Gwynne Dyer's Washington Times op-ed

[Shivan <shivan.mehta@yale.edu>]

redistributed as a fair use.  Shivan

Sunday, July 11, 1999, Washington Times

AIDS' sliding cost scale
Commentary- by Gwynne Dyer

     We don't know what Vice President Al Gore said about AIDS to
South African President Thabo Mbeki, and if his spin-doctors have
their way we never will. After all, he could lose the presidency
over it. But we do know what Gugu Dlamini said about AIDS,
because she said it on the radio. And she lost her life over it.
     Ms. Dlamini, one of at least 3 million South Africans who
are HIV-positive or living with AIDS, simply said that she was
one of the 3 million. She did so on a local radio station in
KwaMancinza, near Durban, because she was a health worker who
felt she should help to reduce South Africa's appalling rate of
1,500 new AIDS infections a day by raising awareness of how
widespread the disease is.
     But rural KwaZulu/Natal is an unforgiving place, especially
for young women who transgress the customary rules of obedience
and silence. A mob of outraged neighbors, claiming that Gugu
Dlamini had "degraded the neighborhood," gathered outside her
house in December and did not leave until she had been kicked,
stoned and beaten to death.
     Between 10 percent and 20 percent of her killers would have
been HIV-positive themselves, so their furious denial of the
reality they live in is understandable, although their actions
were unpardonable. But what is one to say about Mr. Gore, who
inhabits a rather different reality?
     The furor about Mr. Gore, which may yet blight his bid to
succeed President Clinton as president, began when the homosexual
rights group ACT-UP started dogging his rallies. They were
protesting against Mr. Gore's complicity with the U.S.
pharmaceutical industry's campaign to crush South Africa's
attempt to break out of the global-pricing system - a system
guaranteeing that most South African AIDS victims will die
quickly and without access to the drugs that could save them.
     The global-pricing policies for the drugs that now allow
most North Americans and Europeans who have AIDS to lead
reasonably normal lives for years and even decades, while
millions of people elsewhere die miserably within a few years of
developing full-blown AIDS, are not something that the drug
companies' public relations people like to discuss in public. But
given the number of lives at stake, they will have to get used to
the rest of us talking about it. 
     What the companies producing anti-AIDS drugs have done,
basically, is to divide the world into zones in which prices are
calibrated to what the average middle-class customer can pay. An
American AIDS patient, therefore, pays several times more than a
Polish patient for the same annual ration of drugs - and the Pole
pays several times more than an Indian patient, and even the
Indian pays several times more than a Tanzanian.
     In order for this profit-maximization strategy to work, the
drug companies must ensure that the drugs do not pass from one
zone to another. What South Africa did, with its 1997 Medicines
Act, was to attack this entire system by authorizing the
government to import medicines (by which it really meant anti-
AIDS medicines) from other countries.
     South Africa can make these medicines itself, but only under
a license that compels it to charge close to First World prices.
The intention was to save the lives of several million citizens
by importing the same medicines from India, which falls into a
lower-price bracket than South Africa.
     You could make the same argument on behalf of impoverished
people with AIDS in Portugal, the Philippines or Mozambique, but
the South African case has special poignancy because of the
hugely skewed income structure in that country.
     Relatively few South African whites (probably under 5
percent) are HIV-positive, but it is their high average income
that boosts the nation into the ranks of the rich countries that
pay premium prices for AIDS drugs. Whereas the overwhelming
majority of the people who actually have AIDS in South Africa are
nonwhite, and definitely non-rich.
     South Africa's government is attempting a legal end run
around an iniquitous system that puts profits far ahead of
people. Most South Africans have an annual income that fits the
Indian profile, so why shouldn't it import its anti-AIDS drugs
from there?
     Why not, indeed? But about 40 pharmaceutical companies are
challenging the new law in the South African courts, desperate to
avoid a breach in the flimsy dike they have erected to defend
their interests.
     Enter Al Gore, who receives notably fewer campaign
contributions from South African AIDS victims than he does from
American drug companies.
     The companies want to preserve their global price structure,
regardless of local casualties among the poor in various
countries. South Africa is determined to save its people, even if
the drug companies' shareholders get a slightly lower dividend
next year. And Mr. Gore doesn't want to offend anyone - but he
does know which side his bread is buttered on.
     "I support South Africa's effort to provide AIDS drugs at
reduced prices through compulsory licensing and parallel
importing, so long as they are carried out in a way that is
consistent with international agreement," Mr. Gore wrote last
week to Rep. James E. Clyburn, South Carolina Democrat and
chairman of the Congressional Black Caucus. Which means, in
plainer language, that he does not support South Africa's efforts
because they would cut into U.S. drug company profits.
     With any luck, he will lose this fight. And, to be fair, he
won't mind a bit. His heart is in the right place, but he dares
not put his mouth there.

-Gwynne Dyer is a columnist based in London