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Barriers hinder war on AIDS

WASHINGTON — Jesse Jackson is frustrated, first of all, at the way the debate over drugs for AIDS-stricken South Africa is going.

"It's come down to good guys support generic drugs and bad guys support brand names to protect the patents of the pharmaceutical houses that developed the drugs," he says. "That's too simplistic."

He's frustrated as well over the refusal of South African President Thabo Mbeki to declare his country's AIDS epidemic a national emergency. An estimated 4.2 million of South Africa's 45 million people are infected with the virus that causes AIDS. "Mbeki clearly has the power to declare the emergency," Jackson says. "If he does, the contest over the patent rights is suspended, and South Africa could proceed to manufacture a generic version of the AIDS drugs. But he's worried that if he does that, it might send the wrong signal to foreign investors.

"Meanwhile, his people are dying in tragic numbers. Shouldn't saving lives be a higher priority than trade and investment?"

Jackson's frustrations don't stop there. He's pleased that at least two pharmaceutical companies, presumably reacting to public and press criticism, have cut the price of AIDS medications for Africa.

"But if you took a planeload of free medicine, you'd have to pay a tariff to get the medicine in," Jackson says. Obviously, if South Africans are serious about the crisis, he suggests, they'd drop the tariff.

It isn't clear how much of a barrier the tariffs actually are. Many poorer countries defend tariffs and value-added taxes on imported medicines as a necessary way of helping fund their health-care systems, arguing that the taxes don't matter much because drug prices are largely unrelated to manufacturing costs in the first place.

Jackson, who has heard the arguments, doesn't reject them — any more than he rejects the notion that suspending patent protections could hurt investor confidence. It just seems to him that the priorities are all wrong. And not just with Mbeki and the drug companies.

"Of course the pharmaceutical companies need to be at the table, but, given the nature and scope of the problem, so do a lot of other players," Jackson says. "Coca-Cola, for instance, is South Africa's No. 1 employer and has the best machinery for purifying water. It needs to be a player. If today you landed a 747 full of free AIDS medicine in every sub-Saharan country in Africa, you might get the plane unloaded, but there wouldn't be sufficient roads and bridges and trucks to get the medicine where it needs to go. And in many places, there wouldn't be enough doctors and nurses and good water to guarantee its effectiveness.

"I mean, it's not like taking an aspirin tablet for a headache. AIDS treatment requires 20, 30 or 40 pills a day, and there might not be drinkable water to take them. Some of the drugs are supposed to be taken so long before or after a meal, or with milk. But sometimes there is no milk — and occasionally no meal."

So what is Jackson proposing? "Well, terms like 'Marshall Plan' cannot get lost in the patent debate," he says. "This crisis is so much bigger than the price of drugs or the rights to intellectual property and all that. All the players — here, in South Africa and internationally — have a role in this business. In one sense, AIDS is just the end-point in a long chain of neglect."

Jackson is right, or close to it, on virtually every count. But there are problems with the way he makes his argument. First, spreading the responsibility as he does is as likely to reduce as intensify the pressure on those most able to address the crisis he decries: the drug companies and the governments. Even if he's right about the lack of infrastructure in much of Africa, that's hardly an argument for not doing what can be done in places that are accessible. Besides, arguing for building an infrastructure as a necessary element in the AIDS war transforms it from an emergency situation to a longer-term problem — just as Mbeki's concerns about discouraging investment.

Worse, though, to insist that everything be done — building roads, training doctors, improving food and water supplies and (he might have mentioned but didn't) changing patterns of sexual behavior — is more likely to result in shrugs of resignation than in the concerted action he envisions.

Now that's frustrating.

William Raspberry's e-mail address is .