Comrade Mark, this is worthy of you. Some of the other stuff you were
raving on about wasn't. But I've been too hectic with
responsibilities around here to devote the time I should have, to
joining the fray.
I've just come from an inspiring anti-privatisation march by several
hundred comrades in Soweto this morning (the host Anti-Privatisation
Forum have a website link at http://aidc.org.za ). Though I had to
leave early to get a visitor to the airport, the demo reconvinced me
that local-global linkages can and are being made perfectly well by
organic socialists. The Wits University researchers and other SA
intellectuals (especially in Durban and Cape Town) have fairly good
ties to the organic base. (Sure, these relationships can really stand
to be amplified, but I think they are, thanks to really great
creative efforts such as the planned march/protest from
Uni.Durban/Westville against Merck's SA hq nearby, or the new issue
of the "debate" journal put together by Wits lefties. The latter is
being relaunched this coming Friday in a popular, sophisticated,
intellectually rigorous, but still revolutionary way.) Honestly, I
play no role here that justifies the attention you're giving me, but
in the spirit of critique I'll take this forward below.
> From: "Mark Jones" <[EMAIL PROTECTED]>
> To: "crl" <[EMAIL PROTECTED]>
> Reply-to: [EMAIL PROTECTED]
> 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).
That's quite well summarised. But one little mistake is that I don't
endorse "NGO-swarming" as a substitute for really serious
mass-movement building. I think of the Swarm as a kind of
corporate-campaigning type approach that is mainly engaged
in by northern leftwing techies who can hit the enemy hard with a
multitude of surgical attacks. But it doesn't really relate to the
kind of mass mobilisations I've been fortunate to witness (especially
here in Jo'burg between 1990 and 1993 or so). But in fighting
globalisation, Third World mass struggles are gradually evolving in a
good direction, from chaotic 1980s-90s IMF Riots, to big mass demos
run by large democratic working-class organisations (especially over
the last year or so), to programmatic alternatives (even at world
scale, such as at the Porto Alegre sessions controlled by the
grassroots radicals, not the Euro soc-dems).
In this regard, the book Globalisation from Below is much more
explicitly northern-oriented and reformist than I would comfortably
endorse (I hope that was clear enough from my ZNet review). But it
has such good analysis of the rise/fall of movements and such
comprehensive coverage of int'l movement debates, that it's useful
for me in my teaching here in SA. I have ongoing tussles with the
main author, Jeremy Brecher, about his overoptimistic fix-it
strategies, and the difference really boils down to the understanding
of the balance of forces. More than you recognise, Mark, I'm much
more interested in naming the system, in deploying classical marxist
crisis theory (respectful of eco-crisis problems too), in
substituting the word Imperialism for Globalisation, and in taking
forward the strategic implications. The point of invoking all
those anti-capitalist "militant particularisms" is that we'll need
them ALL one day, to build a coalition of left forces capable of
shifting the crisis-shifting/stalling back to those responsible for
the crisis. That, to me, will necessarily involve the nation-state as
a key unit of analysis and control at some stage, and so some kind of
political party-formation will be necessary. But as the rise of
Zapatism in Mexico hints, in the absense of a big mass left party
representing labour, women, environmentalists, indigenous people,
peasants, youth, etc, the networking of progressive civil society
organisations has to suffice in the meantime.
> 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,
Futile not because we don't need revolution urgently, but because
there are (well-known, fatal) flaws in vanguard party-building based
on claims of omniscence and purity. You should have seen the pathetic
groupuscules at the march today arguing with each other (especially
the Sparts whose Aussie ideologue was railing against township
activists in "Keep Left," which is the IS faction that dropped the
British model in order to instead do classical entryism in the SA
Communist Party ... that style of politics is just
self-caricaturing).
> 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
No, the Treatment Action Campaign's move to join the government's
lawsuit was (as we've discussed on e-debate) purely tactical. The
huge (500+) strategy conference that TAC held over the last two days
in Soweto offerred, I hear, the opportunity to move firmly left
again. And in any case, Mark, please please please don't be fooled by
Mbeki talking about poverty (not HIV) causing AIDS. Any African
public health activist can tell you that opportunistic infections
spring from conditions of poverty. For Mbeki, the poverty talk is a
ruse promoted by the rightwing AIDS dissidents, for reasons that I
spell out below in an article ZNet ran in July (sorry if I've posted
it already to this or that list). (Anyhow, here you see I don't have
any trouble talking about the capitalist conjuncture and how the
horrid SA government AIDS policy reflects a deeper economic crisis.)
> 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.
Ok, sorry, here's an antidote:
A Political Economy of South African AIDS
ZNet Commentary, 17 July 2000
by Patrick Bond
Johannesburg, South Africa
Up to a point, Danny Schechter is absolutely right
to focus on the power and the appalling
discursive-policy mistake of a single personality,
SA president Thabo Mbeki, in this country's recent
HIV-AIDS fiasco ("Mbeki's Muddle: South Africa's
AIDS Debate, ZNet Commentary, July 13).
Explains Schechter, "Staring down the barrel of
drug costs that could bankrupt his treasury and
plans for economic development, he provoked a
debate about the proper strategies to pursue that
is still reverberating globally."
The larger problem, however, is not just that the
cost of anti-retroviral drugs like AZT has
hampered treatment. It is, I want to argue, that
the class/race/gender character of South African
health and social policy under conditions of a
failing free-market (known here as "neo-liberal")
economic strategy is inhibiting prevention.
As Schechter points out, Mbeki spent several
months trying (unsuccessfully) to shift attention
from South Africa's ineffective HIV-AIDS policies:
"We cannot blame everything on a single virus.
Poverty is the underlying cause of reduced life
expectancy, handicap, disability, starvation,
mental illness, suicide, family disintegration and
substance abuse." This is also the policy
conclusion that the conservative "AIDS
dissidents," better termed "denialists"--a small,
marginalized bloc of researchers who deny a link
between HIV and AIDS--keep asserting.
But come off it: no African public health
professional needs a lecture on the relationship
between class and health indicators. (In a future
column I'll explain how hypocritical it is for
Mbeki to advance this case at a time most of his
underlings exacerbate poverty and inequality in
virtually all areas of post-apartheid development
policy.)
Beyond the illusory talk of fighting poverty,
Schechter correctly points out, "Mbeki had been
the darling of South Africa's business community
for years, a champion of the type of neo-liberal
economics that pleases cheerleaders for
globalization. A close friend of the Clinton
Administration, Mbeki was considered a man `we'
could work with."
If so, what are the implications? I'll briefly
highlight three:
* first, a presumption made by Al Gore that US
pharmaceutical companies could get away with
mauling SA's 1997 Medicines Act (which
condoned "parallel imports" and generic local
production of life-saving medicines, thus
threatening those firms' ability to exploit
their monopoly market power);
* second, ongoing pressure on the health and
welfare budgets caused by repayment of
apartheid-era debt (in part to US banks) and
adoption of a Washington-friendly
macroeconomic policy; and
* third, the closely-related indifference of
top policy-makers to the masses of superfluous
low-income people, who will never have a role
as laborers in the formal capitalist sectors
of the economy.
Let's start with the last, for no one has made the
argument more simply and clearly than Mbeki's key
spokesperson, Parks Mankahlana, when off-guardedly
he justified to Science magazine why the SA
Department of Health refuses to provide a
relatively inexpensive anti-retroviral treatment
to pregnant, HIV-positive women: "That mother is
going to die and that HIV-negative child will be
an orphan. That child must be brought up. Who is
going to bring the child up? It's the state, the
state. That's resources, you see."
(Mankahlana has personal experience that is
perhaps worth citing here. He has been the subject
of two paternity suits based on failure to pay
child maintenance, one of which was settled out of
court last week in the mother's favor, with the
other to be resolved by a blood test on July 17.)
The scandalous quote was released to the general
public here on Friday. Apparently ashamed that the
cat was out of the bag, Mankahlana--who a week
earlier said he would toss the 5,000-signature
Durban Declaration on AIDS into Mbeki's "dustbin"
because it strongly refuted the dissident camp--
immediately denied making the statement: "Their
story is a complete fabrication." Science's editor
replied that he had recorded Mankahlana in his
Pretoria office on March 24, and offered to play
the tape.
Mankahlana should indeed be ashamed. For
underlying the logic is a triple trumping of Cost-
Benefit Analysis. When people like Dr Costa Gazi
originally began arguing for prevention of mother-
child transmission, they conclusively showed that
treating HIV+ children for AIDS-related ailments
would cost the state far more than the expense
($15 million or so) of two antiretroviral jabs for
roughly 70,000 HIV+ expectant mothers annually,
for whom HIV transmission could thus be prevented
in roughly half the cases.
But first, the cost-savings associated with future
treatment only holds true if the state healthcare
system actually has capacity--and if its personnel
even intend--to care for sick HIV+ infants. Gazi,
who is health secretary of the Pan Africanist
Congress, says that such an assumption is now in
question, and not merely because the public health
service has collapsed in many impoverished
communities. Worse, after HIV+ infants get
treatment for an initial ailment, he says,
caregivers (mainly grannies) are now sent home by
local clinic staff and simply told not to return.
Second, a false presumption (explicit in
Mankahlana's comment) is that the state will be
forced to look after orphans. In reality, the
South African state has a practically non-existent
social safety net for black orphans. As a result,
kinship networks are the only fallback when the
HIV+ mother dies. The HIV-negative orphan is
usually looked after by desperately poor
relatives. The likelihood thus increases of the
orphan dying by the age of five (in a country with
amongst the world's highest infant-mortality rates
for black children). This practical reality lowers
the likelihood of a future productive life for an
AIDS orphan (even if the HIV+ mother is treated
with anti-retrovirals). Hence another negation of
the benefit side of the treatment equation.
Third, what if, against all the odds, the orphan
does grow up to be a productive member of society?
What jobs exist, now and in future, for her/him?
If South Africa's 40% unemployed mass already
provides an overstocked reserve pool of labor, why
keep the 50,000 or so potentially HIV- children of
HIV+ mothers alive by preventing mother-to-child
transmission? Why not, to invoke the mock-"Lugano
Report" that the brilliant social critic Susan
George "liberated" from sinister elites (in her
1999 Pluto Book of the same name), allow AIDS to
"depopulate the vast underclass"?
A related position is that AIDS is killing workers
and low-income consumers at a time when South
African elites in any case are adopting capital-
intensive, export-oriented accumulation
strategies. Already a decade ago, a top banker
explained, on-record (when I was reporting for
National Public Radio): "As the numbers of sick
and dying soar, the entire nature of the labor
market will change drastically. There is likely to
be even added incentive towards mechanisation and
automation. The market could shift from a volume
market to a quality market. The overall ceiling to
the domestic market makes it imperative to promote
South African exports and to widen and strengthen
the range of exports." AIDS and neo-liberalism are
thus synthetic in cause and effect.
I've begun this critique by focusing on the most
insane reasons for not treating HIV+ pregnancies
with anti-retrovirals, and for not taking AIDS
seriously. Some, like Gazi and Professor Thomas
Coates of U.Cal's AIDS Research Institute conclude
that the SA government is "genocidal." Making the
case for mother-child transmission treatment to
the public last year, Gazi was suspended from a
government hospital supervisory position for
asserting that the SA health minister should be
charged with murder. Instead of shutting him up,
the state made Gazi a martyr, and in his Eastern
Cape province public health practice, he has been
spending his own personal funds giving pregnant
HIV+ women the needed doses of AZT.
However, if Gazi is trying to reverse the basic
logic of South African capitalism, as articulated
by representatives of a fundamentally uncaring
state and capitalist class, which simply refuses
to pay the bill for kids deemed unnecessary for
capitalism's reproduction, his will be a long
professional martyrdom.
The second broad point above is a fear by the
state that the floodgates might open if mother-
child transmission becomes an initial wedge for
providing more general treatment to low-income
people. Giving anti-retrovirals to the country's
4.2 million HIV+ residents would--under present
pharmaceutical-pricing constraints--cost roughly
$12 billion per year, according to Zwile Mkhize,
the KwaZulu Natal provincial minister of health.
The vast majority of treatment costs would have to
be subsidized by a state whose entire annual
budget is less than $40 billion and whose budget
for HIV prevention is less than $25 million.
But while the cost of treatment access to all who
need it does initially appear insurmountable, two
rebuttals quickly emerge. First, determinations of
fiscal priorities still reflect durable apartheid-
era political-economic power. The society's
transformation was closely monitored by financial
interests, who demanded drastic cuts in the state
budget deficit (from 9% of GDP in 1993 to less
than 3% today) in the context of a "homegrown"
structural adjustment program and dramatic
corporate tax cuts (from 48% in 1994 to 30%
today). Moreover, activist campaigns like Jubilee
2000 South Africa's call to repudiate tens of
billions of dollars in inherited apartheid-era
local and foreign debt were dismissed as dangerous
by financiers and their comprador friends in the
new government's Department of Finance. (The
revolving door works well, as the three main
authors of the structural adjustment plan left
government to join Deutsche Bank, Investec Bank
and Standard Bank earlier this year.)
Yet debt repayment is the second-largest budget
expense, accounting for more than $6 billion a
year. A controversial new high-tech military
spending package adds nearly another billion
dollars a year. Dramatic shifts in spending
priorities, including a dramatic kickstart to the
economy through widespread public-works projects
(rejected by the neo-liberal Department of Finance
as inflationary), would change the basic
parameters.
The even more decisive rebuttal to the argument
that treatment for all HIV+ South Africans is
cost-prohibitive comes, ironically, from the
government itself. This is the crucial initial
point, above. For in 1997, parliament passed the
Medicines Act, which provides for the Department
of Health to override the Trade-Related
Intellectual Property (TRIPS) provisions of the
World Trade Organisation agreement which South
Africa joined in apartheid's dying months. Those
legal provisions indeed are malleable, allowing
violation of patents in cases of extreme
emergencies, such as AIDS. It should therefore
have been uncontroversial for the SA government to
import cheap drugs (at less than 5% the cost they
are sold locally) from markets like India and
Brazil, or to permit local generic production of
such drugs. That in turn should have negated the
cost-prohibitive argument entirely.
But given the lucrative upper-income (mainly
white) medicines market in South Africa, the major
transnational pharmaceutical companies quickly
objected to the Medicines Act. The country lost
many thousands of people to curable opportunistic
infections while the legality of the patent
violation clause was contested in court. The often
explicit threat was that if the Medicines Act
prevailed, the companies would disinvest from SA.
Only late last year did the firms put their
opposition on hold, and that was only because
another extraordinary barrier to cheaper treatment
of HIV+ South Africans was finally overcome: Al
Gore.
The US vice president conducted a "full-court
press"--in the words of a rabid US State
Department official bragging to Congress in a
February 1999 report--against Mbeki to drop the
"offending language" in the Medicines Act. The
pressure included various punitive trade and aid
measures. South Africa's crime was not only its
1997 law, but also advocacy of similar global
provisions in the form of a mid-ranking health
official's 1999 speech to the World Health
Organisation.
Not only did Gore directly assault South Africa's
ability to conduct economic policy-making and
cheapen vitally-needed medicines, he was now also
attacking the newly-democratized government's
freedom of speech in international fora!
Two crucial reasons seemed to motivate Gore: the
broad principle that US companies with
intellectual property rights should not concede
any exception to their product hegemony; and
campaign contributions by major pharmaceutical
firms.
In a May 1999 report, The Center for Responsive
Politics recorded recent bipartisan gifts to
politicians by Pfizer, Bristol-Myers Squibb, Eli
Lilly, Glaxo Wellcome, Novartis and five other
firms: "Long one of the most powerful lobbies on
Capitol Hill, the pharmaceutical industry spent
nearly $12 million in soft money, Political Action
Committee, and individual donations during the
1997-98 elections--a 53 percent increase over
donations during the last mid-term elections."
Ralph Nader's associates in the Consumer Project
on Technology also documented other close personal
links between Gore and major pharmaceutical firms.
Luckily for HIV+ South Africans, a vibrant
"Treatment Action Campaign" emerged in 1999, held
protests at US consulates in Johannesburg and Cape
Town, and began networking with the Consumer
Project as well as with the Philadelphia core of
ACT UP. Activists pledged to dog the 2000
presidential campaign with banners and in-your-
face hits: "No Medical Apartheid!," "Gore's Greed
Kills!" "AIDS Drugs for Africa Now!" Gore was
confronted repeatedly and aggressively in
Tennessee, New Hampshire, California and
Pennsylvania at the very outset of his campaign.
Numerous newspapers carried front-page stories on
Gore's quandary.
Within weeks, the vice president's own Cost-
Benefit Analysis showed the danger of siding with
the corpos, whose millions would not offset a
campaign fiasco. In a September 1999 meeting with
Mbeki in New York, Gore conceded the validity of
the SA Medicines Act. With Thailand also making
noises about obscene drug prices and with tens of
thousands of protesters in the streets, President
Clinton agreed at the Seattle WTO summit not to
push for a harder-line TRIPS protection for US
pharmaceutical companies. (The firms reacted with
promises of cheaper, though not free, drugs, which
in turn were spurned by activists as too little,
too late. When faced with the prospect of local
production, drug companies changed the subject by
announcing offers of free medicine, which in fact
have never materialized.)
The South African government then failed to take
advantage of the space, as Mbeki searched for
excuses not to implement aggressive anti-AIDS
strategies instead of pursuing the parallel
importation or generic production options. Indeed,
so retrograde was the recent backsliding that at
the Durban AIDS conference last week, maverick
member of parliament Winnie Madikizela-Mandela
accused her government of being "an obedient
servant of multinational companies that continue
to put their profits above our people."
According to greatly-respected HIV+ activist (and
acting SA Constitutional Court justice) Edwin
Cameron, in his keynote speech to the conference,
"The drug companies and African governments seem
to have become involved in a kind of collusive
paralysis. International agencies, national
governments and especially those who have primary
power to remedy the iniquity--the international
drug companies--have failed us in the quest for
accessible treatment."
But even if in retrospect it was pyrrhic, South
Africa's victory over Gore and his corporate chums
was especially sweet to activists because Mbeki
had just three years earlier discounted any such
alliance. He approved official endorsement of an
ANC discussion document ("The State and Social
Transformation") which concluded: "The democratic
movement must resist the illusion that a
democratic South Africa can be insulated from the
processes which characterize world development. It
must resist the thinking that this gives South
Africa a possibility to elaborate solutions which
are in discord with the rest of the world, but
which can be sustained by virtue of a voluntarist
South African experiment of a special type, a
world of anti-Apartheid campaigners, who, out of
loyalty to us, would support and sustain such
voluntarism."
Activists in South Africa point to the Medicines
Act's drug-pricing challenge as precisely such a
"voluntarist experiment"--one that was indeed ONLY
sustained (to the extent it was) by virtue of
heroic international campaigning solidarity. It is
all the more tragic, therefore, that just as the
David-v-Goliath battle against pharmaceutical
companies--and Imperialism Central in the White
House--was won, Mbeki grabbed defeat from the jaws
of victory and began his bizarre questioning of
the link between the HIV virus and AIDS. The
broader war against AIDS took a quick turn for the
worse.
But if the arguments above are valid, the fiasco
unfolded not only because of Mbeki's mercurial
personality, and won't be resolved by a change of
mind--or even by ex-President Nelson Mandela's
closing exhortation on Friday to the Durban
conference that preventing mother-to-child
transmission should be of highest priority.
Necessary as these personal interventions are,
they are not sufficient.
The poli-econ of AIDS points out the need for a
yet more profound struggle against the underlying
assumptions and characteristics of South African--
and international--capitalism.
***
Bond's new books are Elite Transition (Pluto
Press) and Cities of Gold, Townships of Coal
(Africa World Press); his 1999 paper
"Globalization, Pharmaceutical Pricing and South
African Health Policy: Managing Confrontation with
US Firms and Politicians" was published in the
International Journal of Health Services, v29, #4,
pp.765-792. (Thanks much to Julie Davids and Paul
Davis of ACT UP Philadelphia, my housemates last
night, who helped with corrections.)
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