Hope from Brazil

Caspar Henderson
20 August 2003

Last week and the week before were good ones for Africa. This week was a terrible one for the United Nations.

First, the good news: three items from Africa. One, Idi Amin, the former bloody tyrant of Uganda, died in luxurious Saudi exile. Two, Liberian president Charles Taylor departed for luxurious exile in Nigeria (leading to a moment of optimism in Liberia: a slogan noted by the journalist Michael Peel in Monrovia in the mid-1990s - Total Reconciliation by 2014 – it might even come true!). And three, the cabinet of the South African government finally approved a report that is likely to lead to a national plan for use of anti-retroviral drugs to combat HIV/Aids. Number three is one of the greatest victories for civil society activism in the world this year.

You know the bad news. On 19 August the UN headquarters in Baghdad was blown up. At the time of writing, at least seventeen people are reported dead, and many more wounded. The dead include Sergio Vieira de Mello, the UN's special representative in Iraq, and openDemocracy columnist Arthur Helton.

The death of Mr Vieira de Mello and his colleagues is felt here at openDemocracy with great shock. We had recently been in touch with Mr Vieira de Mello's office regarding our forthcoming discussion Visions for Iraq, to which he would have contributed. Mr Vieira de Mello used to read Arthur Helton and Gil Loescher's regular openDemocracy column on Iraq and had commented with characteristic warmth. The shock we feel is compounded by news that arrived later. Arthur was killed, and Gil lost his legs, in Tuesday’s blast.

The Brazilian connection

Mr Vieira de Mello, a Brazilian, was on temporary secondment to Iraq from his post as United Nations High Commissioner for Human Rights. There is no more fundamental human right than the right to life. And it is in this regard that Mr Vieira de Mello's compatriots have made one of the most remarkable contributions of modern times - and one that is likely to be of particular significance for Africa.

Over the past two decades Brazil has developed the world's most successful programme against HIV/Aids and other sexually-transmitted diseases. By producing generic versions of new medicines, the Brazilian government has been able to grant free access to drugs to treat Aids to those infected with the HIV virus, both in at home and Angola and Mozambique.

The results have amazed the world. The Aids-related death rate in Brazil has been reduced by half, there has been an 80% reduction in hospitalisations, and the country has saved around $680 million between 1997 and 2000, and up to $1bn by 2002. A disease that would have killed hundreds of thousands has largely been controlled. The avoided human suffering has been incalculable. The Brazilian model has been adopted by the World Health Organisation.

As Christopher Reardon has shown in an article for the Ford Foundation (which supports initiatives in Brazil and also supports openDemocracy - see our list of funders ), a crucial element in Brazil's success has been the leading role of civil society organisations and the courageous people who organise them, emerging from the dark night of military dictatorship.

South Africa, by contrast, has not yet enjoyed such success, although courageous people have fought hard to change government policy. Around five million people in that country are living with HIV/Aids and around 1,000 die from the disease every day. The disease threatens to devastate the economy and democracy of the country more severely than any other case in modern times. As the situation has gone from appalling to catastrophic, the South African government has recommended garlic and sweet potatoes.

The government first questioned the safety of anti-retrovirals. Then it said they were too expensive. When the benefits as well as the (small) risks are taken into account, the first claim is ludicrous. The second is not much more plausible. Thanks very largely to the efforts of campaigners worldwide and allies like the Brazilian government of the 1990s, affordable generic versions of key drugs are available. Even taking into account caveats about purchasing power parity and the different profiles of the populations most at risk, neither poverty nor extreme inequality (which obtains in both South Africa and Brazil) is the main issue. (Brazil’s 182m citizens had a GDP per head of some $7,600 last year, while South Africa’s 42m citizens had a GDP per head of $10,000).

The most important difference may have been the few years’ head start Brazilian civil society has had in getting organised. South African lobby groups like the Treatment Action Campaign may have had less well-established networks and culture of civic independence to draw on, and have been confronted with more monolithic one-party rule than their counterparts in Brazil.

Cape of Good Hope

As the medical journal The Lancet (free, but registration required) notes in its recent editorial, there is now a real chance to leave behind the past and move swiftly to a better future for the people of South Africa.

But what about globalisation, which, according to some, enables the rich countries to subjugate the poor while further benefiting the rich? In the case of the battle over patents for new drugs there's been some concern that the United States will use the World Trade Organisation (WTO) ministerial at Câncun and/or other negotiations such as the complex bargaining for a Free Trade Area of the Americas (FTAA) to bludgeon into submission those who need affordable new drugs for HIV. And, to be fair, what else can you really do but bludgeon people who would dare to chose such a flagrantly anti-American slogan for their campaign to feed the starving as A nossa guerra é contra a fome (“Our war is against hunger”)?

Well, there's still lots to play for, but the good news may be that Brazil's efforts so far may not have been altogether in vain. As the country's health minister Humberto Costa has observed, when the American officials started making plans for the $15bn their government says it will spend on Aids prevention and treatment in the developing world, the figures it uses for the drugs are based on the prices of generics like those made in Brazil. The Brazilians may yet make serious progress on the issue of hunger.

Footnote - the ultimate blog

New York Times columnist Maureen Dowd reckons that the most telling sign that the internet is no longer the cool American frontier is that web logs have been overrun by the establishment.

Well, this week saw the launch of another blog backed by all the resources of a large media organisation. But however ersatz the hipness, and dry the subject matter, Globolog reckons this is one to watch. Kick-AAS, otherwise known by its more sexy full name of Kick All Agricultural Subsidies , picks up on the issues in the last Globolog, and brings new life to the debate.

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