October 2000

Views expressed are those of the authors, not necessarily of the AFSC.

Naming Genocide in Africa

Attieno Davis and Meizhu Lui are long-term activists for social justice care, both locally and in the anti-globalization movement. They are currently working with Health Care For All's Boston Health Access Project.

Genocide--commonly associated with the horrible plight of Jews under fascist rule in Germany, or ethnic cleansing in Rwanda and Serbia--can be broadly thought of as conscious acts of racial, ethnic, and tribal elimination occurring under the mantle of war. But even in many nations where today there is no war, where the constant threat of bullets, bombs and land mines doesn't frame people's everyday existence, might we not still justifiably use the term "genocide" when talking about the death of whole generations of people?

Shouldn't we use this term, for instance, when discussing the probable death of Zimbabwe and South Africa's 15-year-olds? Isn't it genocide's criminal image that keeps emerging in the faces of 13,000 children, orphaned due to disease? And what might any of this have to do with a health system that claims the right to say, "Your money or your life?"

Africa today is plagued by disease, famine, and war. In the birthplace of humanity, diseases including malaria, the innocent-sounding but deadly sleeping sickness, tuberculosis, pneumonia, meningitis, and three treatable AIDS-related conditions have made death the major business on the continent. As disease and death ravage the continent, the all-knowing and too-powerful pharmaceutical industry in the west has turned its back on the plight of these countries, citing their lack of consumer power. The drug corporations fight against relaxing restrictions on drug patents, which would allow nations in need to make or purchase generic medicines.

According to a May 21 article in the New York Times by Donald G. McNeil, Jr., the bulk of the $27 billion a year invested in research by the pharmaceutical industry is spent hunting for drugs to lengthen or brighten the lives of consumers who are already relatively healthy. Among the biggest sellers are drugs to grow hair, relieve impotence, and fight cholesterol, ulcers, depression, anxiety, allergies, arthritis, and high blood pressure. Meanwhile the drugs needed to treat African trypanosomiasis (sleeping sickness), which still affects some 300,000 people every year, are out of stock.

The poor have little consumer power. According to the market research firm IMS Health of Westbrook, Conn., Africa accounts for only 1 percent of the world's drug sales, compared with the 80 percent represented by North America, Japan, and Western Europe. It's this fact that provides a stamp of approval when a Pfizer or Norvatis decides to produce medicines to treat separation anxiety, or Alzeheimer's disease in dogs. The life of a human being in Africa, the birthplace of all who walk upright, literally isn't worth that of a dog.

This fact is borne out even more clearly by the battle over "intellectual property rights." In 1994, the World Trade Organization accepted the "Trade Related Aspects of Intellectual Property Rights" agreement. Though the agreement grants countries access to participate in Western-dominated import and export trade, many developing countries have increasingly found themselves in a pharmaceutical nightmare since signing onto it.

The Intellectual Property Rights Act protects patents associated with the manufacture of brand-named drugs. Once a country signs onto the Act, it faces punishment in the form of trade sanctions or loss of investments if it buys or manufactures cheaper generic drugs. Thus the profit-making rights of big pharmaceutical makers are given primacy over the socio-health needs of developing nations.

For example, Kenya, with its health budget of $5 per citizen per year, cannot treat the majority of its AIDS patients for cryptococcal meningitis. This disease, which affects some 20 percent of the AIDS sufferers in various countries, can be treated with the drug Fluconazole, which is marketed by Pfizer as Diflucan. The drug, however, is wholesaled to that country for $8.52 per pill, a price presently out of the reach of most Kenyans. (A 1999 study by the Nobel Prize winning agency Doctors Without Borders found them ranging from $3.60 a pill in Thailand to more than $27 in Guatemala, with an average of about $10 per pill. Pfizer did not dispute the average, but said the range is smaller, from $5 in Thailand to $11 in France.The wholesale price is $6.38 in South Africa, $8.52 in Kenya and $9.78 in the US. With retail markups, the drug may sell for $40 a pill.)

An article in the July 8 New York Times quotes Dr. Christopher Ouma of Narobi, Kenya as stating that as soon as he diagnoses cryptococcal meningitis he advises patients: "If they want to be buried in their ancestral village as most Kenyans do, they should board a bus. They have only two or three weeks to live, and the cost of refrigerated trucks ruin many families." Dr. Ouma also told the Times that he must deliver this bleak prognosis at least once a week.

But disease and death's ugly shadows have awakened the resistance of peoples of the sub-Sahara and other developing areas. Increasingly, developing nations are revisiting the "Trade Related Intellectual Property Rights" agreement. A clause in the treaty, which establishes the right to bypass the patent-protecting nature of the TRIPS during a national emergency, is being explored by several countries. Growing demands are also being made that Africa stop being used as a testing ground for new research.

Zimbabwe and Brazil have been leaders among proponents of lowering the costs of the expensive HIV/AIDS medicines and protecting the right to buy cheaper generic drugs. Sub-Saharan HIV/AIDS activists have issued a joint statement criticizing the fact that pharmaceutical research conducted on the continent which indicates a possible new and cheaper treatment has yet to be publicly announced. Their June 21 letter faults the WHO and UNAIDS for what it calls "expert consultation that is being prepared at tremendous cost and waste of public resources." Their letter lists their prescription for the struggle: reducing prices for the antiretrovirals that "are inaccessible for reasons related above all to pricing" and setting up access programs in affected countries.

AIDS has killed 19 million people world wide and infected 34 million more. In Africa, according to a United Nations report on the worldwide HIV/AIDS crisis, the disease affects one of every five adults in seven southern nations. This report predicts, that the situation "is only going to get worse over the next years even if today, by some miracle, all HIV transmission would stop." These numbers, and this prediction, read like genocide, because they could have been significantly different had the US Government decided life in Africa was worth saving.

In 1983, Peter Piot asked for continued funding, to research the existence in Zaire of a virus similar to what was then being called the "Gay-Related Imminodeficiency Disease." His request was rejected by the Regan Admninistration. And throughout the 1990s, the administrators of USAID's AIDS program were more interested in cost-effectiveness than in using HIV intervention treatment programs. This outlook continued to dominate Senate and House debates until the intervention of the Black Legislative Caucus led by Sen. Maxine Waters, and groups like Act Up and Doctors Without Borders.

Today the people of Africa's Sub-Sahara need our support. One of our first acts must be to read behind the lines, ask tough questions, and refuse to be compromised. Recent announcements by several pharmaceutical companies that they intend to reduce the $15,000 price tag on the life-preserving AIDS cocktail read well until you remember the depth of Africa's poverty. In Malawi, the average yearly salary is $250, while a more stable state employee in Kenya is living on $550.

We also have to remember that none of these announcements address any of the other life-threatening diseases devastating the continent. Nor is the recent promise of a $1 billion loan an answer for people and nations struggling to climb out of the incredible holes of debt that sub-Saharan Africa is in.

The obscenely bloated US military budget, devoted to fighting mythical "rogue state" enemies and bombing places like Vieques, could promote peace and support life in Africa. Before that can happen, however, people living in America will have to decide: Is this next go-round with genocide something we can live with?

References on request.

Previous Article    Next Article