Numerous reasons are given why AIDS has engulfed the African continent, ranging from lack of birth control to poverty to government inaction - both within Africa and in the West. But none, perhaps, has frustrated activists more than the high price of drugs aimed at fighting the disease.
With few exceptions, Western medicines are too expensive for Africans to afford. While there is currently neither a cure nor a vaccine for AIDS, medical experts say drugs now available could slow the spread of HIV and prolong the lives of AIDS victims.
At the International AIDS Conference in Durban, South Africa, activists and politicians accused large US drugmakers of putting profits before compassion in the face of a global epidemic that affects 35 million people - most of them in sub-Saharan Africa.
Much of the criticism focuses on the unavailability in Africa of fluconazole, a drug credited with fighting one AIDS complication that now results in death for many Africans.
But the dispute also touches a larger moral issue: whether global capitalism should set aside the profits for humanitarian concerns, and how actively Western governments should share their wealth when developing nations face a crisis of this scale.
"The drastic imbalance [of] resources is costing millions of lives a year," said Peter Pirot, the top United Nations official dealing with AIDS, in an address to the conference. "The entire world must do more."
The scope of the problem is staggering.
Seven African nations have more than 1 adult in 5 infected with HIV, the virus that can result in AIDS, experts say. In Botswana, 35 percent of adults are infected. AIDS has made orphans of some 13 million children.
Last year, the US government gave about $200 million to global AIDS prevention, and future tallies are expected to be much higher. Other countries give far less. Yet it is the pharmaceutical firms that, for now, have come under the most fire, because critics say only they hold the keys to containing the disease.
"There's a global health crisis of historical proportions, and there's an existing set of treatments that allow people to live indefinitely with the disease," says Robert Weissman, the co-director of Essential Action, a Washington-based advocacy group. "But instead of trying to deliver medicine to the sick, we are worrying about the intellectual rights of the pharmaceutical companies."
Weissman and others argue that the US, the World Trade Organization (WTO), and the pharmaceutical industry have made it difficult for poor countries to produce or import generic versions of drugs that they otherwise cannot afford.
Fluconazole, made by Pfizer under the brand name Diflucan, costs as much as $17 per day in Africa, for example, while a generic version might sell for 30 cents. Weissman says the drug can change a patient's life expectancy from weeks to years.
WTO member nations can override patents, such Pfizer's patent on Diflucan, if they face a domestic emergency or crisis in public health. But that criterion has proved hard to meet, and attempts to do so have at times drawn the threat of economic sanctions from the US.
Behind US reluctance to let countries make generic drugs is the pharmaceutical industry's power, says Daniel Berman of the aid group Doctors Without Borders.
"The [drug] companies are hesitant to give up their markets," he said in a telephone interview from Durban.
The US government and drugmakers have begun some efforts that would bring down the drug prices.
In May President Clinton signed an executive order that lets sub-Saharan African countries bypass intellectual property-rights regulations for expensive AIDS drugs. But so far, "things have not changed on the ground," says Mr. Berman.
Five companies have announced initiatives to give free drugs to sub-Saharan Africa, but with restrictions and distribution issues that make some observers skeptical of the impact. Merck & Co. announced this week that it and the Bill and Melinda Gates Foundation would donate $100 million to fight AIDS in Botswana. And Pfizer is in talks with South Africa to supply free fluconazole in a carefully regulated two-year program.
"We want to evaluate how much impact the program has on survival," says Jack Watters, Pfizer medical director for Africa.
Critics call Pfizer's program a "clinical trial" and say the company should supply the medicine without conditions.
But Pfizer maintains that its approach is backed by doctors in South Africa. And it says careful regulation is needed to prevent corruption or diversion of supplies.
"There's no guarantee that the drug will find its way to the people who need it most," Mr. Watters says.
Meanwhile, Glaxo-Wellcome of the UK and Boehringer of Germany have hesitated to make drugs available that greatly reduce the percentage of babies who catch HIV from their mothers at birth, activists say.
Bristol-Myers Squibb got in a patent dispute with Thailand and forced that country to make a medicine in powder form rather than a pill.
But even in rich countries, drugs' impact has been limited. Some successful drugs have lost effectiveness as resistant strains of HIV have developed, experts say.
But for Weissman, "The overriding point is that, no matter what kind of charity companies dole out, countries should have the right to make generic drugs."
(c) Copyright 2000. The Christian Science Publishing Society