TCS Daily

Lords of Poverty

By James Pinkerton - July 12, 2004 12:00 AM

BANGKOK -- I don't question the seriousness of the AIDS crisis. I do, however, question the seriousness of the AIDS response. And an un-serious response -- in which posturing for the media displaces saving people's lives -- could prove to be catastrophic. Not only will millions more die of AIDS as a consequence of such planetary showboating, but the basic system for developing cures to new maladies could be annihilated in a spasm of plundering political correctness.

Exhibit A in the unseriousness-can-have-serious-consequences argument is the so-called "World AIDS Summit." It kicked off Sunday night as UN Secretary General Kofi Annan gave the usual speech that worldocrats love to listen to -- an oration that combines a pat on the back with a call for a bigger budget. "Thank you, Thailand," he began. But then came the real meat of Annan's message: "We are not doing nearly well enough." Of course, in using the plural first person pronoun, he meant no real criticism of his audience; in the favored rhetoric of the careerist compassionate class, it's always a certainty that those in the audience are doing their utmost -- they came all the way to Thailand, didn't they? Instead, the "we" refers to the world, particularly "stingy" governments, corporations, and foundations. It is they that can always do better, serious-money-wise.

The official title of this conference is "The XV International AIDS Conference"; looking at those Roman numerals, I couldn't help but think of another megamedia event that attracts millions of people, and their billions of dollars, from around the world -- the Super Bowl. Indeed, while "XV" doesn't have a huge television audience, it's got everything else: crowds of well-heeled -- or at least well expense-accounted -- visitors, celebrities (reportedly including Oprah Winfrey, Richard Gere, and Ashley Judd), even an elephant parade straight out of "The King and I."

But picturesque as it is, Thailand is no sleepy, Third World country. It has an AIDS problem, to be sure, but the 65 million Thais all seem to know English or want to learn the door-opening language of globalization; they are focused on gadgets, technology, and generally getting ahead. Bangkok reminds me of Tokyo 30 years ago -- nowhere to go but up. And part of that upward mobility means improving its balance of payments by taking as much money from tourists -- oops, I mean anti-AIDS activists -- as possible.

My first clue that Thais saw "XV" as a cash cow came when I visited the convention center here. They call it the Impact Center -- the Thais were obviously thinking "media event" when they named it -- and it could just as easily be in Las Vegas. The big difference is that the security guards are more polite and spiffier; many of them clicked their heels and saluted when I passed by. Inside, in the middle of the registration area, is a big booth from the government's tourism office. Yes, yes, fighting AIDS is important, the Thais seem to say. But all AIDS-fighting all the time makes Johannes and Johanna -- as usual, Nordics are enormously over-represented here -- into dull boys and girls. So why not take time off from thinking about non-nucleoside reverse transcriptase inhibitors and think instead about the Temple of the Emerald Buddha?

But before the Northern NGO people even leave the convention center, why not stop and shop? For the sandals crowd, there's a Starbucks. As for suited gentlemen and ladies, why not enjoy a fine dining experience at the The Fisherman? The sign in front of the restaurant promises "Five Star Dining at Your Preferable Price."

Yup. If you took the trouble to tear yourself away from your cubicle or fellowship or Stiftung to come all the way to Thailand to fight suffering, why suffer yourself? Why not fight suffering the five-star way?

Some spoilsports might assert that spending money on luxe living is the wrong way to fight AIDS. The disease is, without a doubt, a world health emergency; it has killed 20 million people in the last quarter-century -- and 2.5 to 3.5 million people in 2003 alone, according to the World Health Organization. That same year, another five million more people were infected with HIV, bringing the worldwide total of infections up to 40 million. Of these, more than 90 percent receive no treatment whatsoever.

If the situation is this dire, shouldn't every penny be used to help the dying and the at-risk-of-dying? Well, that's one way of looking at the AIDS crisis.

But another way of looking at AIDS is to say, in effect, that yes, people are dying, but yes also, that's a great way to make a living -- indeed, to live rather well. Am I being too cynical? Maybe, but first let's consider the evidence, starting with Graham Hancock's 1989 book, Lords of Poverty: The Power, Prestige, and Corruption of the International Aid Business, in which the author estimates that half of the funds allocated to humanitarian relief and development aid never leave the sticky fingers of the "humanitarians." Hancock's book has been controversial, but one need only walk around Washington DC, or New York City, or Geneva -- the three capitals of international do-goodery -- to see that lots of folks are doing well by doing good.

Now that AIDS is a big part of the world's overall foreign-aid expenditures, it's only realistic to expect that that much of the compassion-action is siphoned away from the desperate and ladled toward programs that mostly benefit the Annanite New Class globetrotters. So indeed, if there's going to be a wide wedge between what's spent on suffering and what the sufferers actually receive in help -- with the difference going to "suffer-crats" -- then one might as well admire Thailand for figuring out how to throw a really good anti-AIDS party. After all, I've never seen an elephant parade at a mere Super Bowl.

In defense of the current free-spending approach, some might argue that all the junk and junketing are worth the cost, because Kofi and Oprah and the five-star restaurants are all helping to leverage media attention, which in turn generates more money than the worthy cause of AIDS-relief would otherwise attract.

That might be a good argument, except for one thing. When these activists arrive here from all over the world, they aren't just here to swap information, plus maybe tourism tips. What's really happening here is far worse -- and vastly under-reported, even mis-reported.

Here's the real story of this conference: the emerging anti-AIDS agenda is about the whittling away -- even the wiping out entirely -- of all patents on all AIDS drugs. That is, making free drugs for all poor people, starting with AIDS. And then, activists hope, the progressive march will trample over patents covering tuberculosis and malaria drugs. And after that, in this bright new world, maybe all drugs should "open-sourced."

From the point of view of those who come here, it fits into their lifelong worldview. After all, those who work for government agencies and NGOs and other activist outfits generally come out of an anti-profit, anti-corporate background. Back home, they grew up saying things like, "Health Care is a Right, not a Business"; so naturally, they apply their pro-public sector/anti-private sector bias to new problems, too. And if agitating for socialization of goods and services is cool for New Jersey or Germany, why not make that same redistributionist mission into an international crusade?

A July 8 press release from the AIDS Therapeutic Treatment Now sums up this latest anti-corporate clarion call, focusing as it does on abolishing the most valuable asset many corporations possess: intellectual property. Here's the key text from the "Bangkok Treatment Action Pledge," circulating widely here:

  • All rich nations should pledge to use generics in HIV/AIDS treatment scale-up plans in aid to poor countries;
  • All drug manufacturers should pledge to 'stand down' in defense of AIDS patents in the developing world;

Look for this view to gain momentum here in the Bangkok media hothouse over the next few days, as the activists gather around this new political mission. After all, if the conventioneers didn't "do" something, folks back home might start to wonder why they had to spend so much money to send them here.

This new activism spasm is already rippling the political economics of AIDS -- and the prospects for companies that make cures. Sunday's Bangkok Post included this headline: "Government plans to copy AIDS drugs." The piece was clear: Bangkok is planning to exercise "compulsory licensing to produce copies of drugs now under patent protection to help HIV/AIDS patients." This proposal, according to Tongchai Tavichachart, head of the Government Pharmaceutical Organization, could cut the cost of such drugs by 80 percent. Well, of course it could. "Compulsory licensing" is a synonym for "confiscation," and confiscating property always cuts down the cost of acquisition.

But there is a catch -- a big one. Confiscation is usually a one-shot deal, because those who get confiscated tend to wise up after that; if the lunch must be free, the baker and the butcher stop offering it.

That's what could happen if "compulsory licensing" becomes cemented into the planetary policy agenda. On Sunday night, I watched as a credulous CNN reporter, Aneesh Raman, praised the Thai government's announcement; he declared that henceforth Thailand would be providing "cost-effective and needed treatment for developing countries." Did I hear that right -- not just country, but countries, plural? What's Thai for "killing the goose that laid the golden eggs"? And by eggs, I'm referring not only to corporate profits, shareholder value, and jobs. I'm thinking also of the medicines that could save our lives.

Am I being alarmist? I don't think so. Steve Hansch had warned me about this looming property-pelfing before I left the US. I first met Hansch almost three decades ago, when we were both undergraduates at Stanford University. He was an activist even then, one of the first in the country to be arrested for non-violently protesting Stanford's investments in apartheid South Africa. Since then, he has devoted his life to humanitarian causes, traveling to such distinctly non-garden spots as Sudan, Rwanda, Ethiopia, Eritrea, Kosovo, and Azerbaijan. He now teaches at the Georgetown School of Foreign Service and is a scholar at the school's Institute for the Study of Internal Migration; he is also the editor/publisher of Humanitarian Times.

In other words, he knows his stuff. And so what does he think about the snowballing effort to wipe out pharma patents? Although he is hardly a conservative, he looks ahead with a hard-earned sense of realism. And he raises a rare contrarian voice to the congealing anti-corporate consensus. "I worry about dumbing down our patent laws and constraining our basic research," he told me. He added, "I want to see the pharmaceutical companies putting in more money into tropical diseases, not less."

So what to do about AIDS? "If the governments of the world want HIV drugs at reduced cost, then they should pay for them," comes Hansch's answer. "If they want to force companies to do research, give them money." For his part, he would dig deep into the world's collective pocket to pay for additional health care for the poor and the imperiled.

But Hansch warns that simple compulsory licensing/confiscation is short-sighted in the extreme -- not only for AIDS, but for anything this side of the Andromeda Strain. "The ecosystem is always evolving new diseases to throw at us," he argues, pointing to the continuing evolution of AIDS and the emergence of new killers, such as SARS. In fact, resistance to first-line drugs in some areas is running as high as 37 percent in some areas. Charles Darwin was right; Mother Nature is still nurturing and naturally selecting.

Revealingly, Hansch is not here in Bangkok. I guess he wouldn't fit in with all the fun. But his voice needs to be heard -- before it's too late, before the research is curtailed or kiboshed, before new and fitter pathogens take hold without the curb of pharmacological countermeasures.


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