This week's column from the Kingston Whig-Standard.
One of the privileges that comes with being an academic is that one is comparably mobile, the world really is one’s job oyster.
I chose to work between 2000 and 2005 in a medical school in Johannesburg, South Africa. Sub-saharan Africa at the time was the world’s region worst hit by HIV and AIDS. At a time when HIV infected people in the West got used to the idea of living to old age, people around me literally were dropping like flies. Talk about culture shock! In the condo-complex where I lived, several of our staff members died preventable AIDS-related deaths. One of my staff member’s life-partner died from AIDS, too. He had just matriculated from college.
Many of our students were infected and discussions began in the university whether we had a responsibility to sponsor medical insurance to ensure their survival while they were enrolled with us. To the outsider this might look like an issue best understood as people in the developing world being unable to afford access to life-preserving medication. And, to be fair, the price tags of essential medicines in many developing countries remain unacceptably high. However, this is not what actually caused in excess of 360,000 entirely preventable HIV-related deaths in South Africa.
The country’s president at the time, Thabo Mbeki, and his health minister, Manto Tshabalala-Msimang subscribed to wild conspiracy theories involving Western agencies wanting to crush African people’s aspirations. In their paranoid world AIDS medicines were a means to poison Africans. HIV was not the cause of AIDS, and AIDS didn’t quite exist as a new disease. They duly found a high-profile, ironically white, United States academic and a few of his, ironically white, allies to confirm their worst fears. Being the country’s president, Mbeki quickly set up a presidential expert panel involving mainstream scientists and a bunch of denialists. A funny idea to create a sparring match between discredited academics and mainstream academics and encourage them to entertain your paranoia. Mbeki clearly thought that a scientific consensus is reached not by evidence but by discussion and some kind of compromise (as if HIV could cause AIDS just a little bit, depending on the compromise reached).
Well, Mbeki and his side-kick Tshabalala-Msimang enforced policies aimed at keeping as many impoverished South African AIDS patients away from life-preserving medicines as was possible. HIV infected pregnant women were not given access to medicines proven to drastically reduce the risk for their newborns to be HIV infected. Thousands and thousands of HIV infected newborns came into this world as a result of these crazy policies. A Harvard University study estimated that in excess of 360,000 South Africans died preventable AIDS deaths during Mbeki’s reign. Some of the medical doctors in public sector hospitals who prescribed and provided AIDS drugs to their infected patients were disciplined by hospital managers carrying out the health minister’s orders.
Ask yourself how the world would have responded if such genocidal policies had been implemented by the apartheid regime preceding the ANC government that’s running the country today. No doubt international bodies would have busily prepared genocide charges. No doubt international campaigns would have got off the ground blaming the racist government for the preventable deaths of such a large number of South Africans. A black politician with liberation credentials presiding over what could demonstrably be described as genocide barely led to people batting their eyelids. Human lives clearly remain cheaper even today in that part of the world than elsewhere. Another, even crazier, head of state, Gambia’s president Yahya Jammeh insists that a herbal concoction he invented cures AIDS. Foreign aid workers disbelieving the story end up being kicked out of the country, and any Gambian criticizing his take on this medical problem end up in jail. Meanwhile Jammeh instructed HIV infected people to stop taking AIDS drugs.
What bothers me greatly is that government policies leading demonstrably to large numbers of preventable deaths remain unpunished. It is one thing if Mbeki had said that his government decided not to provide AIDS drugs due to their high cost. If you don’t have the resources to treat everyone it is fair game to allocate resources. But denying access to life-preserving medicine to large numbers of impoverished South African public sector patients because of truly crazy ideas about Western conspiracies is surely something else. Yet Mbeki walked away, enjoying today his generous retirement pay-out. His alcohol guzzling health ministerial side-kick died eventually of liver cirrhosis. Even there she remained true to her unethical form by jumping the queue toward a donor liver.
Well, enough on AIDS. This week United States talk show host Katie Couric used her show on national TV to peddle nonsense about the HPV vaccine. In Mbeki style she juxtaposed scientific mainstream views with anecdotes supplied by vaccine critics. The impression created was that there is a genuine debate, that there are genuinely two sides to this vaccine, when patently there are no two sides. While some of the stories presented were genuine human interest stories, they showed nothing relevant at all with regard to the safety and efficacy of this vaccine. It was clearly irresponsible of Couric to give a high-profile stage to quacks promoting their anti-science agendas. Almost certainly as a result of her action people who would clinically benefit from getting vaccinated won’t get vaccinated. Some of these women will eventually go on to develop cervical cancer. Is it acceptable, for the sake of ratings to promote quacks’ views on national television? I doubt it.
To be fair, Couric’s case is different to Mbeki’s actions. Women choosing not to get vaccinated did it on bad information they received through her TV show. Arguably women making such important health care choices would do better than to listen to anecdotes on a talk show when making important health care related choices affecting themselves. Let the buyer beware, as the old Romans said. On the other hand, the impoverished HIV infected South Africans depended on the national health care system to deliver life-preserving medicines. They did not have the luxury of choice to begin with. So, while the blame for bad choices in Couric’s cases arguably should be shared between those who act on anecdotes heard on her talk show and those who produced the show, the blame in South Africa falls squarely on Mr. Mbeki’s shoulders. Remarkably until today he was neither prosecuted nor did he ever utter an apology for the genocidal policies he presided over.
Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.
