Kerry, Part Four: The International AIDS Crisis

Written by Current Events

Today we look at Kerry’s AIDS position paper, and as usual, our candidate talks a great game. In a sense, one could almost argue that these guys shouldn’t even have a position on AIDS—as with any disease, all you have to do is say “_____ is bad” and wait for the applause. It’s a gimme, a big piñata. And yes, AIDS is a global health crisis, but it isn’t the only one. Before we get too deeply into the details of Kerry’s proposals, I’d like to float the possibility of a racial undertone here, and that the focus on AIDS is something of a sop to minority voters. In other words, urging R&D for AIDS vaccines equals giving the appearance of caring about Haiti and Africa, which equals giving the appearance of caring about minorities. The appearance, I submit, does not reflect the reality. Just a thought before we begin—and now, off we go. As always, our man has broken his stand on the subject into handy bullet points:

Initiate Comprehensive, Integrated 5-year U.S. Government Strategy to Combat Global AIDS. Diehard cynics will no doubt say this is a classic example of liberals trying to solve a problem by throwing money at it, but nonetheless, there’s something noble here. We could nitpick—why only five years, John?—but that would be, well, nitpicking. For now, let’s give Kerry his easy swing at the piñata. Of course, the paragraph beneath the bold type is full of the worst political hot air—references to “specific goals” that naturally do not mention any specific goals, and buzz phrases like “multi-sectoral approaches” and “reduce programmatic duplication.” But please, let’s be patient.

Provide Increased Resources for the Global Fund and Bilateral Programs to Meet the $30 billion target in 2008. The Global Fund has had well-documented problems with budget shortfalls recently—a look at the Fund’s spreadsheet detailing pledges against moneys received is heartbreakingly illuminating—and here Kerry takes Bush to task for his measly $200 million annual pledge. Kerry says he’ll give $30 billion between 2004 and 2008, which works out to $750 million annually. He also says his administration will “push other donor governments, wealthy corporations, and foundations to provide their share as well.” To which I think we can all say a hearty “hooray.” There’s something Kerry’s leaving out here, though. We’ll see whether he addresses it later on.

Ensure More People Receive More Treatment. Kerry promises to meet World Health Organization goals for global treatment: three million people by 2005, seven million by 2007, and a “move toward universal treatment” by 2012.

Increase Resources for Tuberculosis and Malaria Programs. “Tuberculosis is a leading killer of people living with HIV/AIDS and malaria leaves many individuals, particularly children, weakened and vulnerable.” Kerry wants to increase funding for DOTS programs and the Global Tuberculosis Drug Facility. He also promises to increase funding for anti-malarial drug and vaccine research. This sounds great, although Kerry really isn’t saying anything specific. “Increase funding” by how much?

Increase Diplomatic Efforts and Pressure on Countries Ignoring the AIDS Threat. Here, Kerry targets “China, Russia, and India” as “the next wave of the epidemic” and accuses them of moving “too slowly or not at all.” He promises to “ensure the AIDS issue is front and center on the US agenda for these countries.” I confess ignorance with regards to how closely the US agenda for these countries reflects their actual policy decisions. Can’t blame Kerry for trying. Again, however, he’s ignoring a critical element of this debate.

Eliminate the Global Gag Rule and Its Application to AIDS Funding. The rule Kerry’s talking about here is the Bush Administration’s obnoxious insistence on funding only abstinence-based programs. The gag rule has had some holes poked in it recently, but it remains indicative of overall United States policy. Kerry says “denying women access to life-saving information on reproductive health and HIV prevention is simply wrong,” and I couldn’t agree more. For once, we can credit Kerry with taking a courageous stand—coming out against the gag rule may not cost him many votes directly, since those who support it are overwhelmingly Bush Republicans, but it does provide the Bush campaign some handy ammo. You won’t hear this point discussed during the “debates,” but it’ll certainly be a favorite topic among evangelical Christians between now and November.

Expand U.S. Efforts to Train Health Care Personnel. This touches on something Kerry brought up in an earlier paper; namely, a shortage of nurses and doctors. His contention here is that “there will never be enough doctors in many of the most affected countries,” so he proposes that we follow Haiti’s lead, and train community members to “recognize the symptoms of AIDS, TB, and malaria, (and) help support patients and administer drugs.” Again, hats off to Kerry for not only proposing an innovative wrinkle in United States policy, but also looking to (and crediting!) Haiti for inspiration.

Expand Public-Private Partnerships. Astute readers may have noticed that, so far, Kerry has nothing to say regarding Bush’s controversial “faith-based initiative,” which can be considered foolishly optimistic pandering or smart politicking, depending on how you look at it. This bullet point smells like a weak effort to bring its supporters on board—Kerry praises “faith-based organizations” for playing a “critical role in the campaign against HIV/AIDS” and calls their continued involvement “essential.” Looking at the leading lights from the faith-based community who have had a political voice in the AIDS arena, this statement would seem to land somewhere between disingenuous and lying, but perhaps Kerry knows something the rest of us do not.

Support Access to High Quality, Low Cost Drugs. Ah, now we’re getting somewhere. Anyone who has spent any time looking into any kind of global health crisis knows that promises of financial relief ring hollow without a permanent solution to the problem of, as Kerry puts it, “High Quality, Low Cost Drugs.” Kerry comes right out and says it here: “Improving access to high quality drugs at the lowest prices available is the only way to save millions of lives.” Unfortunately, his solution is to “fully uphold the World Trade Organization’s Doha Declaration on intellectual property and public health.” The Doha Declaration, ultimately, doesn’t say much of anything at all—and so, by extension, neither does Kerry.

I think it’s necessary to get into a few specifics here. The World Trade Organization, for all intents and purposes, is the ultimate arbiter of global economic disputes, and its intellectual property policy (known popularly as TRIPS) has caused untold grief and death throughout the world. In essence, with regards to global public health, TRIPS has acted to prevent people from gaining access to affordable medication. This isn’t something that has received a great deal of press, mostly because A) it’s complicated and B) some powerful folks benefit from it. Powerfully. The United States has been complicit here, to say the very least. Clinton, for instance, offered billions in aid to South Africa, on the condition that it purchased all its medicine from the United States and paid back the loans “at commercial interest rates.” (South Africa refused.) Whether you see this as smart banking or death profiteering depends, I suppose, on how much pharmaceutical stock you own.

Where TRIPS comes in, specifically, is as a bludgeon to deliver economic sanctions against countries (such as Argentina or India) capable of developing and/or manufacturing medicine much more cheaply than the United States. Obviously, given a choice, those in need of this medicine will purchase it as affordably as possible. The WTO recognizes this and solves the problem by making it illegal. And it affects everyone, not just patients in developing countries—a fact discovered long ago by American senior citizens. The markup on WTO-approved medicine has been estimated to be roughly 400 percent. Again, whether you see this as smart business or death profiteering depends on how much pharmaceutical stock you own.

Anyway, there’s nothing Kerry can do about any of this. The WTO’s authority supersedes that of the United States government here, and this is why, for the most part, his entire AIDS position paper is basically meaningless.

Support Deeper Debt Cancellation. “John Kerry supports deeper and broader debt cancellation for all impoverished nations engaged in the fight against AIDS,” which I suppose is all of them. He notes: “Of the 26 nations that have received some initial debt relief, at least 18 pay more in debt servicing each year than their entire national expenditures on health care.” It’s tempting to believe the conservative notion that brown people around the world are simply bad with money, and that canceling debt only encourages their irresponsible spending, but such theories strain credulity. Kerry’s position here highlights the sad facts of a global battle being waged through—hello again—the World Bank and the WTO. I don’t have the time to get into it here. Suffice it to say that the WTO creates unfavorable economic conditions for nations, then takes advantage of these conditions by offering monetary “relief” under the most mind-bogglingly awful conditions you could imagine. These conditions include, but are not limited to: privatization of national utilities, abolition of the minimum wage, outlawing trade union bargaining rights, reduction of public employment, and—of course—slashing taxes on corporations and the wealthy. The result is predictably economic pandemonium:which necessitates more “aid”:you get the picture.

You’ve probably gathered by now that Kerry isn’t proposing any real change to the existing structure here, just temporary relief. Whether he should be faulted for this depends on your point of view. What the World Bank and WTO do are essentially out of Kerry’s control, so he can promise very little. On the other hand, by leaving out what we’ve just discussed, he’s giving his tacit approval to the “free-market” robber barons responsible for this mess in the first place.

That’s it for now. Next time, we’ll go over Kerry’s plans for expanding national service. ‘Til then: