Monday, July 20, 2009

Actions Have Consequences

Throughout his term as President of the Republic of South Africa, Thabo Mbeki denied that the human immune virus (HIV) caused Acquired Immune Deficiency Syndrome (AIDS). He told a provincial conference in October 1999 that his government was reluctant to use AZT (or Nevirapine for that matter) because of legal issues and because of scientific evidence that AZT particularly was toxic. He said he had found this compelling evidence online from the writings of AIDS deniers such as Peter Duesberg from Berkeley University.

Last year, researchers from Harvard University released a report accusing Mbeki’s government of responsibility for 330,000 preventable deaths of people who were denied AIDS treatment that had been proven to work elsewhere. Because he believed (or wanted to believe) that AIDS was caused by poverty, bad nourishment and ill health, he refused to provide anti-retroviral (ARV) drugs that could have saved hundreds of thousands of lives. The ARVs were expensive, and would have been a burden on a nation with one of the world’s most severe HIV/AIDS epidemics. At the time the Harvard study was released in November, 5.5 million South Africans – 18.8% of the country’s population – had contracted HIV. South Africa likely would have become dependent on foreign aid to sustain treatment for its HIV-positive population.

In order to maintain his position and his policies, Mbeki and his government even refused free drugs and grants to purchase drugs. His government limited Nevirapine donated by the pharmaceutical company Boehringer Ingelheim to two pilot sites when it could have prevented thousands of babies from being born with AIDS transmitted by their mothers at birth.

You may wonder why this old story is being brought up again. Well a report just released entitled “Saving Mothers 2005-2007” analyzed all maternal deaths in South Africa during that period and found a 20% increase in maternal deaths over the previous three-year period. An estimated 40% of the increase in deaths was due to HIV/AIDS. The policy established to prevent South Africa from facing a potentially costly health care burden continues to register unnecessary deaths even after Mbeki relented and allowed ARV treatment. Undoubtedly, there are those who have yet to succumb to AIDS, whose life span could have been longer had they received treatment earlier.

Poor or short-sighted policy decisions by leaders sometime have consequences that outlast their term in office. Often there is no easy or acceptable policy a government can take. There are trade-offs in whatever course is taken. However, the slow response to ARV treatment and acknowledgement of the AIDS threat in Africa led to unnecessary deaths. One appreciates the change in policy in many countries, but the time and lives lost can never be recovered. It has been an expensive lesson that hopefully will not be repeated with the next pandemic.

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