[Ip-health] [Fwd: Economist-In Mandela's Shadow]

[Mike Palmedo]

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Mike Palmedo
Consumer Project on Technology
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mpalmedo@cptech.org
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Date: Fri, 13 Dec 2002 11:37:57 -0500 (EST)
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From: "Rachel COHEN" <Rachel.COHEN@newyork.msf.org>
To: Multiple recipients of list <healthgap@CritPath.Org>
Subject: Economist-In Mandela's Shadow


In Mandela's shadow

Economist 12th 2002

Thabo Mbeki has great ambitions for the future of his country. But his
fiercest critic is not to be shaken off



LAST January, when the African National Congress (ANC) celebrated its 90th
anniversary, Thabo Mbeki, South Africa's president, made a long speech. To
general astonishment, he made no mention of the ANC's most famous figure,
Nelson Mandela. The feeling is mutual. When Mr Mbeki entered parliament at
the state opening in February, all stood to respectful attention except Mr
Mandela, who sat stock-still in his chair despite gentle tugs from his
wife.

At 84, Mr Mandela has lost none of his charisma. On his visits to dusty
townships, people stand for hours waiting for him and scream with joy when
he appears. In parliament, MPs leap to their feet, sway, dance and sing in
adoration. At dinners and private discussions, even close friends flutter
with affection and respect. As he takes an armchair at a lunch in
Johannesburg a roomful of businessmen, lawyers and family friends sink to
their knees and form an attentive circle at his feet. He calls Queen
Elizabeth by her first name ("well, she calls me Nelson"), and goes
hand-in-hand with Bill Clinton, beaming for the cameras.

Mr Mbeki, by contrast, can be painfully shy. He admits he is an awkward
showman, fondest of his own company. He has solitary interests: reading,
the Internet, computer chess, landscape photography, poetry. On
presidential tours, known as imbizos, he is stiff and formal. With
journalists he is often impatient, bristling at ignorant questions. Mr
Mandela is widely known by an affectionate nickname, Madiba. Mr Mbeki has
none.

It is an open secret that another man, Cyril Ramaphosa, was Mr Mandela's
first choice as his successor. But Mr Ramaphosa was out-manoeuvred in the
early 1990s, and by 1999 Mr Mbeki was president. Were it not for Mr
Mandela, he would be riding high and virtually unopposed. At the ANC's
five-yearly conference, held next week in the vineyard town of
Stellenbosch, Mr Mbeki will be picked again as party leader; his close
allies are almost certain to romp to all the high party positions; and
victory is more or less assured at the general election in 2004.

His party dominates politics, holding two-thirds of the seats in parliament
against a divided and feeble opposition. And his country is becoming more
and more of a presence in the continent. Mr Mbeki presides over the African
Union, Africa's putative answer to the EU, and is also the brains behind
the New Partnership for Africa's Development (Nepad), an ambitious plan to
attract more capital investment. Last year (at Mr Mandela's request) he
sent his deputy-president, Jacob Zuma, and a battalion of soldiers to help
keep the peace in Burundi, and he has offered 1,500 more soldiers as UN
peacekeepers for eastern Congo. Under Mr Mandela, South Africa shed its
isolation in Africa; under Mr Mbeki, it is actively engaged.



Causes for complaint
Yet all is not well within Mr Mbeki's administration, not least because Mr
Mandela has let it be widely known that he is unhappy with it. The old man,
tata, as Mr Mbeki sometimes calls him dismissively, has started to meddle.

Some of his recent unhappiness stems from local politics. In the ANC's
heartland of the Eastern Cape, where Mr Mbeki and Mr Mandela were both
born, the ANC provincial government is in such disarray that Mr Mbeki has
had to send people from national government to sort it out. This has caused
enormous discontent within the party. In KwaZulu-Natal, a truce between the
ANC and the Zulu nationalist Inkatha Freedom Party, brokered under Mr
Mandela but largely negotiated by Mr Mbeki, is collapsing as the two
parties fight for local control.

Yet most of the animosity comes from Mr Mbeki's handling of South Africa's
AIDS crisis, which Mr Mandela believes has been badly bungled. The disease
has already killed hundreds of thousands of South Africans and is set to
claim the lives of at least 4.5m more, over 11% of the population. Already,
300,000 households are headed by orphaned children. Unsurprisingly, a
recent survey showed that 96% of South Africans consider the disease to be
a "very big" problem for the country.

AIDS is already striking hard at the professions, notably teachers and
nurses. Some analysts worry that the disease has weakened the capacity of
the army (with an infection rate of well over 23%) and the police. Life
expectancy is slumping as child mortality rises. Ill-health is also
entrenching poverty: for a middle-income country, surprisingly large
numbers of people report being short of food.

A year ago, Mr Mandela warned that leaders and their wives must do more to
fight AIDS. That was an explicit reference to Mr Mbeki's inactivity, though
also an admission of his own negligence as president between 1994 and 1999.
All year Mr Mandela has raised the profile of AIDS, drawing a stark
contrast with Mr Mbeki's wriggles and denials.

The national government and some provinces have done a lot to boost primary
health care, train nurses, fund education-and-prevention campaigns and give
out more free condoms. The government also helps to fund research into a
vaccine and has opened 18 pilot sites to test the effectiveness of
anti-retroviral drugs, which are commonly used in rich countries to keep
those infected with HIV healthy. But the president himself has often
frustrated these efforts.

Mr Mbeki questions figures that show the epidemic has taken hold in South
Africa. He argues that anti-AIDS drugs may be more dangerous than AIDS
itself. He refuses to single out AIDS as a special threat, preferring to
talk of general "diseases of poverty", and will rarely speak about it
publicly. Peter Piot, the head of UNAIDS, was once brought secretly to meet
Mr Mbeki in Cape Town, in an effort to persuade him that the human
immuno-deficiency virus was the cause of AIDS. The two men sat late into
the night drinking whisky and fruitlessly arguing the point.

Mr Mbeki also refuses to encourage people to know their HIV status and to
lessen stigma around the disease. He will not take a public AIDS test, and
has only once been pictured holding an infected child. Taking their lead
from the president, no members of his government and very few MPs, civil
servants, or public figures of any sort admit the obvious when their
colleagues die of the disease.

Mr Mbeki himself seems personally affronted by the attention given to AIDS.
He resents any prejudice against Africans as diseased, in part because
apartheid scientists tried to create and spread viruses that would kill
only black Africans. In the early 1990s the then ruling National Party even
alleged that ANC leaders returning from exile in other parts of Africa
(such as Mr Mbeki himself) were bringing AIDS into the country.

Appalled by Mr Mbeki's obtuseness on the subject, Mr Mandela has been
trying to force him to do more about it. He openly backs the Treatment
Action Campaign (TAC), one of the most aggressive and effective opposition
movements in the country. Earlier this year the TAC sued the government in
the Constitutional Court and forced it to set up a national programme to
give anti-AIDS drugs to infected pregnant women. The group's leader, Zackie
Achmat, who himself has AIDS, refuses to use anti-retroviral drugs until
the government makes them widely available. Madiba has visited and hugged
Mr Achmat, and promised to lobby the president on his behalf. Last week the
two men again appeared together, to launch a privately-funded plan to get
anti-AIDS drugs to thousands more of the poor.

In September at Orange Farm, a township just south of Johannesburg, Mr
Mandela launched a particularly sharp attack. He demanded general provision
of anti-retroviral drugs by the government, pushing aside worries about
cost, toxicity and capitalist imperialism. Then he ordered two of his
grandchildren to join him on stage, wagged his fingers at them, and told
the crowd:

I have 29 grandchildren and six great-grandchildren. They are very naughty.
They tell me I have lost power and influence, that I am a has-been. They
tell me to sit down. That I must stop pretending I am still the president.
Now, you have heard all these important people here today, you have heard
what they say about me. So, now you must stop telling me to sit down!

That message was aimed at Mr Mbeki.

Earlier this month, Mr Mandela launched an independent report on AIDS that
concluded: "We must manage this disease or it will manage us." After
perfunctory praise for government research, he said again that too little
is being done, officially, to fight AIDS and the stigma that surrounds it.
"I have often said to the government there is a perception that we don't
care that thousands are dying of this disease. If you look at the pages of
the Sowetan, at the death notices, it is clear that our young people are
dying."

While many private companies?among them AngloAmerican, Coca-Cola and De
Beers?have decided that it is cost-effective to provide free anti-AIDS
drugs to infected workers, the government is reluctant to make similar
promises to other South Africans. Mr Mandela wants such drugs to be
universally available, and ordinary South Africans agree. A recent survey
of nearly 10,000 people revealed that over 95% want the government to
provide anti-AIDS drugs now.



Not Madiba alone
Mr Mbeki often refuses phone calls from his predecessor. When he does, Mr
Mandela is told that he misunderstands the complexity of AIDS. The old man
has been asked by senior ANC leaders to stop undermining the government,
and to tell the press that the only problem with official AIDS policy is
one of communication.

Will his interventions in fact have any effect? Possibly, since he is not a
lone voice. Many heads of state and former presidents have privately tried
to persuade Mr Mbeki to do more on AIDS, if only for the sake of his own
reputation. Mr Clinton, who was beside Mr Mandela at Orange Farm, confided
his view of the president's position on AIDS: "In his own mind, he thinks
he has moved a long way." The challenge now is to persuade him to do as
much as leaders in poorer African countries.

In Nigeria, said Mr Clinton, politicians talk openly about the disease. "It
has kept its [infection] rate low because there was no organised,
systematic and official denial of the problem there. In South Africa I see
systemic obstacles still, to doing what has worked elsewhere. Leaving
people to their own devices is just not good enough." In particular, Mr
Clinton criticises the failure to make mass use of anti-retrovirals, drugs
that are already widely used in Brazil and India.

In September, Mr Piot protested that the World Summit on Sustainable
Development, held that month in Johannesburg, paid almost no attention to
AIDS. Delegates conceded that the disease was given a low priority to avoid
embarrassing the host. Mr Piot and Carol Bellamy, the head of UNICEF, have
both complained that Mr Mbeki's Nepad plan for African recovery makes no
substantial mention of the fight against AIDS.

Mr Mbeki now seems to be slightly shifting his position, if only to
persuade Madiba, Bishop Desmond Tutu and others to stop "back-seat
driving". In April the government agreed to set out a plan for provincial
governments to give nevirapine, an anti-retroviral drug, to infected
pregnant women and rape victims. Mr Mbeki's chief spokesman, Joel
Netshitenzhe, even suggested that factories might be built to produce
generic anti-AIDS drugs. And the government has been talking to firms and
health activists about a national treatment plan for the disease.

In the past few months Mr Mbeki has kept silent on the subject, while
trying to cultivate a more friendly persona (he has taken up golf so that
he can bond with George Bush, who is expected to pay a visit next month).
But South Africa's president will not be pushed into a position he opposes,
especially not by westerners, the media, the UN or activists.

Ultimately, then, the most effective pressure will come from within his own
party. Next week's ANC meeting in Stellenbosch is a chance for members to
push Mr Mbeki to act decisively. And one member, the only world-famous one,
will go on pushing hardest of all, no matter how often his calls are not
returned.


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