producing epiphanies (was Re: Thousands protest Barak in Chicago)

Patrick Bond's article shows a tragic and didactic story. It allowed me,
for the first time, to put together coherently the bits and pieces which
I was aware of, but ignorant on how they fit together.

This story deserves to be told more widely. It shows the interconnection
between themes like corporation-driven international politics,
cooptation of local elites, regression of human rights and manipulation
of minds. Writers can use this article to illustrate the connection
between dying children, Big Medicine, intellectual property rights and
American foreign policy.
Millions of decent people are concerned by the
mistreatment of children but cannot see how it is connected with
political issues. Told to such people, a story like this one shows how
governments can value corporate greed above children's health. If the
drama of trees and wildlife is one way to raise consciousness, and
ecology has found its way into children's books and TV scripts, then
what about *this* evolving thriller? It has the power to inspire
epiphanies -- the revelation that one's human concern for others is
powerless if it does not find political expression.

Petros Haritatos, Athens

-----Original Message-----
From: Patrick Bond <pbond@wn.apc.org>
To: Tarik Kiley <mostrue@excite.com>; wsn@csf.colorado.edu
<wsn@csf.colorado.edu>; p-gomberg@csu.edu <p-gomberg@csu.edu>
Date: Τετάρτη, 15 Νοεμβρίου 2000 9:14 μμ
Subject: Re: Thousands protest Barak in Chicago


> From:          Paul Gomberg <bijhpgo@csu.edu>
> I had in mind the refusal by the South African government to launch a
> campaign against the AIDS pandemic there. This has led Mbeki to
question
> the role of HIV in AIDS.
> Mbeki spokesman Parks Mankahlana explained by the government would not
> porvide nevirapine to prevent mother to child transmission of HIV:
"That
> mother is going to die and that HIV-negative child will be an orphan.
> That child much be grough up. Who is going to bring the child up. It's
> the state, the state. That's resosurces, you see?" Did the apartheid
> racists ever say or do anything worse?
> Conditions for the South African working class continue to
deteriorate.
> This is what nationalist "liberation" achieved for the South African
> working class.

Can't disagree:

(ZNet Commentary, July 2000)
A Political Economy of South African AIDS

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.)

Patrick Bond (pbond@wn.apc.org)
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:  bond.p@pdm.wits.ac.za
work phone:  (2711) 717-3917
work fax:  (2711) 484-2729
cellphone:  (27) 83-633-5548