Wall Street Journal - June 28, 2001
George B.N. Ayittey*

The toll of AIDS on sub-Saharan Africa is at once incomprehensible and chilling. As a succession of African leaders have reminded us this week at the United Nations AIDS conference in New York, seven out of 10 people living with AIDS in the world are Africans.

Twenty-five million Africans are infected, and 90% of them don't even know it. This year, the number of AIDS orphans will reach 13 million, a figure equal to the population of London. Africa has already lost 12 million people to AIDS -- that's more than Africa has lost in all its wars. The World Bank estimates that $3 billion a year is needed to combat the HIV/AIDS epidemic in Africa.

The economic toll is no less hard to imagine. AIDS is decimating Africa's labor force, killing the youngest and strongest at a disproportionate rate, and further crippling its efforts at economic recovery and development.

In an impassioned appeal, U.N. Secretary General Kofi Annan called this week for a "global war chest" of $7 billion to $10 billion a year to battle AIDS. The Bush administration has promised $200 million, the British a matching sum, and the Canadians about one-third of that. One can never be sure how much of this will actually be raised, and how much is merely the expression of good intentions. But after bickering over the inclusion of words like "homosexuals" and "prostitutes," the conference patched together an essentially rhetorical document, calling on governments to reduce infection rates and protect those at risk.

Such gestures will not affect the spread of the disease in Africa. Nor will the constant clamor of AIDS activists, who continue to target the pharmaceutical industry, accusing it of putting profits ahead of lives by refusing to lower the cost of drugs for poor African patients.

Merck, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, and Hoffmann-La Roche have offered to sell their AIDS drugs to poor nations at cost. Since "at cost" is still beyond the means of most Africans, activists are geared up to put more pressure on the industry for further price reductions, principally through a weakening of international intellectual property rules. This is the wrong approach. For a disease which has no cure, prevention is a better approach.

Notwithstanding their noble intentions and concern for AIDS sufferers in Africa, activists have pushed this campaign into dangerous territory. The exclusive focus on drug prices has left a number of major players off the hook and, consequently, has the potential of exacerbating the epidemic. It's also ironic, since it is the pharmaceutical industry that is spending billions of dollars in R&D to find better treatments and, one day, hopefully, a cure.

Let's take African leaders. It is incomprehensible that they should continue to spend scarce resources on the procurement of arms to oppress their people, and to prosecute senseless civil wars. Each year, African governments spend more than $8 billion on new weapons and the military. The South African government alone has just spent $5.5 billion on new arms purchases. The 14 or so conflicts currently raging on the continent have created about 12 million refugees -- more than half of the world's refugee population.

The refugees, in turn, serve as easy targets for sexual predators and breeding grounds for the AIDS virus. West African peacekeeping soldiers fathered some 25,000 children in Liberia. According to Teniola Olufemi, coordinator of the Ecomog Children Project, the Nigerian contingent accounted for 50% of the cases. In addition, the health-care systems required to deliver and administer AIDS medicines have collapsed in many African countries, as has the infrastructure of roads, electricity, water, communications and other basic requirements for an effective response to the epidemic. Besides, cultural taboos and outdated myths in polygamous societies are a major obstacle to detection and treatment.

Even African public-health experts have themselves warned that unless public-health systems are strengthened, the benefits of cheaper AIDS drugs could be undone by ineffective distribution or misuse, leading to the development of new strains of drug-resistant viruses. The South African government, for example, now admits that the health system must be upgraded before the drugs -- even at lower prices -- can be safely distributed in the public hospitals. At a recent meeting on AIDS in Abuja, the Nigerian capital, an expert warned that there was great opportunity for corruption in selling and distributing AIDS drugs. Other Nigerian experts say that studies have found that pills sold over-the-counter to the poor are often counterfeit or substandard.

But will common sense ever prevail? The organizers of the U.N. AIDS session -- Ambassadors Penny A. Wensley of Australia and Ibra Deguene Ka of Senegal -- vowed to move the conference beyond the issues of drug prices and accessibility. But to no avail: The official debate focused largely on the cost of AIDS drugs. African governments and AIDS activists should refocus their energies on removing the real obstacles to achieving a lasting solution to the world's worst epidemic. A solution will remain beyond our reach if there continues to be an excessive focus on drug companies and patents. This not only distracts attention from the delivery and prevention aspects of combating the disease, but also shields African governments from responsibility for its lightning, and lethal, spread.

* Mr. Ayittey, a native of Ghana, is a professor at American University and president of the Free Africa Foundation in Washington. He is the author of "Africa In Chaos" (St. Martin's Press, 1998).

010628
WJ010623

Copyright © 2001 - The Wall Street Journal. Reproduction of this article (other than one copy for personal reference) must be cleared through the WSJ Permissions Desk.

ÆGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

ÆGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1990, 2000. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.