The Real Tragedy

The press these days is obsessed with avian flu. “Officials are preparing as though the virus is the heir apparent to the 1918 international flu pandemic, which killed more than 40 million,” says the Baltimore Sun.

Precautions are encouraging, but remember that the ability of scientists — not to mention the media — to predict the course of diseases is extremely limited.

In 1986, Newsweek forecast that by 1991, HIV, the virus that causes AIDS, “will have spread to between 5 million and 10 million Americans.” Never happened. Infections peaked at about 1.5 million, and, since 1995, the disease has been sharply on the decline.

I am not minimizing the horror of AIDS, but the disease has largely checked in the United States and Europe by education on prevention, through high-quality professional care, and, after a multibillion-dollar effort by American and European drug companies plus basic research by academic institutions, with anti-retroviral (ARV) drugs, which stop HIV from developing into full-blown AIDS.

In the 24 years since it first appeared, AIDS has mutated from a middle-class disease mainly afflicting male homosexuals in the United States to a disease of poverty, mainly afflicting heterosexuals in Africa. Last year, 2.3 million people in sub-Saharan Africa died of AIDS compared with 20,000 in Europe and the U.S. combined.

What to do?

The best antidote for AIDS, or any other disease, is prosperity. Wealth makes health. It is no accident that Africa is home to the other two global epidemics, tuberculosis and malaria. Even if deaths from the three were erased tomorrow, another scourge would flourish in Africa, where the infrastructure of prevention and cure — communication, education, roads, clean water, clinics, good health workers, and a diligent bureaucracy — is pitifully lacking.

Ending poverty is the most pressing problem in the world. While the solution is clear (free and democratic political and economic systems, guided by the rule of law and purged of corruption), the process will take decades.

In the meantime, Africans need emergency help, and they are getting it, primarily from the United States. But, unfortunately, publicity-seekers, thieves, and ideologues abound in the world of AIDS relief, and they are damaging the overall effort. For example:

_ The World Health Organization now admits it will not come close to meeting its ballyhooed “3 x 5” target, getting 3 million AIDS patients into therapy by 2005. Worse, 18 Indian-made ARVs on the WHO-approved list were either decertified or withdrawn by their manufacturers for not being “bioequivalent” to the patented U.S. and European drugs from which they were copied.

Some of the medicines have been lately reinstated, but WHO policies encourage the use of such copycat drugs, even though there is no evidence that they are less expensive, on average, than the originals and serious worry that they will promote resistance and the advent of more virulent strains of HIV, which cost 10 times as much to treat.

_ With great fanfare, the Clinton Foundation last year announced that it had negotiated a price of $140 a year for ARV treatment, about half the typical price in Africa. But that figure is a cruel hoax, as a transcript of a meeting in Mumbai between AIDS activists and officials of Indian drug companies confirms. Hardly anyone pays it.

The representative of Cipla, one of the largest Indian firms, said that the $140 offer had rigid unpublicized conditions, including “large, confirmed irrevocable orders,” which were never met. Clinton promised 200,000 patients by 2005, but another Indian drug official said that the foundation had not produced even 40,000.

An activist from Cameroon then said, “The Clinton deal is not working…. I’m surprised that you believed what Clinton told you.”

Said Cipla: “He is a very good talker.”

_ Brazil, the 11th largest economy in the world, has been threatening to seize the patents of drug companies that make ARVs. The results of such policies are already emerging. As my colleague Roger Bate has found, fewer companies are making anti-AIDS drugs. Why would you if your investment will be stolen?

The tragedy of AIDS in Africa is that, even absent prosperity, the disease could be controlled _ with honesty, integrity and faith in sound science and economic incentives. But with Clinton and the WHO, with Brazilian and African kleptocrats in the mix, I despair of a solution any time soon.

(James K. Glassman is a resident fellow at the American Enterprise Institute and host of the website