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September 11: What Happens Now?

By John S. James

September 21, 2001

Several major AIDS organizations in Manhattan were in the disaster area near the World Trade Center. It appears that everyone in those offices got out alive, although some lost friends or relatives. The long-term consequences for the global fight against AIDS, tuberculosis, malaria, and other major infectious diseases remain unknown but ominous.

Every day HIV infection alone kills more people than died at the World Trade Center and other terrorist attacks on September 11 (AIDS Epidemic Update: December 2000 by UNAIDS estimated 3 million deaths in 2000 -- over 8,200 per day -- and the numbers have risen since then). But even on September 10 the prospects for worldwide response did not look good. The epidemic did get media attention during the previous year. But it was becoming clear that the U.S. and other rich countries did not have the political will to pay more than a fraction of the cost of a serious program for controlling the disease. (The total cost would be about $10 billion per year from the entire world -- about $2 billion from the U.S. if the cost were shared in proportion to the size of each country's economy.) The problem wasn't lack of money; in just one week after the September 11 attack, the U.S. had found and signed into law $40 billion -- money no one had thought about, let alone proposed, just seven days before.

We still believe as we did on September 10 that ultimately there is enough interest and good will in the U.S. to support a proportional contribution to the money and leadership of an effective worldwide AIDS and infectious epidemic program. The central problem is that nobody has found an effective strategy for dealing with the three fundamental political divisions that have always blocked an effective response to the epidemic.

  1. The international pharmaceutical industry is more interested in protecting its patent rights than in controlling the epidemic. Some companies cut prices to some poor countries by 80 to 90 percent when they had to, but then largely washed their hands of the global problem, leaving drugs that will largely remain unused (except for prevention of mother-to-infant transmission) because they are still so far beyond reach. There is no plan that pharmaceutical companies, medical professionals, and activists can get behind enthusiastically and bring to Congress, international agencies, foundations, and other decision makers (as they can with the AIDS Drug Assistance Program for funding treatment for U.S. patients).

    Industry so far has tried to lead an unworkable campaign to preserve drug patents everywhere, with piecemeal charity for some poor countries -- negotiated between each country and company, revocable any time, and with secret political quid pro quo. What could work instead is to preserve drug patents in rich countries while relaxing them in poor ones where there is no significant market anyway, then pushing for global funding for systematic bulk purchases, which can and should be profitable to the patent holders (we want them with us when going to funders). Countries neither rich nor poor will need a mixed system. This approach could greatly relieve the global access problem -- and end industry's horrible public relations from people dying because they cannot pay impossibly high prices for needed medications. Events are already moving in this direction, but with industry impeding this solution instead of helping to lead it (for example, see "U.S. and Switzerland Oppose Developing-Country Proposal on Access to Medicines," in this issue).

  2. Also critically important is the conflict around sexuality throughout the world, and the resulting stigma around AIDS. A great many individuals and institutions have so much invested in saying "No!" that they find it difficult to pivot emotionally and be helpful to someone infected through sex or drugs, or to support measures to make behavior they oppose less dangerous. As a result, it is hard to mobilize consistent support for rational, can-do responses to this worldwide health emergency.

  3. In addition, the HIV epidemic increasingly affects mostly the poor, whose life and death interests are usually not taken seriously. This problem increases with the growing inequality in the modern world.

All this was in place on September 10, and still is. No one can predict what will happen now. Some concerns:

Yet there has also been more solidarity among Americans in the week and a half since the disaster -- from willingness to help those affected, to expressions of patriotism, to activism for peace, to people being less isolated from each other in everyday life.

No one can predict what will happen. There is no U.S. precedent for the attack of September 11 -- and few attacks in any country with so many killed and so little warning. We can only do our best work each day.


ISSN # 1052-4207

Copyright 2001 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.


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