A recent look at health care in Africa highlights two important pieces of information — one positive that has already saved millions of lives, the second unfortunately negative and a symptom of how money corrupts human morality.
Let us start with the good news, the fight against AIDS in Africa. Just a decade ago, Africa was a continent under devastation because millions of individuals were suffering with AIDS and dying without affordable treatment. In some African nations, the AIDS infection rate in the adult male population, the mainstay of the workforce, was 25 percent. This meant decimation and despair, not only in lives lost, but also in national economic infrastructures. Whole nations were sinking into poverty and were at the brink of civil and national conflicts and wars.
In 2003, President George W. Bush created the President’s Emergency Plan for AIDS Relief (PEPFAR). This plan proposed large-scale treatment, prevention and compassionate care to fight AIDS in African nations with weak health care systems. The initial plan offered $15 billion; with its success, subsequent commitments were obtained for a total of close to $50 billion so far. This under-publicized program has turned out to be one of the greatest health care successes in the world, and has saved more lives than any other recent single initiative. In 2003, only 50,000 people in Africa were on antiretroviral therapy for AIDS. Today more than 6 million people receive AIDS treatment through PEPFAR and the Global Fund. Half a million children are estimated to have been born without AIDS due to PEPFAR programs to diagnose and treat mothers with AIDS, in order to prevent mother-to-child transmission. PEPFAR is estimated to have saved more than 5 million lives, and will save millions more.
The impact of President Bush’s visionary program is beyond any anticipated expectations. It drastically reduced AIDS infections, suffering, deaths and disruption of family networks. The program also stabilized economies of several African nations through sustenance of a healthy workforce, thus preventing conflicts and wars. President Obama received the Nobel Peace Prize in 2009 for the hope his positions created in potentially reducing the threats of wars. President George W. Bush should receive the Nobel Peace Prize for the fulfilled promise of having saved millions of lives in Africa.
Now the bad news. In January 2014, Doctors Without Borders released documents outlining a secret campaign planned by a Washington lobbying firm, hired by the pharmaceutical industry. The documents detailed a proposal (prepared for the Pharmaceutical Research and Manufacturers of America [PhRMA] and the Innovative Pharmaceutical Industry Association [IPASA]) to form a fake grassroots organization named “Forward South Africa” to advocate for stronger patent laws against generics, ostensibly to protect the ability of pharmaceutical companies to develop new treatments. This was publicly denounced as a genocidal endeavor, as restrictions or delays on generic drugs will make treatments for many highly curable disorders unavailable and unaffordable to millions in Africa.
Dr. George Merck, the son of the founding family of the large pharmaceutical firm Merck, and one-time president of the company, declared in 1952 that “medicine is for people not for profits.” This essentially reflected the goals and mission of almost all pharmaceutical companies until recent times: to help save lives while making reasonable profits. Dr. Rashi Fein elegantly stated: “Decent people — and we are decent people — are offended by unnecessary pain and suffering; that is by pain and suffering for which there is a treatment.” Embedded in the pharmaceuticals’ mission was a sense of corporate social and moral responsibility to alleviate pain, suffering and death through medical help. This has been hijacked in the past decade in favor of a mission that maximizes corporate profits as the only fiduciary duty of the pharmaceutical corporation’s shareholders. This gradual loss of moral decency is reflected by increasing endeavors to advance agendas that help financial margins at any cost, even patient lives. This is illustrated by the endeavor uncovered by Doctors Without Borders, by the increasing costs of cancer drugs and medical devices, by the recent incremental campaigns against the “340B program” that offers drugs to vulnerable patients at discounted prices, and by other similar schemes. Fortunately, in response to the documents released by Doctors Without Borders, the pharmaceutical lobby dropped its plans. This is not a one-time action. Driven by greed, pharmaceutical companies may continue to support, finance and propose secret and not-so-secret initiatives, under different virtual or actual organizations with embellished or deceitful titles.
Efforts should continue to educate and advise citizens and corporations about profit-driven endeavors that may harm patients. Reporting the harmful and immoral consequences of these maneuvers on human suffering and lives lost may pressure corporations to reconsider their agendas in favor of more socially and morally responsible missions.
Hagop Kantarjian, M.D., is chairman of the Leukemia Department at The University of Texas MD Anderson Cancer Center and a Baker Institute nonresident fellow in health policy.