March 15, 2003
The Plague We Can't Escape
By LARRY KRAMER
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www.nytimes.com]
Why does no one have the courage to say loudly and unequivocally that 50 million people around the world are going to die in a matter of days or months or at the most a few years unless they are treated immediately with the life-saving drugs that are now available? I have arrived at this figure after conversations with many experts.
Why has no effective plan been started to stop this immense horror? "AIDS is not a death sentence" is heard over and over again, when it most emphatically is a death sentence to these 50 million people, most of them in countries other than our own, most of them poor and without health insurance. In China, Ethiopia, India, Nigeria and Russia, the number of AIDS cases is predicted to double by 2010, with a total of 50 million to 75 million infected people in those countries alone.
This plague is not going away. (And may we all please start calling it a plague?) These 50 million people are dying now. They do not have time to wait while we clean up their countries' water supplies and change their economic and educational systems, rain condoms on their communities, promote abstinence and teach them about the dangers of drug abuse.
There simply is not enough time or money to make these noble and expensive suggestions doable. The $15 billion in AIDS programs that the heroic Dr. Anthony Fauci of the National Institutes of Health designed and won support for from the Bush White House will not enter the system for two years. It is already bogged down in so much bureaucracy that in my estimation most of it will never see the light of day.
Most of all, 50 million dying people do not have time for governments and drug companies to battle endlessly over patent rights and who can manufacture generic versions of life-saving drugs. In the 1940's, streptomycin was the first antibiotic to be effective against tuberculosis. Merck owned exclusive rights to the drug, which meant it could profit mightily from it. But George W. Merck, the company's head and the son of its founder, released its hold on the patent, thus allowing any company to manufacture streptomycin and effectively keeping its cost minimal and hundreds of thousands of people alive. George Merck was on the cover of Time in 1952 above a caption of his own words: "Medicine is for people not for profits."
It is impossible to imagine today's Merck or any other pharmaceutical manufacturer being so humane. GlaxoSmithKline, which controls most of the drugs people with H.I.V. must take, refused for years to provide AZT at a reasonable price to poor countries. Only after a publicized dispute did it hand over rights to its AIDS medicines to a local generic drug company in South Africa. AZT was developed to treat H.I.V. at the National Institutes of Health — financed by taxpayer money — in collaboration with Burroughs Wellcome, now GlaxoSmithKline. The most recent anti-H.I.V. drug, Fuzeon, also developed in part with taxpayer money, has been priced at $21,000 a year in Europe by its manufacturer, Roche. (It is feared it will cost even more in America.) For one person. That works out to more than $57 a day.
It is incumbent upon every manufacturer of every anti-H.I.V. drug to contribute its patents or its drugs free for the salvation of these people. Almost every such drug on the market — there are some 18 effective drugs — has already more than paid for its development in spades, and also earned millions of dollars in additional profit for its makers.
I believe it is evil for drug companies to possess a means of saving lives and then not providing it to the desperate people who need it. What kind of hideous people have we become? It is time to throw out the selfish notion that these companies have the right not to share their patents. The world should no longer tolerate this. There are too many of us now dying, and there are too many destructive illnesses appearing every day. A new world prescription must be written immediately.
When I first heard about what would become known as AIDS there were 41 cases of some strange occurrence. Almost 25 years later we have failed to mount a thoughtful, concerted effort to stop what is now this plague. We have failed to keep up any pressure. We have failed to outrage each other enough so that people in authority would have no choice but to do something.
For almost 25 years we had our chance to do something. Year after year, we blew it. AIDS tells us about the worst of America and the world. It tells us that people don't care about others. It shows us over and over and over again that people can be allowed to die. It should break everyone's heart. Why doesn't it?
Larry Kramer, co-founder of Gay Men's Health Crisis and founder of Act Up, is author of "Women in Love and Other Dramatic Writings."
Copyright 2003 The New York Times Company