IN DEFENSE OF AL GORE — JUST THIS ONCE

So for almost two years now, the government of South Africa has been attempting to implement amendments to its Medicines Act that would make possible the procurement and distribution, in low-cost, generic form, of otherwise prohibitively expensive but potentially life-preserving anti-retrovirus therapies developed in the United States. But for just as long, concerned that the amendments as drafted might expropriate the patent rights of U.S. pharmaceutical companies, the Clinton administration has sought modification or outright repeal of the South African legislation.

All of which — the bilateral intellectual property dispute, narrowly, and the cataclysm of HIV in Africa, more broadly — has failed to win high-profile attention in America. Until this spring. In April, the “Consumer Project on Technology,” one of the many tentacles of the Ralph Nader octopus, began publicizing a State Department report that “revealed” the participation of Vice President Gore in diplomatic negotiations with South Africa over the Medicines Act amendments. And in short order, AIDS activists began disrupting Gore’s public appearances, chanting “Gore is Killing Africans!” for benefit of the network television cameras.

Subsequent, objective news analyses of the underlying controversy have been sketchy at best. But two well-known opinion journalists — John B. Judis, on the left, and Arianna Huffington, on the right — both claim to have investigated the question. And, surprisingly, both have wholeheartedly endorsed the basic activist complaint against Gore.

In an essay in the current American Prospect, Judis dubs the vice president “K Street Gore,” and attributes his “weak and morally repugnant” hesitancy about generic AIDS drugs in South Africa to an “interlocking directorate” of Gore advisers with ties to the U.S. pharmaceutical industry lobby. On “issues that impinge upon his high-tech network of supporters,” Judis concludes, Gore has here proved “willing to do the wrong thing to keep them happy — and keep them in his corner” with financial contributions.

Arianna Huffington offers the exact same judgment, though still more sharply. “Pharmacologic Al,” she writes in her nationally syndicated column, has allowed “powerful special interests to secretly dictate policy — even when the life or death of millions is at stake.” The provision of modern AIDS medications to South Africa is “one of those rare issues — such as child abuse and drunk driving — on which there cannot possibly be two sides” of equal virtue. South Africa must have the drugs.

In other words, according to this commentariat odd couple, Al Gore, by preventing South Africa from obtaining the drugs immediately, really is killing Africans. Which raises two questions. One: Is such a remarkable savaging of the vice president fair? And, two: Fair or not, does the spectacular bloody-hands charge against Gore at least represent welcome public awareness of a long-underappreciated international humanitarian emergency?

On the first score, the answer is no. The suggestion that the vice president has passively condemned impoverished South Africans to hideous death by contagion — in exchange for corporate-backed campaign donations — is not even remotely fair. It is groundless and grotesque.

U.S. pharmaceutical companies stand to lose a fortune on their patented medications if foreign governments start unilaterally authorizing the manufacture or importation (from “gray market” countries like India) of cheap knock-offs — as South Africa has announced it intends to do in this case. And these losses, the companies point out, pose a more than financial risk. It sometimes costs hundreds of millions of dollars to discover, test, and start distributing a desperately needed new medicine. If originating American laboratories are no longer permitted to recover these mammoth investments with profits protected by patents that are respected internationally, then they may well dramatically scale back their research and development efforts. On future AIDS therapies, for example.

This is a far from stupid argument, and it seems to have fully persuaded certain major players in the Clinton administration. But it turns out, on close inspection, that the vice president isn’t exactly one of them.

Gore’s staff — which will patiently explain all the trade-law technicalities to anyone who bothers to call — is appropriately cognizant of the value of American pharmaceutical patent rights, and remains intent to ensure that South Africa not totally ignore its treaty obligations to observe those rights. But Gore has otherwise declined to do the pharmaceutical industry’s “bidding,” as the cartoon criticism of him would have it. Earlier this year, during interagency meetings, he successfully opposed an industry-backed plan to target South Africa with trade reprisals. Calm, continued negotiations, the vice president thought, were a better idea. And two weeks ago, in a letter to the Congressional Black Caucus, Gore explicitly confirmed his willingness, given the health crisis in Sub-Saharan Africa, to consider any well-designed effort “to speed the availability of lower-cost pharmaceuticals in South Africa,” including generics.

Al Gore, in short, stands falsely accused of obstinately resisting a public health initiative he doesn’t necessarily resist at all.

Happy ending, then? Could it be that from this recent media eruption — despite the cruel slanders to which it has subjected the vice president — a previously unrecognized political consensus has emerged that the widespread introduction of anti-retroviral medications is the obvious solution to the African AIDS epidemic? And that the only remaining question is precisely how to do it?

Here, too, alas, the answer must be no. Because for every prominent physician who favors the distribution of advanced AIDS drugs in Africa, there is another prominent physician who views the idea with something close to horror. And the doubters’ warnings cannot be blandly dismissed.

The modern, multi-drug anti-AIDS “cocktail” now so common in the industrialized world is a fiendishly tricky therapy. You must take your pills on a strict schedule. You must take some before meals, some after. Some medications must be refrigerated, some not. Depart from the prescribed regimen even a bit, even for a single day, and a new strain of HIV may quickly spread throughout your body. If you then infect some other poor soul, his virus may prove resistant — from the onset — to most or all known anti-retrovirus compounds. This is not a theoretical problem. It is happening already in the United States.

And in Sub-Saharan Africa, including South Africa, where public health systems competent safely to deliver, administer, and supervise such an inherently risky medical intervention are sadly nonexistent, the standard American AIDS cocktail might thus wind up saving no one, and make the epidemic even less manageable.

Throughout the whole of Africa, non-AIDS infectious diseases — pneumonia in infants and children, malaria and tuberculosis in adults — also take huge numbers of lives each year. These diseases are more easily diagnosed and treated than AIDS. AIDS is more dramatic, however, and so organized efforts to deal with such “minor” infections go starving for international funding, even where the purchase of relatively simple, non-patent antibiotics is concerned.

By largely ignoring this separate crisis, and insisting instead on a questionable HIV-specific intervention, are the vice president’s critics themselves “killing Africans?” Someone might say that. But we would not. No American is “killing Africans.” Infectious diseases are killing Africans. And while all men of good will agree that something must be done, the horrible truth remains that it’s difficult responsibly to assert that we know just what that something is.

In the current fracas, it seems to us, Vice President Gore is attempting to keep all reasonable considerations in balance. He wants his country to sustain in principle the international patent-protection regime. He wants to foreclose no potentially effective response to the infectious-diseases crisis in Africa. And he declines to endorse the dangerous fantasy that a perfect response has already been identified. We are pleased to say — and we may never say anything like this again — Al Gore is doing the right and honorable thing.

David Tell, for the Editors