[fwd from pen-l.
Patrick Bond believes that "where there is no militant mass movement for
reforms, there is no fertile ground on which to sow revolutionary seeds",
asYoshie put it on this list. Talk of single-minded focus revolutionary class
war is in this view, silly raving, even a kind of political dementia which
dooms us to irrelevance. It is necessary to engage the enemy (corporate
capitalism), confronting it piecemeal thru myriad local struggles which mirror
its own myriad tentacles. Not only politically necessary, but ethically
necessary since we have a duty to defend the helpless, and seek viable reforms
in the here and now. The issue of HIV/AIDS in Africa is an urgent example of
this intersection of struggles/interests between the local state, corporate
capital (the pharmaceuticals), the emergent global state (WTO etc) and radical
social democracy (the NGO-Swarm).
Here's how Patrick Bond writes about the issues. The problem I have with this
approach is that, as capitalism enters deeper into general crisis, there will
always be ever-more-appalling instances of its genocidal savagery and utter
contempt for all life, and this provides its own seductive rationale for
arguing that we should not be 'sidetracked' by futile 'Leninist' schemes, when
there is so much suffering to deal with *right now*: the result, as the
following dialogue shows, is that the militants themselves end up where they
began: completely captured on the enemy's own political terrain, hostage to
their own good intentions, incapable of articulating the issue of HIV/AIDS in
a wider context, ie, a critique of the capitalist conjuncture which leads
directly to straegic issues of the revolutionary warfare which is *the only
way to resolve the issues of AIDS, rural poverty* etc. Paradoxically, the
NGO-swarm militants have easily been outlfanked on the left by Thabo Mbeki
himself, who quite properly prioritises the issue of poverty, which is a
direct political attack on imperialism's plunder of the neocolonical
peripheries. But words like capitalism, imperialism, necolonialism, revolution
and class war are all completely ABSENT from Patrick Bond's discourse and from
his conceptual universe. He speaks of 'classes of patients' but that's the
only kind of class analysis you'll find here.
Mark]
> From: "Lisa & Ian Murray" <[EMAIL PROTECTED]>
> Date: Sat, 17 Mar 2001 19:54:47 -0800
> [So, is the Aids medicine litigation being pursued in SA courts to avoid
>being a
> WTO dispute settlement body decision that would have been yet another nail
in
> that institution's coffin?]
Not so much, as far as I read it. The 40 pharmacorpos which are
"suing Mandela" (as the WSJ put it a couple of weeks ago) have
grounded their case in SA's own liberal/soc.dem. rights rhetoric, and
in the process want to establish not only their own property rights,
but also a variety of other entitlements given to human being and
"juristic persons" (corpos) in the Bill of Rights.
(As a trivial footnote, two SA comrades and I, supported by Nader's
people, tried to block adoption of the juristic person clause,
unsuccessfully, in mid-1996 when the constitution was ratified. The
ever-sleazy Paul Krugman last year labeled Nader anti-democratic for
his support; the NYT refused to print the clarifying letter that the
three of us, including one ANC member of parliament, sent along the
next day.)
Anyhow, the plaintiffs' case specifically avoids all mention of
HIV/AIDS, focusing instead on rights and feasible actions that can be
taken by Pretoria outside the Medicines Act (e.g. patent exemptions
in existing law). For tactical reasons, the activists (Treatment
Action Campaign) went in with a friend-of-court brief supported by
government, and the judge ruled they could join, and gave the
pharmacorpos three weeks to reply to the substantive addition of the
AIDS pandemic as justifying large-scale state intervention. Sadly,
Pretoria is relying upon the most minimalist reading of the Act in
its defense, and is in the process potentially undermining the
possibility of future local generic drug production (according to the
some readings). Activists say that doesn't matter, they'll force
Pretoria to wratchet up the attack at a later point, but the main
thing is to win the position that the pharmacorpos are killing people
now, if even merely to justify parallel importation of branded drugs
from sites where price discrimination doesn't generate monopoly
profits. The implications for import of Brazil/Thailand/India
generics remain a bit fuzzy.
But I think no one disputes that the Medicines Act is WTO-compliant
(given the "emergency" exemptions clause in TRIPS).
Resolving the issue is still fraught by political rhetoric and
positioning. Activists (including even the erratic Winnie Mandela)
have claimed Pretoria is in bed with the pharmacorpos because of the
genocidal lack of government action in making antiretrovirals
available to date; the pharmacorpos claim that Pretoria is ignoring
their good faith efforts to do some deals (e.g. yesterday's papers
revealed that the Dep't of Health has rejected $50 mn worth of free
AIDS tests because of -- read it and weep -- lack of refrigeration
and tendering complications); and Pretoria (Thabo Mbeki specifically)
claimed last year that the activists are shills for the pharmacorpos
because after all, "HIV does not cause AIDS," so it is pointless to
push anti-retrovirals "instead of" (hah) fighting poverty (which
Mbeki still believes, judging by an appalling talk given to the Davos
WEF in late January, is the "cause" of AIDS... and of course in
reality poverty has skyrocketed since the ANC adopted neoliberal
policies even before coming to power in 1994 ... details of which are
to be found in John Saul's excellent Jan 2001 Monthly Review cover
article).
To give you a bit more detail, on behalf of Multinational Monitor
I did an interview with the key activist, Zackie Achmat, and the
January 2001 issue of MM carries part of this, plus some additional
commentary by Zackie on the character of campaigning. I think the
final version is on the Nader website, but here's what's handy
from my hard-drive...
Gates, Merck, Bristol-Myers-Squibb,
Pfizer and other companies
on SA activist's campaign list
Zackie Achmat runs South Africa's Treatment Action Campaign
(TAC), the organisation most responsible for raising issues
of pharmaceutical product access, as a crucial link in the
strategy to combat the HIV/AIDS pandemic. He spoke to
Multinational Monitor on January 5, 2001.
MM: You've led intense struggles to get better drug access
for South Africa's 4.2 million HIV-positive people, yourself
included. This has pitted you against both multinational
corporations and the South African government, especially
president Thabo Mbeki. Late last year, Mbeki reportedly
called the Treatment Action Campaign a "front for the drug
companies" during an internal caucus with his African
National Congress (ANC) members of parliament, because of
your campaign's emphasis on treatment.
ZA: Let's deal with this forthrightly. Mbeki also said that
TAC had infiltrated the trade unions, and that we wanted to
embarrass him because of his statements from a year ago
questioning the link between the HIV virus and AIDS. In
reality, Mbeki embarrassed himself.
As for the trade unions, they had just demanded, at
their September congress in front of Mbeki himself, that
government reject this bizarre theory of AIDS and government
policy. Are we a front? We get no donations from drug
companies, and we were the first and loudest organisation to
tackle them. So after Mbeki's outburst, we went to the South
African government Public Protector to demand that he
retract the statement, but that office hasn't responded yet.
Meanwhile, the union leaders, like Zwelinzima Vavi, were
furious about this insult to their integrity. The South
African Democratic Teachers Union, for example, headlined
their newspaper the next month in huge letters, "Sorry Mr
President, we can't infiltrate ourselves."
MM: Mbeki soon backed down and said he wouldn't make further
statements on AIDS.
ZA: Yes, but he had already done a tremendous disservice to
the country, particularly to the ANC. There is no doubt in
my mind that a lot of people didn't vote ANC in the recent
municipal election because of the AIDS issue. The ANC vote
went from 67% in the 1999 general election to 60% in
December. Thankfully, the trade unions pushed Mbeki into
silence, saying very explicitly, "You're wrong on HIV and we
want treatment!"
But the other point that most critics are making now is
that while Mbeki claimed that poverty was the key cause of
AIDS deaths, in fact if you look at the SA government's
position on poverty reduction, it is also a disaster. The
country's worst-ever outbreak of cholera, which affected
12,000 people in low-income rural areas with more than fifty
fatalities during the last five months of 2000, was
catalysed by the inhuman cutoffs of clean water by
government bureaucrats because people couldn't pay a R51
($6.80) connection fee.
TAC hopes that the ANC's municipal election promise of
free water and free electricity is implemented, but we
desperately need the leading advocacy groups in South
Africa, like Jubilee 2000 and Cease Fire, to work closely
with trade unions to redirect the budget to that end, and to
increase the health budget. We need a 33% increase to
develop infrastructure, to train, and to employ more staff,
up from R24 billion ($3.2 bn) to R32 billion ($4.3 bn).
Recently, per capita health spending has been declining,
which can only be considered politically irresponsible, in
the midst of the AIDS disaster.
MM: This would be aimed, mainly, at assuring all who are
HIV+ ultimately get treatment.
ZA: Yes, but for us, a move away from the multinational
corporate producers to local generic production is the only
way. We actually need not only state production of drugs,
but also private generic competition here in South Africa.
MM: But states in this region appear a long way from that
kind of challenge to corporate prerogatives. Even Winnie
Madikizela-Mandela declared that the ANC government, which
she serves as a member of parliament, is "an obedient
servant of multinational companies that continue to put
their profits above our people." And the greatly-respected
HIV+ activist and judge Edwin Cameron said in a keynote
speech to the Durban AIDS conference last year that "The
drug companies and African governments seem to have become
involved in a kind of collusive paralysis."
ZA: The problem is partly that the African governments not
being able to imagine an alternative. However, we are
slightly more optimistic now. Over the past few months,
there has been a strong joint statement by health ministers
from the Southern African Development Community on bulk drug
procurement. Even our own health minister, who we are taking
to court for failing to implement a country-wide mother-to-
child transmission programme, is showing some spine with the
drug companies.
However, we have to be vigilant, because as our minister
has publicly commented, drug companies and other donor
agencies are trying hard to divide the African countries on
questions of how to attain sustainable healthcare provision,
and particularly drug provision. It's easy to do that,
because a country like Malawi doesn't have money to buy
medication, compared to South Africa.
MM: Which companies and donors was she referring to?
ZA: In my mind, there's no doubt that she was citing, in
relation to the Botswana donation, Merck and the
Bill/Melinda Gates Foundation. The drug company donations
are extremely limited, and are self-interested in warding
off a more serious challenge to their monopoly control of
patents on some crucial drugs. Likewise, we all understand
the Gates Foundation's self-interest in defending
intellectual property rights.
The Botswana prototype for drug company philanthropy has
generated a rising level of disgust. What has happened,
according to activists and objective observers, is that
Merck and Gates have virtually moved in to run a parallel
health programme to the Botswana ministry of health.
However, after this lesson in manipulation, the Southern
African health ministers set out a good set of guidelines
regarding donations from companies, insisting that these
should not undermine the structure of the health system,
should not undermine either potential generic production--
like Brazil, India and Thailand do--and should not dissuade
countries from using the exemption in the World Trade
Organisation's TRIPS treaty that provides for parallel
imports in the case of an emergency, like AIDS.
Another encouraging factor was our minister's statement
that she would not give up the right for generic production.
She also took a trip to Brazil, where she made positive
noises about generics, though without a real commitment to
start production here.
MM: What, realistically, can you expect government to do on
treatment?
AZ: We would like to see, by mid-year, the implementation of
what the government said it would do last August on
prevention/treatment of opportunistic HIV-related diseases.
For example, the tuberculosis budget is just R500 million
per year, which just scratches the surface of what's needed.
We have a TB case rate in South Africa of more than 350 per
100,000 people, which is the world's worst. In the mining
industry, it's as high as 3,000 per 100,000. The main
problem in the lowest-income provinces is that between a
quarter and three-quarter of rural clinics don't have TB
drugs. This is partly because of limited managerial capacity
in rural areas, combined with budget cuts, especially to
hospitals, which always drop consumables like medicines
first. So the TB budget needs a massive increase.
We are also demanding introduction of cotrimoxazole to
prevent PCP-pneumonia, which kills mainly HIV+ infants. A
monthly supply would cost R4 ($0.53) for children and R8-24
($1.06-3.18) per adult, which is a great savings over
hospitalisation costs, which are up to R150,000 per patient
($20,000). But right now, there's not sufficient political
commitment from the government to get access to drugs even
for these extremely obvious areas of treatment.
MM: What do you say to critics who claim that expanding
treatment through cheap parallel imports, as you advocate,
risks introducing drugs of questionable quality, is
infeasible due to lack of health-system capacity to
administer drugs properly, and consequently will expand
drug-resistance strains of HIV?
ZA: First, on the quality of imports, we now have official
clearance to import Fluconazole, at 2.2% of the price
charged private-sector clinics, and we've shown that the
drug is high quality. Even the Medicine Control Council,
which charged me with illegal importation of medicine when
I brought in 10,000 Fluconazole capsules from Thailand last
year just to make the point, also concedes that the quality
is fine.
By the way, TAC is still being investigated by the SA
Revenue Services for that civil disobedience, and they'll
probably charge me for tax evasion. They won't get more than
R2,800 from Value Added Tax on the symbolic shipment I
brought in, so it's clearly petty harassment by the ANC
loyalist who runs the tax system.
Second, we should not underestimate the difficulties of
providing anti-retrovirals, and we don't. If it's done on
the basis of a clear, well-defined plan, it shouldn't be
beyond our capacity in South Africa to establish an
effective system for administering treatment.
Third, we agree that if you have weak implementation,
drug resistance strains will emerge. Certainly, our health
professionals need more training in prescription techniques.
Still, 12% of new infections in the US are found to be
based on drug-resistant strains. Is anyone saying that the
US must stop providing treatment? Moreover, it is well known
that rich countries have witnessed a dramatic
overprescription of antibiotics, leading to many kinds of
drug-resistance diseases. So this isn't just a problem of
HIV/AIDS treatment, and we shouldn't be the class of
patients denied access as a result.
The problem of drug resistance can be addressed through
other means as well. Our private medical-aids insurance
system puts an excessive limitation on payment for therapy,
which leads doctors to prescribe a dual therapy treatment
instead of triple-therapy, or even to prescribe AZT as
monotherapy, which gives rise to much quicker drug-
resistance. In addition, South Africa is the most frequent
site for clinical trials in the developing world, due to
good infrastructure. After treatment is halted when trials
are finished, there is a problem of drug resistance. But
none of these problems should be grounds for saying, no more
treatment, especially since it is mainly low-income black
women who are the beneficiaries of treatment.
MM: Is the South African government moving towards
establishing a clear, well-defined plan?
ZA: Right now, the minister simply does not have a plan for
anti-retrovirals. But there are two other ministers who are
also blocking progress. The finance ministry does not
provide enough money, and the ministry of trade and industry
has not taken a clear position on local production.
This is important, because the minister, Alec Erwin, is
scared to offend the WTO and the investment community by
allowing local generic production. He knows that this will
send negative signals to other corporate investors.
But what these South African ministers are dead wrong
about, is that every other well-informed business leader in
the world now realises that unless there is generic
production, then too many people will die, and overall
health system costs will be much higher, than the cost of
alienating the pharmaceutical firms by violating their
patents.
MM: It looked like you won the first major battle in the war
with pharmaceutical companies in September 1999, when then-
vice president Al Gore agreed to back off the pressure he
put on Mbeki and Erwin to withdraw a South African law which
made it possible to import drugs and license generics for
local production. Then came Mbeki's turnaround. What did you
learn from that struggle?
ZA: As I said, the bigger problem is the government's
unfounded fear of alienating investors in general. But on
the positive side, we had the most exciting experience in
rallying international solidarity since the anti-apartheid
struggle. The most helpful research organisation was the
Consumer Project on Technology. The most important voice to
help generate a global consensus that drug companies were
committing genocide against the poor was Medecins sans
Frontieres. The most serious activists fighting against
profiteering on AIDS and other diseases were ACT UP in New
York, Philadelphia and Paris.
But what ultimately also is critical for us, is the
conscientisation now underway in broader civil society, here
and elsewhere. Last year, the Congress of SA Trade Unions
and their Southern African allies pushed through a
resolution supportive of generics at the Durban conference
of the International Confederation of Free Trade Unions.
This issue is resonating with trade unions across the South,
including Korea and indeed throughout Africa.
MM: The drug companies are claiming that with their
donations, they are now doing as much as can be expected. UN
AIDS is under pressure because they aren't monitoring the
donations in Africa, but was the UNAIDS/Industry initiative
fatally flawed from the outset?
ZA: Well, first, the various donations have come only
because of protest. These are, in any case, just holding
operations for the drug companies, which hope they can delay
the import or local production of generics in Africa. And
the very large South African private sector is still not
covered in one of the largest deals, between Pretoria and
Pfizer, for Fluconazole.
Whatever the nature of a particular donation, we can't
afford to let up pressure on the drug companies, otherwise
prices will go way up again after they capture the market.
In any event, some of these programmes are also financially
self-interested. In Botswana, for every dollar Merck gives,
the Gates Foundation gives a dollar, which comes back to the
company when they buy Merck drugs at wholesale price, which
can be added to Merck's tax deduction on the donation. The
big question about the drug companies' donations is how long
they can be sustained, and how many people will be reached?
Evidence so far is not encouraging.
What is, however, most disturbing about the drug
companies' philanthropy, is their ability to buy off
potential protest from the established AIDS organisations
and researchers. Bristol-Myers-Squibb, for instance, has
given $120 million to a "Secure the Future" programme over
three years, directed at women, children and NGOs. That
gives them the clout to go into established AIDS
organisations and literally purchase loyalty by researchers
and NGO leaders. Some NGOs have become much less critical
than they should be. And BMS' two drugs are ddI and D4T,
which in any case were developed by the US National
Institute of Health and Yale University. Yet both are still
priced prohibitively in South Africa.
MM: Finally, from your perspective, is progress being made
on a vaccine, and how are drug companies doing in R&D more
generally?
ZA: Of course we would support a vaccine, but in reality,
there's no chance of getting even a 50% effective vaccine
within 7-10 years, according to the main scientific
researchers. The World Bank, Gates and other funders,
including our government, all hope for a magic bullet.
In the meantime, millions are due to perish, and
millions more will contract HIV. We wish they would spend a
lot more of the resources now going into vaccine work into
something more practical, namely a microbicide gell or spray
which can prevent HIV transmission during vaginal and anal
sexual intercourse, because it kills off lots of STD bugs.
It's much more promising, but it's massively underfunded. I
think that so few companies are doing serious work on
microbicides because people who will use it most are poor
women. If the perception within the drug companies is that
the rich, white heterosexual market doesn't need it, you can
expect it to become a fatally low priority.
TABLE: Comparison shopping for life-giving drugs
Product SA Pub.Sector SA Priv.Sector Thailand
Fluconazole(200mg) R28.57 R80.24 R1.78
AZT(100mg) *R2.38 R5.54 R2.38
ddI(150mg) NA R10.90 R6.00
d4T(40mg) NA R26.00 R2.75
3TC(150mg) NA R22.80 R16.30
Nevirapine(200mg) NA R31.75 R12.00
(NA: Not Available) (R8 = $US1)
*Lower cost AZT is the result of activism. The AZT
price was reduced from R5.54 in the public sector
following TAC demonstrations and protests. The same
applies to the lower cost of Nevirapine for mtct.
Sources: Thai GPO and Biolab; India CIPLA; South
Africa Department of Health; Private Discount
Pharmacy. Prices valid as of 16 October 2000.
(Drugs and dosages are used to compare prices rather
than proposed treatment regimens.)
The following are the holders of the patents on the above
drugs, responsible for the extremely high prices paid by
South Africans:
Bristol-Myers-Squibb (ddI _ didanosine)
Bristol-Myers-Squibb (d4T _ stavudine)
Glaxo-Wellcome (AZT _ zidovudine)
Glaxo-Wellcome (3TC _ lamivudine)
Glaxo-Wellcome (AZT/3TC)
Pfizer (Fluconazole)
Boehringer Ingelheim (Nevirapine)
Patrick Bond ([EMAIL PROTECTED])
home: 51 Somerset Road, Kensington 2094 South Africa
phone: (2711) 614-8088
work: University of the Witwatersrand
Graduate School of Public and Development Management
PO Box 601, Wits 2050, South Africa
work email: [EMAIL PROTECTED]
work phone: (2711) 717-3917
work fax: (2711) 484-2729
cellphone: (27) 83-633-5548
* Municipal Services Project website -- http://www.queensu.ca/msp
> > >
