Corporate Cost-benefit Analysis And Culpable Hiv/aids Homicide

During the last few days of June, at the same time the Treatment Action Campaign and Congress of South African Trade Unions are holding a massive people’s conference in Durban to take forward the struggle against HIV/Aids, Thabo Mbeki will beg for increased investment commitments for Africa from G-8 leaders in Kananaskis, Canada.

Included amongst those commitments is the Global Fund to Fight Aids, TB and Malaria, which according to the United Nations should logically reach $10 billion annually to meet Third World demands for inexpensive medicine, more health workers and improved facilities. But the Fund has received less than a tenth of that money, after George W. Bush denied a congressional allocation of $700 million in May.

Mbeki’s search for funds and investment is likely to be futile, notwithstanding misleading hype over a new Marshall Plan for Africa. His New Partnership for Africa’s Development is notable for how corporate-friendly Mbeki hopes African governments will make themselves to attract new investment, especially in privatised infrastructure.

The occasion of the Tac/Cosatu conference should raise the opposite
question: how Africa-friendly are multinational corporations, particularly when so many African workers are HIV+?

Set aside, for the moment, the ongoing distractions from loony HIV/Aids dissidents who continue to have Mbeki’s ear, judging by his recent circulation within the ruling African National Congress of a bizarre 114-page denialist tract. Even if Mbeki changed his mind, there are at least three deeper-rooted structural reasons why Pretoria is hampered in rolling out treatment to five million HIV-positive South Africans.

Done properly, such treatment would potentially transform the disease from inexorably fatal into a chronic illness such as diabetes.

One reason is the pressure exerted by international and domestic financial markets to keep Pretoria’s state budget deficit to 3% of Gross Domestic Product. Recall the telling remark of the late Parks Mankahlana, Mbeki’s main spokesperson, who once justified to Science magazine why the government refused to provide relatively inexpensive anti-retrovirals to pregnant, HIV-positive women: `That mother is going to die and that HIV-negative child will be an orphan. That child must be brought up. Who is going to bring the child up? It’s the state, the state. That’s resources, you see.’

Instead of saving lives, Mbeki’s finance ministry adopted higher priorities: slashing corporate taxes from 48% in 1994 to 30%; redeploying state resources so as to import roughly R60 billion [$6 billion] worth of high-tech arms; and repaying roughly $25 billion worth of apartheid-era foreign debt and a bit more in apartheid domestic debt, which could have been declared Odious in legal terms. Such examples of fiscal laxity the local and international bankers generally approved, in contrast to expanding state health spending and other social budgets, which the bankers have explicitly not supported.

The second structural reason is the residual power of pharmaceutical manufacturers to defend their rights to `intellectual property’ (monopoly patents on life-saving medicines). This pressure did not end when the Pharmaceutical Manufacturers Association withdrew their notorious lawsuit against Pretoria in April 2001.

Indeed, Big Pharma’s power was felt in the debate over essential drugs for public health emergencies at the Doha World Trade Organisation summit last November, and since. Corporate pressure helps explain why it is only Robert Mugabe’s regime that, as of May, dares offer generic anti-retroviral medicines to HIV-positive citizens. In Mugabe’s case, ironically, the drugs are available mainly through urban clinics which are still operative, to a low-income proletarian population Mugabe normally treats with extreme repression.

The third structural reason for the ongoing HIV/Aids holocaust in South Africa is the vast size of the reserve army of labour, for this feature of capitalism allows companies to replace sick workers with desperate, unemployed people instead of providing them treatment.

The latter point deserves elaboration, simply because so many lives are at immediate risk, and so much evidence has mounted recently that corporate South Africa’s preferred approach is, in essense, mass murder by denial of medical benefits.

Perhaps the principle was expressed most eloquently by financier George Soros, who was asked about treating HIV+ South Africans in April by the SA Broadcasting Corporation. He answered, `I think to provide treatment to the bulk of the people is just not feasible. I think to provide treatment for instance to qualified workers actually saves money, actually saves money for companies.’

The interviewer responded, `Aren’t you uncomfortable to talk in a way that is a kind of death sentence to those who we can’t afford to treat?’ Replied Soros, `I think the cost of providing actual treatment to everyone at the present.. I don’t think it’s realistic. It’s not achievable.’

In a more systematic way, the same conclusion was reached after a year of study at Africa’s largest company, Anglo American Corporation. Anglo has 160,000 employees, of whom 21% are HIV+. After Big Pharma withdrew from its lawsuit in April 2001, the company announced it would provide anti-retroviral medicines to its workforce, which meant literally tens of thousands of lives could be saved in the short term.

Anglo is also self-promoting corporate social responsibility by playing host to global business at the World Summit on Sustainable Development–notwithstanding its role in the recently exposed Lesotho mega-dam corruption which taints Johannesburg’s water; its contribution to the rand’s 2000-01 crash through export of profits and dividends to its new London financial headquarters; its devastation of the Zambian copperbelt by recently closing down the largest (privatised) mines; its contribution to the spread of HIV/Aids via its migrant labour system; and countless other historical and contemporary contributions to apartheid, patriarchy, ecological devastation and labour exploitation.

How serious was Anglo about the anti-retroviral medicines promise? In June 2001, the Financial Times reported on Anglo’s `plans to make special payments to miners suffering from HIV/Aids, on condition they take voluntary retirement.’ But in addition to bribing workers to go home and die, Anglo told the FT, `treatment of employees with anti-retrovirals can be cheaper than the costs incurred by leaving them untreated.’

`Can be’ was the caveat, as Anglo headed down the slope of denialism. A month later, Johannesburg’s Business Day newspaper asked cost-benefit questions of AngloGold chief executive Bobby Godsell: `My first response as CEO is I don’t carry in my head in rands or cents the cost of Aids… HIV positivity is a subterranean syndrome.’

Although Godsell professed a `confident commitment’ to dealing with Aids and `acting responsibly towards employees,’ the leader of the mineworkers union, Gwede Mantashe, disagreed: `They do not have an Aids policy. They have had a lot of undeserved and undue publicity.’

Good publicity continued, however. In August, Anglo’s vice president for medicine, Brian Brink, bragged in Business Day about a `strategy [which] involved offering wellness programmes, including access to anti-retroviral treatment.’

According to that report, `The company believed that the cost of its programmes would eventually be outweighed by the benefits its received in gradual gains in productivity, [Brink] concluded. Although it was indeed a risky strategy, it was the only one Anglo could pursue in the face of such human suffering.’

Then in October, Anglo simply retracted its promise, once cost-benefit analysis showed that 146,000 workers just weren’t worth saving. According to the FT, Brink `said the company’s 14,000 senior staff would receive anti-retroviral treatment as part of their medical insurance, but that the provision of drug treatment for lower income employees was too expensive.’

Brink explained the criteria for the fatal analysis: `[Anti-retrovirals] could save on absenteeism and improved productivity. The saving you achieve can be substantial, but we really don’t know how it will stack up. We feel that the cost will be greater than the saving.’

The callous feeling became official policy a few months ago. As the Wall Street Journal recorded on April 16, `In a controversial move that could have wide ramifications for how companies in poor countries handle Aids, mining giant Anglo American PLC has put on hold a feasibility study to provide Aids drugs to its African work force, according to people familiar with the situation. When it disclosed its plans for the study a year ago, Anglo garnered wide praise because it was one of the first major corporations to reveal measures aimed at treating Aids cases among its rank-and-file African employees.’

Godsell passed the buck, blaming everyone but Anglo: `We’re making very heavy weather of the pilot study, with a variety of obstacles relating to both industry and national politics, as well as very limited support from drug companies.’

A month later, South Africa’s most eloquent pro-corporate commentator, Ken Owen, defended the merits of Anglo’s policy: `I am sceptical about most doomsday economic scenarios generated by the Aids epidemic… For the rest of this decade, at least, the lost workers will be quite readily replaceable from the millions of unemployed, and society will adjust in a myriad of ways to labour shortages. For example, a million domestic workers constitute a reserve pool of labour that can be drawn into industry.’

Where does this sickening display of arrogance leave the treatment-activist movement? Will the 2001 victory over Big Pharma and the expected Constitutional Court ruling against Mbeki on access to drugs for pregnant HIV-positive women allow key strategists to turn, with their labour allies, against capital-in-general?

The answer may lie in changing the terms of costs and benefits, by making firms socially liable for killing their workers through malign medical insurance neglect.

A good precedent exists. After being regularly hounded by activists and accused of genocidal tendencies by serious commentators and the media, Mbeki allegedly made an HIV/Aids policy U-turn in April, by finally agreeing to provide medicines to pregnant women and rape victims. But the change in mindset came only once public pressure and embarrassment became overwhelming, and foreign journalists threatened to distract attention from Mbeki’s G8 fundraising mission. (And it may be only temporary, unless watchdogging pressure is maintained.)

But the structural problems associated with rampant South African neoliberalism mean that not much progress can be expected from Pretoria until HIV/Aids activists and trade unionists adopt a more radical advocacy agenda that gets behind the greed of Big Pharma and the insanity of Mbeki’s Aids-denialism. Such a strategy would expose Anglo’s cost-benefit analysis–and would add to the cost side of the company’s equations some explict social punishment for proceeding with a frugal employee benefits programme that can only be termed culpable mass homicide.

With the WSSD, opportunities for global humiliation of Anglo’s–and SA corporate capital’s–own genocidal instincts abound.

(Wits University professor Patrick Bond is editor of Fanon’s Warning, a new book critical of Nepad, published by Africa World Press and the Alternative Information and Development Centre.)



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