aid to South Africa until the State Department explained how it was helping his corporate friends. State’s final report said Washington was “engaged in an assiduous, concerted campaign” to change the law and specifically cited Gore’s diplomatic pressure on Pretoria. When AIDS activists got hold of the report, they launched a counteroffensive–against Gore.
Last week noisy protesters from ACT UP staged their fourth demonstration in a month–at a $1,000-a-plate fund-raiser outside a swanky Philadelphia hotel. (Gore’s people say only a handful of protesters have shown up at most campaign events.) Conservative commentator Arianna Huffington took up the attack, dubbing the VP “Pharmacologic Al,” and Ralph Nader’s lobbyists have also put pressure on. Gore, who insists that he supports inexpensive AIDS drugs for South Africa,has some credible allies. The AIDS Action Council, the largest AIDS lobby group in the United States, believes the protests against the veep are misdirected. “This is like blaming Roosevelt for the Holocaust,” says Council director Daniel Zingale.
The blame game could go on for quite a while. The drug industry’s challenge to the new law is tied up in South Africa’s Constitutional Court, and no one expects a resolution until next year. Nevertheless, activists in South Africa and the United States are planning more protests. And drug companies are threatening to take their investments out of South Africa.
Meanwhile, the doctors at Rietvlei do what they can. “If Africa had access to these medicines, then it would be Africa’s responsibility to find a way to make them work,” says Rietvlei Superintendent Hoffman. Until then, he will continue to keep his HIV-infected patients in the dark about the existence of drugs that could save their lives. It seems a small kindness, but right now it’s about all he has to offer.
