Buried in the hoopla over handouts thrown at the Third World is a very surprising statistic: the United States spends less than 0.1 percent of its GNP on foreign aid. It sits last on the list of the world’s 22 donor countries, if you measure aid as a share of income. Up to 40 million HIV-positive people live in the Third World, and the United Nations estimates that 8,000 people die every day from AIDS. The situation that these 40 million and growing face is this: inaccessible, highly priced medicines, a lack of treatment facilities and, often, acute social stigma. The U.N. Global Fund for AIDS, Tuberculosis and Malaria, estimates that $6.5 billion will need to be raised in 2003 and $10.5 billion in 2005 to adequately fund AIDS treatment and prevention programs around the world.
Fat chance of that happening. Jeffrey Sachs describes the Bush administration’s decision to contribute $200 million to the Global Fund this year (note the denomination — a mere 0.2 percent of an estimated $100 billion war on Iraq) as “turning a cold and steely eye away from the millions dying of disease.” We couldn’t agree more.
Antiretroviral therapy has decreased AIDS deaths in the United States and Europe by 70 percent. The therapy costs from $12,000 to $15,000 a year in this country, and until recently, it was not much cheaper in developing countries. The patents that keep drug costs high here and in other countries are fiercely guarded by the Trade-Related Aspects of Intellectual Property Agreement. Over the past three years, activists around the world have pressured rich country governments — first among them the United States, which was the primary architect of the TRIPS agreement — to clarify and modify TRIPS to allow access to cheaper generic drugs in the third world. The argument is pretty clear. People earning under $300 a year (the bulk of the world’s poor) cannot pay $12,000 for antiretroviral therapy. An increase in already healthy corporate profits is a shockingly inadequate reason for denying someone with AIDS in sub-Saharan Africa a 5-, 10-, or 15-year lease on life. The truth is drug companies make almost no profit off sales in poor countries. Africa is less than 2 percent of the world drug market. The only reason to keep prices high there was to ensure that no one started asking questions about why drugs cost so much here in the United States.
The Doha declaration of 2001 finally recognized this gaping moral vacuum in world trade legislation by emphasizing that global intellectual property laws should not prevent persons in any country from accessing essential medicines. It recognized that developing countries have the right to make or import generic drugs under any circumstances, as long as they follow certain agreed-upon procedures.
But Doha left one key issued unresolved. While countries like Brazil, Thailand and India have begun developing their own generic antiretroviral drugs (which now sell for as little as $200 a year, a far more affordable figure for Third World populations), many sub-Saharan African countries and smaller nations worldwide do not have such indigenous production capacity. They need to import — and the very logic of free trade that the WTO is based upon, which argues that countries will benefit if each specializes in what they are best at (a system economists call “comparative advantage”), suggests that they should be able to do so. To facilitate this exchange, the WTO promised at Doha to work out a system that would allow developing countries to export their generics; never mind that it tried every available tactic with the active collusion of the U.S. government to stop them from producing in the first place.
That was in 2001. How much can change in a year. Because of successful opposition to their draconian position on intellectual property at the WTO level, the United States and U.S. drug companies have placed their hopes on a series of new regional and bilateral agreements. The Bush administration’s current position on the Free Trade for the Americas Act and bilateral agreements such as those between the U.S. and Chile flagrantly undermines the Doha declaration. Its stipulations are TRIPS-“plus,” or eventually, harsher protection standards than even those guaranteed by the WTO agreement. In a further act of compassion and understanding, no agreement has been reached on the Doha issue of exporting generics, because the Bush Administration and other rich country governments have insisted on unheard-of limitations and WTO oversight; for example, that such exports be limited to certain diseases and be preapproved by the WTO.
In a country crowded with the urgently competing issues of recession, war, corporate crime, and celebrity shopping theft, it is easy to miss the fact that Bush’s efforts around HIV and AIDS represent nothing as much as a giant step backwards. But it might be hard to miss if — for instance — you were in Botswana, where there are fewer distractions and two in every five people are HIV positive.
The bottom line? The Global Fund for AIDS needs more U.S. money — $2.5 billion this year, to be precise. WTO rules around intellectual property rights need urgent revisiting. If it makes you angry that an alumnus of this University in which we study has, in fact, concertedly tried to do just the opposite, then voice your concern. Call the White House Comment Line (202-456-1111), and express your outrage. Find out more on the Campaign for Access to Essential Medicines from the Nobel Prize-winning Medecins Sans Frontieres (www.msf.org).
Bush might be comfortable knowing that he has done absolutely nothing to reduce the 8,000 deaths a day he has the power to affect. You don’t have to be. Please join a group of us from the Yale and New Haven communities at a short vigil to commemorate World AIDS Day on Thursday, Dec. 5 at 7:30 p.m. in the Dwight Hall Chapel on Old Campus. A diverse panel of speakers will discuss ways to engage the issue at Yale, in New Haven, and globally. Do come.
Amy Kapczynski is a third-year student at the Law School. Achal Prabhala is a first-year student at the School of Management. Ramnath Subbaraman is a first-year student at the School of Medicine. They are members of the Yale AIDS Network.