Fighting AIDS was supposed to show George W. Bush's softer side. "Seldom has history offered a greater opportunity to do so much for so many," he said in his State of the Union address this past January.
He has since reconsidered, deciding instead to offer a few more opportunities to the few. First he handed the top job of his Global AIDS initiative to a Big Pharma boss, then he broke his $3 billion promise of AIDS relief and now there are concerns that he may sabotage a plan to send cheap drugs to countries ravaged by AIDS.
This past August, the World Trade Organization announced a new deal on drug patents that was supposed to give poor countries facing health problems the right to import generic drugs. But the deal seemed unworkable: the United States, at the behest of the pharmaceutical lobby, had successfully pushed for so many conditions that the agreement exploded from a straightforward fifty-two words to a sprawling 3,200-word maze.
Countries wanting to import cheap generics must jump through multiple hoops to prove they are truly in need, unable to afford patented drugs and incapable of producing the medicines domestically. Meanwhile, there is no guarantee that there will be a sufficient supply of drugs for them to buy, since the deal also puts up hurdles for countries wanting to export.
"A 'gift' tightly bound in red tape," declared a coalition of NGOs, including Médecins Sans Frontières and Third World Network.
Perhaps that's why US Trade Representative Robert Zoellick praised the agreement. So did Harvey Bale, the premier spokesman for Big Pharma and director general of the International Federation of Pharmaceutical Manufacturers Associations. Bale, who had lobbied against the deal, told Reuters that the latest neutering resulted in "a fairly balanced text" that "adds clarity."
But now something unexpected is happening. The Canadian government, under intense pressure from AIDS activists and the United Nations, is trying to put the WTO agreement into practice. In September, the government announced plans to amend its patent law to allow the manufacture of generic versions of patented drugs exclusively for export to poor countries.
African AIDS groups have hailed the plan as a breakthrough, especially if it spurs more countries to suspend patent protections to export generic drugs to countries in need. And the need is huge. Of the roughly 30 million Africans with HIV, 4.1 million need antiretroviral drugs, yet only 50,000-75,000 have access to them. The World Health Organization has pledged to get 3 million people into treatment by 2005. That would require a minimum of 6 million pills a day, a demand that cannot be met by the current generic drug suppliers alone.
All of a sudden, Harvey Bale is not pleased. The agreement he praised when it was just a feel-good press release is now, according to Bale's recent statements, a "dead end" and "window dressing," resulting in a "negative black eye for Canada."
Bale has pulled out all of Big Pharma's favourite myths: Africa doesn't need cheap drugs, it needs infrastructure (it needs both); brand name companies have already slashed their prices to compete with generics (discounted brand versions are still at least twice as expensive); weakening patents will hurt corporate profits and destroy the incentive for new research (Africa accounts for roughly 1 percent of the $400 billion pharmaceutical industry's total sales).
Now that the pharmaceutical lobby has let its opposition be known, all eyes are on are Washington. Will the United States try to block the Canadian initiative or water it down-and if so, how?
Canadian officials say they fear that the Bush Administration's weapon will be the North American Free Trade Agreement. NAFTA permits governments to suspend drug patents if the drugs are "predominantly" for domestic purposes but makes no explicit allowances for exports to other countries.
For the past two years, US trade negotiators have haggled over the details of the WTO drug deal, eventually signing it. If the United States now uses NAFTA to kill or weaken the plan just when promises are turning into medicines, it would be a staggering display of bad faith, even by Bush standards.
Any government considering joining the Free Trade Area of the Americas should be hearing deafening alarm bells right now. The patent protections in the draft FTAA agreement are even tougher than those in NAFTA; if it is adopted, as the Bush Administration hopes, the United States could try to block affordable drug exports anywhere in the Americas. Put simply, the Administration is rigging bilateral and regional trade deals to undermine any attempt by poor countries to exercise their rights in the multilateral sphere.
Canada could well win a NAFTA challenge, but there is no indication that Ottawa is up for the fight. Paul Martin, the man set to become Canada's next Prime Minister, has stated that Canada's "number one challenge is keeping that American border open." If it looks like the AIDS drug initiative would place that goal in jeopardy, the Canadian government's newfound courage could quickly evaporate.
At a press conference on October 7, Zoellick left the door open for a NAFTA challenge, calling Canada's plan a "very fine step" but adding, "we, of course, would expect that Canada would maintain the rules we agreed on."
Bush's AIDS strategy is far less ambiguous. His $3 billion a year AIDS pledge has been whittled down to $2 billion, possibly much less. And on October 3, the Senate approved Bush's choice to head his global AIDS initiative: Randall Tobias, former CEO of drug giant Eli Lilly, charter member of the industry group leading the charge against the Canadian plan.
Tobias's appointment is a bit like trusting the CEO of ExxonMobil to lead a government effort to promote solar power. The Bush Administration insists that Tobias, who is holding on to his Eli Lilly stock, will not use the job to do Big Pharma's bidding and will support the use of generics if they are cheaper.
The first test will be whether Randall Tobias joins his old friend Harvey Bale to declare war on an initiative that could save millions of lives. A version of this column first appeared in The Nation.