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January 23, 2000, Sunday ,THIRD EDITION
SECTION: NATIONAL/FOREIGN; Pg. A1
LENGTH: 1619 words
HEADLINE:
HOLBROOKE PUTS UN FOCUS ON AFRICA'S WARS, AIDS
EPIDEMIC
BYLINE: By Sam Allis, Globe Staff
BODY:
NEW YORK - It's Africa month
at the United Nations, produced and directed by Richard Holbrooke.
As
impresario, the US ambassador has earned kudos for using his role as temporary
president of the Security Council to orchestrate an unprecedented focus on the
troubled sub-Saharan region. From Vice President Al Gore to
Nelson Mandela and a half-dozen sub-Saharan leaders, Holbrooke has assembled a
strong cast to deliver a pointed message to UN diplomats and the rest of the
world that, morality tone poems aside, war and an AIDS pandemic
will destroy the continent if left unaddressed. And they threaten the rest of
the world as well.
Yet when Holbrooke turns over the seat to his
Argentine counterpart at the end of the month, the limits of rhetorical power
will be clear. After the wave of Africa oratory has crested,
the same intractable issues will remain.
To wit: How can the bloodshed
in Burundi, the Congo, and Angola be stopped for good? How can the sexual
behavior of men and women in the region be altered to reduce HIV transmission
rates? Where is the moral and political backbone of African leaders to stop war
and destigmatize HIV? What is the proper posture of the developed world in
general, and the United States in particular, in all of this?
And,
perhaps thorniest of all, what role will the pharmaceutical giants play in an
African AIDS solution?
Holbrooke has lauded Gore for
his UN address Jan. 10 on AIDS at the first Security Council
meeting in the organization's history to address a health issue. Gore promised
at that time to help poor countries obtain anti-HIV medicine at affordable
prices, and pledged to increase by $100 million the US
commitment to fight AIDS in Africa, bringing
the total for its worldwide program to $325 million.
Neither Holbrooke nor Gore has provided specifics about how such
inexpensive medical help will materialize. And while the increase in funding is
admirable, it remains puny compared to the $1.6 billion that
the Clinton administration proposed last week in foreign aid to
Colombia to fight the drug war there. In Washington Realpolitik, drugs at home
trump AIDS abroad.
The Security Council meeting on
AIDS was historic less for the presence of Gore, the first
sitting vice president to chair the body, than for the belated recognition that
health crises are security concerns.
It shattered the distinction
between "soft" and "hard" issues, according to Holbrooke, that has been
delineated by Joseph Nye, head of Harvard's John F. Kennedy School of Government
and a former Clinton State Department official.
"Many of us have
believed since the end of the Cold War that the definition of security had to be
broadened to include these issues," Holbrooke said in an interview last week at
his office across the street from the United Nations. "Joe Nye should stop
making those distinctions, because while they may work as a taxonomy at the
Kennedy school, they work to the disadvantage of his goal in the real world."
Semantics aside, the harrowing numbers are now familiar to much of the
public: More than 22 million people in sub-Saharan Africa carry
HIV, almost 14 million have died from the disease, another 30 million will die
in the next 20 years. Each day, 11,000 new HIV infections occur.
As
public awareness grows, so will the pressure on pharmaceutical giants like
Bristol-Myers Squibb, Merck, and Glaxo Wellcome to provide, at reduced cost or
for free, more of their life-saving anti-HIV medicine such as AZT, 3TC, and
protease inhibitors.
At the World Trade Organization meeting last month
in Seattle, Clinton offered vague words about relaxing the international
intellectual property laws that protect the rights of the
pharmaceutical companies over the drugs they have invested hundreds of millions
of dollars to develop.
"Intellectual property
protections are very important to a modern economy," Clinton said. "But when HIV
and AIDS epidemics are involved, and like serious health care
crises, the United States will henceforward implement its health care and trade
policies in a manner that ensures that people in the poorest countries won't
have to go without medicine they so desperately need."
No one knows just
what this means. But some in the pharmaceutical industry are clear about what it
will not tolerate. "We are not willing to abandon our intellectual
property rights," said Shannon Herzfeld, vice president for
international affairs of the Pharmaceutical Research and Manufacturers of
America, the Washington-based industry trade group. "They are our lifeblood."
Most of the large outfits Herzfeld represents have launched their own
projects in sub-Saharan Africa to improve the health care
delivery systems there. Last year, for example, Bristol-Myers launched a
$100 million program called "Secure the Future" to train health
care professionals and build health infrastructures in five countries.
According to the World Bank, sub-Saharan countries spent about
$5 per person on health care between 1990 and 1995. The annual
per-capita income in the region, excluding South Africa, is
about $300. Activists concede that these countries would be
unable to distribute and monitor anti-AIDS medication today
even if the pharmaceuticals decided to give away their medicine to the
HIV-infected poor.
Critics have dismissed such efforts as window
dressing. "A few million dollars here and a few million there do not constitute
a good-faith effort," said Sandy Thurman, who heads the White House
AIDS office. "At the end of the day, somebody has to budge."
The industry as a whole has yet to consider a comprehensive, long-term
program addressing the incendiary issue of reduced pricing of their
anti-AIDS drugs for poor African countries.
At the root
of their hesitancy is the specter of activists in this country demanding similar
discounts here as well. And if the industry bends on AIDS, what
about heart disease? Or hypertension? Where do you draw the line? Also, more
than 90 percent of new HIV infections occur in developing countries that are
least able to pay for treatment.
Differential pricing scares the
pharmaceuticals. "As an industry, we can't address that. The individual
companies make those decisions all the time," Herzfeld said, referring to a
tiered approach. "I don't think we can get together and carve up the world in
terms of pricing."
Holbrooke doesn't buy it. "They have to," he
countered. "This is a catastrophic epidemic of plague dimensions. They are all
beginning to recognize, belatedly, that the policy has to evolve."
Yet
movement has been glacial. Peter Young, who used to direct Glaxo Wellcome's
global HIV business and now runs Alphavax, a small North Carolina biotech firm
working on an AIDS vaccine, knows the industry well.
"If the industry had been dealing with this whole thing constructively,
they could have preempted a lot of this," he said. "It's always an easy choice
to stay in the bunker. Most at this point are keeping their heads down and hope
it will just move on."
Some activists are about to mount a public
campaign vilifying the pharmaceutical groups to force them to bend. The Rev.
Eugene Rivers, the Boston minister who has launched a much-publicized program to
change sexual practices in sub-Saharan region, is girding for battle.
"The utopian view, which will go nowhere, is that they should surrender
their claims on intellectual property. It's a silly
proposition," Rivers said. "The more realistic is a knock-down, drag-out public
fight that will lead to a negotiated settlement. There has not yet been a
full-scale movement to transform them into the moral equivalent of Bull
Connors."
Strong stuff. And counterproductive, according to Seth
Berkley, president of the International AIDS Vaccine
Initiative, a New York-based nonprofit group that works with pharmaceuticals to
find a cure. "That's the worst thing we could do," he said of the Rivers
stratagem. "They need carrots, not sticks. Our challenge is to get them to the
table. You have to protect intellectual property. Otherwise, a
company will say, 'We'd rather make Viagra.' "
Funded in part by Bill
and Melinda Gates, who have donated $25 million, the
International AIDS Vaccine Initiative has a pot of
$80 million to provide venture capital to biotech companies
working on an AIDS vaccine. Rather than take an equity
position, it gains the marketing rights for the drugs, at cost, plus a small
percentage in developing countries.
Berkley is convinced that tiered
pricing is critical to an AIDS solution in
Africa. But the pharmaceuticals need the political cover of
governments to adopt that approach. Thus far, such backing has been absent,
according to Young.
"Western governments must aggressively say that
differential pricing must be part of the picture," he said. "I can't think of a
single Western government that has made an official statement that they applaud
differential pricing, or that they will structure tax breaks or incentives based
on price breaks."
Holbrooke agreed with the tiered approach in
principle, but he steered clear of the specifics that flummox all sides. And he
flatly rejects the notion that the United States can affect change in the sexual
behavior of sub-Saharan Africans. "This is the role of the local leaders," he
said. "Even if we want to, the United States cannot go out and do this."
His month of focus on Africa, then, is a campaign of
words. The hard part must occur elsewhere. Come February, his rhetorical
playbook on the AIDS pandemic gets thin. Then, when the klieg
lights are dark, it remains to be seen what his January offensive will have
produced. One need not be a cynic to wonder.
GRAPHIC:
PHOTO, The US envoy, Richard Holbrooke (right), and Secretary General Kofi
Annan, flanking Senator Jesse Helms as he spoke to the UN last week. / REUTERS
PHOTO
LOAD-DATE: February 12, 2000
