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Issue 42, October 1999

Aids Drugs imperialism

ONE OF capitalism's latest nostrums is the '24-hour-society', with the development of all-day trading by shops and leisure facilities hailed as a kind of consumers' nirvana.

A '24-hour-society' has a rather different meaning in Zimbabwe. There it is the mortuaries which are opening round the clock, to enable the relatives of the 240 people who, on average, die from AIDS every day, to collect the bodies of their loved ones.

The body count of AIDS has now outstripped malaria and war to become the leading cause of death in Africa. Last year the pandemic claimed two million African lives. Of the world-wide total of 14 million AIDS victims, 11 million have perished in Africa.

Two-thirds of the continent's hospital beds are occupied by people living with AIDS. The United Nations children's organisation UNICEF has reported that six million African children have now lost one or both parents, while its sister agency UNAids has identified 20 under-developed countries which may see as much as 60% of their economically active population cut down.

In particular, the AIDS pandemic is wreaking havoc in the states of east and southern Africa. These account for almost half of the estimated total world cases of HIV - that is, people carrying the virus which, without proper medical intervention, usually progresses to one or more form of AIDS.

Within the sub-Saharan region one country, South Africa, has been described as 'the epicentre of the global AIDS quake', with the fastest-growing rate of HIV-infection in the world. In the worst-hit areas, 29% of pregnant women are testing HIV-positive.


A pregnant woman carrying the virus stands a one-in-three chance of giving birth to a child who will be HIV-positive. While a cure for people living with AIDS and a vaccine against infection both continue to elude researchers, drugs have been developed which can prevent transmission of the virus from mother to baby.

Similarly, effective medication exists for a range of individual AIDS-related illnesses such as the deadly form of fungal infection called cryptococcal meningitis. Last but not least are the tailored packages of drugs known as 'combination therapy'. For several years now combination therapy has succeeded in containing and reversing the growth of the virus in the immune systems of many HIV-positive people in the advanced Western countries, thus slashing death rates.

In the face of the world-wide AIDS pandemic, the masses of the ex-colonial and other under-developed are paying again and again, and literally with their lives, for the poverty of the social system.

In Uganda, for example, combination therapy costs between 225 and 600 per month, placing it beyond the reach of workers and farmers, and even of middle-class professionals. Most of the 20 poor countries cited in the UNAids report have no access whatsoever to most of the latest AIDS drugs.

Against this background desperate conflicts are emerging between, on the one side, the governments of third world countries and, on the other, the richest drug corporations on the planet, backed by the United States administration, aided and abetted by other Western governments.


Under free market international agreements signed under the aegis of the World Trade Organisation (WTO) in 1997, when a company develops a new product it can enjoy its patent on an exclusive basis for 20 years and more. During this period, other companies can only manufacture the item if they are granted a licence, and pay royalties to the patent-holder at a negotiated rate.

An exception has been held to apply in 'crisis' situations, however, where a government itself can award 'compulsory licences'. Haggling continues over the precise definition of these exceptional situations, but states with food shortages or without telephones have got away with awarding compulsory licences in agriculture and telecommunications. On this basis, and even within a capitalist context, the case for compulsory licencing of AIDS drugs would seem unanswerable.

In 1998 Thailand sought such a licence from companies such as Pfizer to produce cheap local versions of drugs such as fluconazole, the antibiotic needed to fight the AIDS-type meningitis mentioned earlier. Where Pfizer had demanded $14 for a daily dose, non-profit Thai companies charged $1. The capitalist government of Thailand described this as a 'win-win' situation for all concerned. Simply for owning the patent, Pfizer would get a 'fair' royalty on increased sales, and the one-in-five Thais living with AIDS affected by meningitis would receive treatment which they would otherwise have been denied.

Rather than 'win-win', however, Pfizer and other US drug companies favoured 'profit maximisation' - with the weak going to the wall. They lobbied the Clinton administration - whose chief of staff John Podesta is conveniently the brother of the drugs industry's chief lobbyist. Despite the fact that the US was a signatory to the WTO agreements, it refused to acknowledge the validity of the compulsory licensing option and threatened the Thai authorities with trade sanctions, unless it abandoned its AIDS drugs policies. With 25% of its exports going to the USA, the Thai authorities caved in, retreating so far as to pass special legislation making future compulsory licences illegal.


Now the latest country in Washington's sights over compulsory licences is the state with the worst AIDS crisis in the world - South Africa.

In 1997 the South African government passed a Medicines Act which provided both for these licences and for 'parallel importing', under which drugs could be purchased from the lowest-charging existing licensee on the world market rather than the top whack of the developed-world patent-holder. Since then the world's 'big 40' drugs monopolies have deluged the South African courts with actions against the legislation. Meanwhile the US government has moved to give the ANC administration of Thabo Mbeki a taste of the humanitarian 'medicine' it applied to Thailand. US Vice-President Al Gore has been leading the negotiations with South Africa, which has been left in no doubt that it is a 'suspected infringer of patent law', with the stick of trade sanctions being readied for action.

Gore's position caused fury among African-Americans and people living with HIV and AIDS in the US. Supporters of the protest group ACTUP have followed Gore on the trail of his presidential campaign with placards saying 'Gore's greed kills'. In the face of these protests, Gore has now adopted a Catch 22-type position: 'I support South Africa's efforts to enhance healthcare for its people... through compulsory licensing and parallel importing, so long as they are carried out in a way that is consistent with international agreements'. In the British HIV magazine Positive Nation, a Philadelphia ACTUP campaigner is quoted describing Gore new statement as 'smoke and mirrors'.


Last year, the ruling assembly of the World Health Organisation (WHO), having initially kept its distance from the issue, finally came down on the side of developing countries seeking to cut the price of AIDS medication for its populations. Under its 'Revised Drug Strategy', 'where trade agreements are in conflict or unclear, public health considerations must outweigh all others' (Positive Nation). The US then threatened to withdraw from WHO.

The message is clear: so long as capitalism rules the world, the interests of the monopolies take precedence over everything, from the small change of international capitalist law to the health and very existence of millions.

Vince Dicey

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