HIV and AIDS in Sub-Saharan Africa - Essay Example

Running Head: HIV/AIDS IN SUB-SAHARAN AFRICA HIV/AIDS in Sub-Saharan Africa [The of the appears here] [The of the institution appears here] Introduction The number of people dying and living with HIV/AIDS is on the rise, yet only a lucky few have access to life-prolonging antiretroviral (A.R.V.) drug therapy (Clavel and Allan 2004). The primary reason for this lack of access is due to high cost of these 'luxuries' in Sub-Saharan Africa (Mader 2004). This paper takes a look at how we can ethically justify and challenge the reluctance of the major transnational pharmaceutical corporations in playing an active role for the eradication of this menace. Also in the later parts, we see how the international agencies can play their role in helping these transnational pharmaceutical corporations to sustain while selling drugs to these developing nations of Africa. Apart from pricing there are other factors which play their part in hampering the fight against HIV/AIDS. These are well noted by Calfee & Bate (2004): "...In a fundamental sense, much of the criticism of drug pricing and related matters in treating HIV/AIDS in poor nations is misplaced. A rapid drop in prices, accompanied by a near-abandonment of intellectual property and the widespread availability of inexpensive generic drugs, has revealed that stumbling blocks in progress against HIV/ AIDS in sub-Saharan Africa are not drug prices or patents. Rather, the barriers are inadequate health care infrastructures, an inability to administer drug therapy when it is needed and to avoid inappropriate drug therapy, the threat and reality of drug-resistant HIV strains, resistance to reasonable HIV therapy by governments, and severe administrative bottlenecks that have nothing to do with drug pricing or availability." (Calfee & Bate 2004, p140-152) Pharmaceutical Corporations & Social Responsibility For the fight against HIV/AIDS the access to antiretroviral medications is of prime importance. Until prevention and education programs are completely effective, A.R.V.'s are needed to save lives, and the transnational pharmaceutical corporations can provide them. The major American manufacturers of A.R.V.'s-Merck, Abbott, Bristol-Myers Squibb, Pfizer and Glaxo Smith Kline-have dedicated millions of dollars to the fight against HIV/AIDS in developing nations (Angell 2004). The assistance has taken various forms: donating A.R.V.'s, reducing their price to cost, investing in medical infrastructure and education programs and voluntarily waiving patent rights so that generic, less costly versions of their drugs can be sold. In determining how transnational pharmaceutical firms should respond to the HIV/AIDS pandemic, Reisel and Sama (2003,pp. 368-69) observed the following: "The pharmaceutical industry is motivated by competitive and economic factors. From a competitive standpoint, research and development (R&D) intensive firms are continuously under pressure to differentiate their discoveries from that of competitor firms.... With profitability so closely linked to sales of patented drugs that are not challenged by generics or substitutes, the pharmaceutical industry uses its influence to delay patent expiration whenever possible." The efforts are commendable but still one may ask whether these pharmaceutical companies (much less governments of wealthier nations) are doing enough to ensure access to A.R.V.'s. Most sub-Saharan African families simply cannot afford the drugs, even at discounted prices. Price reductions and other relief measures are inadequate when compared to the abnormal profit margins of drug companies. In 2001, for example, Abbott Laboratories posted $16.3 billion in sales and $2.9 billion in net earnings (Angell 2004). Those who defend the current pricing practices of drug companies argue that profits are needed for the research and development of new drugs (Grabowski, Vernon & Joseph 2002; DiMasi, Ronald & Henry 2003). They also remind critics that corporations are not charities: they exist primarily to make money (Angell 2004). There is a general view that executives must do no more than follow the law as they try to earn maximum profits for stockholders. Their prime focus should be to respond to market forces by providing products and services that people require. In this way, everyone is happy, at least in theory: jobs are created, salaries are elevated, and income is generated in the economy. Any action that the corporation takes to benefit society, beyond what the law and market demand, is simply laudable but not required. However, in recent decades, this free-market view of corporate social responsibility has been challenged, especially as corporations have become multinational. In many ways, the largest corporations resemble small governments in the influence they wield over people's lives. Moreover, advances in technology, communications and travel have made the world a much smaller place. Today, a corporation's business decisions can have far reaching effects. For these reasons, many ethicists conclude that corporations must exercise their power in a socially responsible manner. They assert that executives have a duty beyond earning profits and following the letter of the law. While corporate managers may justifiably aim to make a profit, they do not need to make the maximum possible profit. Stockholders should settle for less-than-maximum profits, so that some earnings can be used for other ends, such as helping the community and assisting people in dire need. The contemporary view of corporate social responsibility rests on certain ethical principles: (Crane & Matten 2004) Principle of Human Dignity: All people, regardless of where they live or who they are or what they look like, enjoy a special dignity simply because they are members of the human race. Principle of the Common Good: As human beings, we necessarily live in society with other people. Without a well-ordered community, we would not be able to thrive as human beings. Principle of Justice: In human relationships, we must treat one another with fairness and equity, giving to others what they are entitled to as human beings. For both companies and individuals the values of decency, fairness and compassion are absorbed in the concept of social justice. A distributive form of justice defines what society owes a person (Van Soest 1995), particularly regarding allocation of the basic necessities like food, clothing, and shelter. IN sub Saharan Africa these basic necessities are considered as luxuries for many families. There are three perspectives from which we can consider the distribution of A.R.V.s to the masses --egalitarian, utilitarian, and libertarian (Crane & Matten 2004). According to Rawls (1971) the egalitarian perspective is that in a socially just society all social primary goods like liberty and opportunity, income and wealth, and the bases of self-respect should be distributed equally unless an unequal distribution is to the advantage of the least favored. Thus, at their most primary, all HIV infected people in Africa should be treated equally (Rawls 1971). However, it is impossible to be impartial as inequality already exists. Thus, when people are of different social status, resources must be allocated in a way that benefits everyone, but the greatest benefit is to those who have the least. The utilitarian view states that the distribution of resources is right when the greatest good for the greatest number of people is considered (Van Soest 1995). The definition of the greatest good or who represents the greatest number is usually left to interpretation thus it varies within different individuals and corporations. According to the libertarian view, when individuals have rightfully acquired the resources they possess, they have the freedom to decide how to dispose off them (Van Soest 1995). Proponents of this view might also oppose government interference--believing that decisions regarding the distribution of A.R.V.'s are best left to the pharmaceutical companies who produce them. Role of International Agencies Expecting managers and stockholders to look to the long term and to settle for less-than-maximum profits is near to impossible especially in the recent rise in the trend of materialism. Cost-benefit analysis still rules the day. In the cold, utilitarian calculus of the bottom line, adherents of the contemporary view persist in urging managers to consider moral principles. If following ethical principles is not enough reason to convince skeptical managers and stockholders, then international agencies can convince the transnational pharmaceutical corporations that expanding access to HIV/AIDS drugs in Sub-Saharan Africa is good business (Kumarasamy 2003). In a world where economies are so interconnected, economic disaster in Africa will surely affect corporate profits. By saving lives and improving quality of life now, drug companies will support markets for the future. Moreover, the companies will benefit from the favorable public relations that will come with a substantial commitment to fighting HIV/AIDS. (McEwan 2001) Transnational pharmaceutical corporations in recent years have been demonized by politicians and the media for the prices of their drugs and therefore are in need of good public relations. Saving lives can create in consumers the good will that all corporations seek to cultivate. Finally, governments can encourage drug companies to expand access to A.R.V.'s by offering various incentives in the form of tax breaks or reduced regulatory control, which will lower the cost of doing business. As witnessed in the last few years, advocacy groups, stockholders and voters have pressured pharmaceutical corporations and governments to respond more boldly to the HIV/AIDS crisis. The United Nations, by relying on its moral authority, has effectively mobilized public opinion around the plight of those suffering from HIV/AIDS. While governments must respond to voters, corporations have a unique pressure point: directors and managers are answerable to stockholders. However, recently, this has induced some drug companies to take concrete steps to ensure greater access to their life-saving A.R.V.'s. (McEwan 2001) International agencies of good will are confronting their moral responsibility to help those suffering with HIV/AIDS in response to the almost incomprehensible scope of the HIV/AIDS pandemic in the developing world. In the last six months, the U.S. Congress and the president promised hundreds of millions of dollars in additional funding to fight HIV/AIDS abroad this year. (Frank 2003) Regrettably, those commitments have since been reduced and delayed, and fall far below the $2.5 billion that the United Nations expects the United States to spend (Frank 2003). Conclusion In a comprehensive research Kennedy, Frederick & Lord (2004) note: "The HIV/AIDS pandemic continues unabated, and last year more than 3 million people died of AIDS-related causes.... 40 million are infected now, and southern Africa has the greatest concentration of cases. By 2010, we may see as many as 100 million HIV-infected people outside Africa.... The national security dimensions of the virus are plain: It can undermine economic growth, exacerbate social tensions, diminish military preparedness, create social welfare costs, and further weaken already beleaguered states." With strong commitments and initiatives, ethical principles come to life. Though comprehensively defined in the paper above, the ethical principles must be applied to the facts. And in business politics, the facts are messy, the interests are varied, and the questions raised are multiple. Which method of ensuring access to A.R.V.'s is most effective: donating drugs, lowering prices or waiving enforcement of patents How much profit is enough for executives to fulfill their duty to give shareholders a fair return on their investment What minimum level of health care infrastructure is necessary for any influx of A.R.V.'s to be effective Of the many social needs, how much of a priority do we give to A.R.V. drugs, as opposed to other medications, and how much priority do we give to Africa, as opposed to another part of the globe (Low-Beer 2004) The answers are for sure not easy to come by but the questions need to be taken head-on. Government leaders, international relief agencies, religious groups, private foundations, medical professionals and corporate executives must present a unified front against the HIV/AIDS pandemic if lives are to be saved. Every voter and investor can join in this most worthy of battles, but there will be a cost not in blood but in dollars. Reciting ethical principles is the easy part. Living by them is much harder, for great principles like respect for human dignity, the common good and justice sometimes require great sacrifice. With each day that goes by, more lives are claimed by the deadly menace, but so too, more people respond to the rallying cry to save the African continent and the world at large. References Angell, Marcia (2004), "The Truth About the Drug Companies," New York Review of Books, 51 (July 15). Calfee, John E.; Bate, Roger (2004), "Pharmaceuticals and the Worldwide HIV Epidemic: Can a Stakeholder Model Work" Journal of Public Policy & Marketing, Fall2004, Vol. 23 Issue 2, p140-152, 13p Clavel, Franois and Allan J. Hance (2004), "HIV Drug Resistance," New England Journal of Medicine, 350 (March 4), 1023-35. Crane, A. & Matten, D. (2004), Business Ethics. Oxford: Oxford University Press, pp. 75-109. DiMasi, Joseph A., Ronald W. Hansen, and Henry G. Grabowski (2003), "The Price of Innovation: New Estimates of Drug Development Costs," Journal of Health Economics, 22 (2), 151-85. Frank, Richard G. (2003), "Government Commitment and Regulation of Prescription Drugs," Health Affairs, 22 (May-June), 46-48. Grabowski, Henry G., John Vernon, and Joseph DiMasi (2002), "Returns on Research and Development for 1990s New Drug Introductions," Pharmacoeconomics, 20 (Supplement 3), 11-29. Kennedy, Charles R.; Harris, Frederick H.deB.; Lord, Michael (2004), "Integrating Public Policy and Public Affairs in a Pharmaceutical Marketing Program: The AIDS Pandemic." Journal of Public Policy & Marketing, Fall2004, Vol. 23 Issue 2, p128-139, 12p Kumarasamy, N. (2003), "Generic Antiretroviral Drugs--Will They Be the Answer to HIV in the Developing World" Lancet, 364 (July 3), 3-4. Low-Beer, Daniel (2004), "Review of Rethinking AIDS Prevention, by Edward C. Green," Lancet, 364 (July 3), 19-20. 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