[Ip-health] New York Times: Clinton makes up for lost time in battling AIDS

[Thiru Balasubramaniam]

<SNIP>


When doctors specializing in public health met him at the William J.
Clinton Foundation in Harlem in the fall of 2002, Howard Hiatt, the
former dean of the Harvard School of Public Health, bluntly asked
Clinton why those present should expect that "you'll be able to
accomplish now what you didn't undertake in your presidency - an attack
on this plague?"

"Everyone was worried," said Richard Marlink, who headed Harvard's AIDS
Institute. "Is this a campaign with photo ops and press releases or a
long-term commitment?"


<SNIP>


His foundation also has negotiated steep cuts in the price of AIDS
medicines through deals with drug companies that cover more than 400,000
patients in dozens of countries, helping propel momentum for treatment
of the destitute.

Dr. Bernard P=E9coul, who led a campaign for access to medicines for
Doctors Without Borders from 1998 to 2003, credited Clinton and his
foundation for showing independence from the politically powerful drug
industry and helping to accelerate the decline in prices for generic
AIDS medicines in developing countries.

"They have been very clever in supporting generic policy in the United
States, a country where it's not easy," he said. "And sometimes they've
been even more courageous than the United Nations system, which is under
pressure from member states."

<SNIP>

Clinton has come a long way on global AIDS. For most of his presidency,
his trade office fought to protect the patent rights of pharmaceutical
companies against attempts by developing countries to make or import
cheaper generic medicines. "I think it was wrong," he now says of that
approach.


<SNIP>


 From the start, Clinton had a host of issues on his agenda, but quickly
found himself drawn into AIDS. He turned to his old friend Ira
Magaziner, a fellow Rhodes scholar and corporate consultant who had
managed the Clintons' failed health care reform effort. Magaziner has
since led the foundation's AIDS program.

The two men discovered in 2002 that the Bahamas was paying $3,500 per
person a year for generic AIDS drugs. "I said, 'Ira, please find out why
in the hell these people are paying $3,500 for $500 drugs,' " Clinton said.

They learned the Bahamas was buying through middlemen, so the foundation
helped the country purchase directly from Cipla, the Indian generic-drug
manufacturer. "So our first victory was a lay-down," Clinton said. "All
of a sudden, they could treat six times as many people for the same
amount of money."

Opportunities proliferated, and Clinton's enthusiasm grew.

His name opened doors with generic drug makers. With growing demand for
AIDS drugs already on the horizon, as well as the economies of scale
that come with that, Magaziner took a team of volunteer consultants to
India in 2003 to negotiate for lower prices. Companies opened their books.

"The name Clinton in India holds more charisma and credibility than any
other American name," said Dr. Yusuf Hamied, Cipla's chairman.

Through cost cutting, spurred by breakthrough talks with companies that
supplied ingredients to the drug makers, the team got deals. Cipla, for
example, halved the price of the most common AIDS triple-drug therapy,
already declining due to competition, to $140 a person per year.

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eb.0829clinton.php

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Clinton makes up for lost time in battling AIDS

By Celia W. Dugger The New York Times
TUESDAY, AUGUST 29, 2006

*RWINKWAVU, Rwanda*
<http://www.iht.com/cgi-bin/search.cgi?query=3DRWINKWAVU,%20Rwanda&sort=3Ds=
wishrank>
Bill Clinton worked the crowd of AIDS survivors, clasping the
outstretched hands of children alive because of the AIDS medicines his
foundation donated.

Inside the rural hospital here that he recently helped renovate, where
Rwandans were hunted down and killed during the genocide he regrets he
didn't try to stop as president, Clinton heard people once skeletal from
AIDS tell of their resurrections to robust health.

Since he left office more than five years ago at age 54, one of the
youngest former presidents ever, Clinton has made a lasting mark in a
cause that he came to only late in his presidency: fighting the AIDS
pandemic across Africa and the world.

Few public figures in America have spawned as much speculation about
what motivates them as Clinton. Abroad, even fewer inspire the
affectionate reception Clinton received as he raced across seven African
countries in eight days in July. Crowds at roadsides and in hospitals
wanted to touch him - and he obliged by shaking hands, kissing babies
and hugging people with AIDS.

Here on Clinton's fourth visit to Rwanda, it was clear the efforts by
his foundation had personal meaning. He said he was sorry his
administration failed to intervene during the 1994 genocide. "The United
States just blew it in Rwanda," he said flatly. Paul Kagame, Rwanda's
president, said he had accepted Clinton's repeated apologies.

But on this trip, Clinton seemed anything but a man tormented by guilt.
Rather, he reveled in his role as a private citizen championing people
with AIDS.

"The reason I do this work I do is that I really care about politics and
people and public policy," he said in one of several interviews,
scornfully dismissing questions about whether his global AIDS work is a
form of redemption for what he failed to accomplish on the issue as
president, or for the Monica Lewinsky scandal. "I'm 60 years old now,
and I'm not running for anything, so I don't have to be polite anymore,"
he said. "I think it's all a bunch of hokum," he added, calling such
speculation psychobabble.

"I have never met anybody who spent all their time talking about
everybody's motives who at the end of their life could talk about very
many lives they had saved," he said.

Clinton was adamant that he had done all he could about global AIDS with
a Congress hostile to foreign aid, though he conceded that his
administration fought too long to protect the patent rights of
pharmaceutical companies against countries trying to make or import
cheaper AIDS medicines.

*'Everyone Was Worried'*

After he left office, Clinton faced some skepticism as he took up the
cause of people with AIDS dying faraway deaths in poor countries. His
administration, which sought more resources to combat AIDS domestically,
had a far weaker claim to leadership on AIDS worldwide.

When doctors specializing in public health met him at the William J.
Clinton Foundation in Harlem in the fall of 2002, Howard Hiatt, the
former dean of the Harvard School of Public Health, bluntly asked
Clinton why those present should expect that "you'll be able to
accomplish now what you didn't undertake in your presidency - an attack
on this plague?"

"Everyone was worried," said Richard Marlink, who headed Harvard's AIDS
Institute. "Is this a campaign with photo ops and press releases or a
long-term commitment?"

In the years since, doctors at the forefront of AIDS treatment have
worked with Clinton. Marlink volunteered to help Clinton's foundation in
South Africa. Hiatt, who serves on the board of Partners in Health, a
nonprofit group that works with Clinton in Rwanda, said the former
president "has really perceived the seriousness of the problem."

Clinton and his foundation have undertaken projects with two dozen
developing countries, raising money to post nurses in rural clinics in
Kenya, mustering experts to train hospital managers in Ethiopia and
buying drugs for thousands of sick children, among other things.

His foundation also has negotiated steep cuts in the price of AIDS
medicines through deals with drug companies that cover more than 400,000
patients in dozens of countries, helping propel momentum for treatment
of the destitute.

Dr. Bernard P=E9coul, who led a campaign for access to medicines for
Doctors Without Borders from 1998 to 2003, credited Clinton and his
foundation for showing independence from the politically powerful drug
industry and helping to accelerate the decline in prices for generic
AIDS medicines in developing countries.

"They have been very clever in supporting generic policy in the United
States, a country where it's not easy," he said. "And sometimes they've
been even more courageous than the United Nations system, which is under
pressure from member states."

The Clinton foundation's budget last year was $30 million, raised from
private donors. Clinton, who oversees its operations full time, has
plunged into many causes, from childhood obesity to tsunami relief to
global warming, but he has made his most substantive contribution on AIDS.

He said Rwanda was one of the first countries he chose to work in
because "they had a really good chance to dig out of the hole and I
wanted to help them do it."

For years, he tried to coax Dr. Paul Farmer, known for his work caring
for the poor in remote, rural Haiti, to recreate his model of AIDS
treatment in Africa, the heart of the epidemic.

Last year, Farmer and the group he co-founded, Partners in Health,
arrived in Rwinkwavu. With support from the Clinton Foundation and
others, he has transformed a dilapidated facility that lacked even a
doctor into a thriving rural hospital.

More than 1,500 people have been put on AIDS medicines here. Reproducing
the pioneering model used in Haiti, Farmer has community workers, many
of them peasants, deliver antiretroviral medicines to people with AIDS
every day, minimizing reliance on scarce doctors and nurses.

Like most international leaders and American advocates for people with
AIDS in the 1990's, critics say, Clinton's efforts on global AIDS did
not match the epic scale of the human tragedy as it unfolded across
Africa and millions died and were orphaned.

In recent years, the fight against AIDS has leapt onto the world stage,
claimed by Clinton and his Republican successor, George W. Bush.

There is a measure of irony in this. Since 2003, Bush has marshaled
billions of dollars in American assistance for a global assault on the
disease, financing lifesaving treatment for hundreds of thousands of
people with AIDS. Yet because of his foreign policies, notably the war
in Iraq, he is often met by protests when he travels abroad, while
Clinton is warmly embraced across the developing world.

"George Bush has actually delivered more resources, but Clinton is ten
times more popular in Africa," said Princeton Lyman, who was American
ambassador to South Africa under Clinton. "That's because, just like he
does everywhere, he portrays that sense that he cares."

On his recent tour of Africa - his fifth since 2001 - Clinton showed a
remarkable ability to establish a human connection with people he met.

In Johannesburg, Clinton and a frail Nelson Mandela, about to turn 88,
clutched each other's hands like a long-lost son and his beloved father.

En route to the airport in Lilongwe, Malawi, where crowds of people
strained to catch a glimpse of him, Clinton suddenly halted the
motorcade, conducted an impromptu interview in the middle of the road,
then plunged into a throng of young men reaching out to touch him.

At a hospital in Mafeteng, Lesotho, Clinton strolled into a sunny
courtyard with 6-year-old Arriet Moeketsi, a little girl in a polka-dot
dress. Arriet, who takes AIDS medicines donated by Clinton's foundation,
trustingly leaned her face against the former president and never let go
of his hands during a prolonged news conference.

Bill and Melinda Gates, the billionaire philanthropists, watched.
Clinton had visited an AIDS project of theirs in Durban, South Africa,
and they had come to Lesotho to see his work. When Clinton left the
hospital with Arriet, a Clinton volunteer asked the Gateses to stay back
so photographers could follow him.

The world's wealthiest couple seemed to take no offense. The two Bills,
as they have been dubbed, have taken to doing high-profile AIDS advocacy
events together, with Clinton bringing star power and Gates his deep
pockets.

"He plays a unique role in shining a light on the problem," said Gates,
after he made it into the courtyard.

Clinton has come a long way on global AIDS. For most of his presidency,
his trade office fought to protect the patent rights of pharmaceutical
companies against attempts by developing countries to make or import
cheaper generic medicines. "I think it was wrong," he now says of that
approach.

During the first six years of his presidency, federal spending to fight
AIDS worldwide stagnated at paltry levels, never topping $141 million.

But by his last budget, spending more than tripled to $540 million, but
Clinton says that was far from enough. Even so, he contends that no one
could have done better.

*The Role of Congress*

The Democrats controlled Congress for only his first two years in
office, he pointed out, when "everybody's obsession" was the AIDS
problem in America. After that, the Republican-dominated Congress that
later supported Bush's $15 billion, five-year global AIDS plan fiercely
resisted spending on foreign assistance.

"Have you forgotten what I had in the Congress?" he asked. "That the
Republican Congress spent all their time trying to trash me?

"And the only reason they gave money to George Bush for AIDS is they
wanted to have something they looked progressive on since they were
cutting taxes for rich people like me," he said.

Michael Gerson, who was a senior adviser to Bush on global health
issues, noted that the Republican Congress was, in fact, open to
persuasion that global AIDS was a spending priority. But he also said
the issue had ripened by the time Bush was president. The price of
antiretroviral drugs fell after Clinton left office, helping change the
view that it was too costly and difficult to treat people in poor countries=
.

But Gerson also said of the Clinton record: "I don't believe they were
visionary or pushed the system. I don't think they were thinking big."

The debate over whether Clinton missed a political opportunity to lead
the charge on global AIDS years before Bush seized it is far from over.

Greg Behrman, the author of "The Invisible People: How the U.S. Has
Slept Through the Global AIDS Pandemic, the Greatest Humanitarian
Catastrophe of Our Time," offers a split verdict.

"There are two acts here," he said. "Clinton's post-presidential
leadership has been extraordinary. As president, though, the record is
clear. Clinton was not a leader on global AIDS and the consequences have
been devastating."

After he left office, Clinton considered his future with a keen eye on
history, analyzing what former presidents had done.

He concluded that another former Southern governor, Jimmy Carter, a
Nobel Peace Prize winner who is now recognized for his work on human
rights, democracy and neglected diseases, was "the only person who'd
done anything that remotely resembled what I thought I could do."

 From the start, Clinton had a host of issues on his agenda, but quickly
found himself drawn into AIDS. He turned to his old friend Ira
Magaziner, a fellow Rhodes scholar and corporate consultant who had
managed the Clintons' failed health care reform effort. Magaziner has
since led the foundation's AIDS program.

The two men discovered in 2002 that the Bahamas was paying $3,500 per
person a year for generic AIDS drugs. "I said, 'Ira, please find out why
in the hell these people are paying $3,500 for $500 drugs,' " Clinton said.

They learned the Bahamas was buying through middlemen, so the foundation
helped the country purchase directly from Cipla, the Indian generic-drug
manufacturer. "So our first victory was a lay-down," Clinton said. "All
of a sudden, they could treat six times as many people for the same
amount of money."

Opportunities proliferated, and Clinton's enthusiasm grew.

His name opened doors with generic drug makers. With growing demand for
AIDS drugs already on the horizon, as well as the economies of scale
that come with that, Magaziner took a team of volunteer consultants to
India in 2003 to negotiate for lower prices. Companies opened their books.

"The name Clinton in India holds more charisma and credibility than any
other American name," said Dr. Yusuf Hamied, Cipla's chairman.

Through cost cutting, spurred by breakthrough talks with companies that
supplied ingredients to the drug makers, the team got deals. Cipla, for
example, halved the price of the most common AIDS triple-drug therapy,
already declining due to competition, to $140 a person per year.

Similarly, Clinton was able to use his relationships with political
leaders, like President Thabo Mbeki of South Africa, who had questioned
whether H.I.V. caused AIDS. The country had not begun treating its
people for the disease, though almost five million had been infected.
"He was getting killed in the global press about it," Clinton recalled.

Clinton, who knew him from his own time as president, met with Mbeki in
2003 as one politician to another. "I said, 'You know, I really want to
help you, and as you know, I may be the only one of those involved in
this work who's never been publicly critical of you,' " Clinton said he
told Mbeki. " 'But this is something you have to do.' "

Mbeki soon invited Clinton's foundation to help the country write a
comprehensive treatment plan. South Africa now has more than 130,000
people on antiretroviral drugs, still far short of what critics say is
needed.

Since 2004, Clinton has campaigned to raise the profile of children with
AIDS. A scant 20,000 children in the developing world were then getting
drug treatment, while more than 500,000 a year were dying. The Clinton
foundation has raised $4.4 million to buy drugs for 13,000 children,
train health workers, renovate pediatric wings and pay for lab tests.

"Children are alive in numbers we couldn't have imagined a couple of
years ago because of what he's done," said Peter McDermott, chief of
H.I.V. and AIDS programs at Unicef.

Clinton's ambitions seem to grow daily, and his foundation is now
branching out in Africa from AIDS into poverty. As he relaxed one recent
evening in a sumptuous, $2,260-a-night suite in Johannesburg, with zebra
skin rugs underfoot (the lodgings provided to him gratis by a rich South
African businessman who owned the hotel), he got excited just thinking
about fertilizer.

Magaziner has people riding trains and trucks that carry fertilizer to
figure out why a commodity that should enable farmers to grow more food
and avoid hunger costs so much in Africa.

"You follow the trail!" Clinton said.

Clinton was joined on his trip by Sir Tom Hunter, a Scottish
entrepreneur who has promised to spend $100 million of his fortune in
collaboration with the foundation, much of it on economic development.

"Tom, where's Tom?" Clinton called out excitedly as he chatted with
representatives of a nonprofit group that promotes solar-powered lights
during an event here in Rwinkwavu.

What if Rwanda could manufacture such lights locally? Clinton mused. Why
not electrify villages so children can study at night? "It might be
possible to get a factory here that would serve all of central Africa!"