Toward a New Foreign Policy.

Key Recommendations

* The U.S should lead other rich nations in supplying essential medicines to Africans living with AIDS, and devote significantly more resources to fighting AIDS in Africa.

* The U.S should lead the fight for debt relief for African nations and ensure that the savings go into AIDS relief and other healthcare programs.

* The U.S and other rich nations should work with African governments to create an environment conducive to AIDS relief on the continent.

The immediate goal of a reinvigorated U.S policy should be the dismantling of all legal and logistic obstacles to the provision of affordable drugs to all Africans living with AIDS. The developed nations, led by the U.S., should rise in unison and make a simple pledge: No African Man, Woman, Child, or Infant Should Be Denied Access to Lifesaving AIDS Drugs, by December 2002.

As the leading global democracy, the U.S. should democratize access to essential AIDS medicines for poor nations. We commend the Bush administration for maintaining President Clinton's executive order on flexible access to AIDS drugs for poor nations. However, the U.S. needs to do more. The U.S. should ensure that the World Trade Organization (WTO) implements a flexible interpretation of the Trade-Related Intellectual Property Rights Agreement (TRIPS), thereby allowing poor nations facing the AIDS emergency to provide cheap AIDS drugs to their citizens. The U.S. and its allies should also ensure that all WTO rulings reflect a sound public health framework to ensure that the goal of unencumbered trade does not create adverse health consequences in poor nations.

The U.S. government should work more closely with the pharmaceutical companies to ensure that all obstacles to speedy and effective delivery of AIDS medicines to poor nations are eliminated. These obstacles include: (1) the concerns of pharmaceutical companies about possible parallel imports of cheap AIDS drugs into the lucrative Western markets by poor nations; (2) the concerns of citizen advocates and AIDS activists that access to AIDS drugs should not come under the purview of market forces and restrictive patent laws; and, (3) the concerns of African governments that they should have the exclusive prerogative to determine national emergencies and possible remedial actions. Washington should also work to persuade U.S. multinational companies doing business in Africa to provide AIDS prevention and treatment programs for their workers and family members.

The U.S. should devote more resources to fighting AIDS in Africa. America has always responded to major humanitarian needs, whether in Europe, Asia, or Latin America. It is time to spend readily available resources to stop AIDS in Africa. Harvard researchers estimated that a scaled-up U.S. response of $1.5 billion would cost about $5 a year per American. Doubling such a commitment would cost each American about $10 a year--a commitment well worth making, considering the magnitude of the crisis and its long-term implications for global peace and development.

It is not likely that other rich nations will spend significantly more money on AIDS without a serious commitment from the United States. The Constituency for Africa (CFA), under the leadership of former Congressman Ron Dellums, proposed a HIV/AIDS Marshall Plan for Africa with significant public- and private-sector funds to fight the disease. As a result, Congress, in August 2000, passed Public Law 106-264, the Global AIDS and Tuberculosis Relief Act of 2000, sponsored by Jim Leach, R-Iowa and Barbara Lee, D-California, that earmarked $150 million dollars for each of the fiscal years 2001 and 2002, for a Trust Fund. The Trust Fund will be used to leverage funds from multilateral development banks like the World Bank and to encourage similar commitments from other Western donors. The Trust Fund will also fund the implementation of specific HIV/AIDS programs in Africa. President Clinton signed the bill into law, as a modest start to what promises to be a long journey.

The U.S. should use its significant leverage in the G8, the IMF, and the World Bank to provide debt relief for African nations. The U.S. has the excellent opportunity at the G8 summit, in July 2001, to persuade its allies to forgive the debt of African nations, on the condition that African governments plow back such savings into verifiable investments in AIDS prevention and treatment programs and other healthcare services. The U.S. government is not the major holder of African debt--it is owed about $360 million out of the estimated $350 billion in controversial debts--but the U.S. has the moral, economic, and political leverage to advance a genuine debt relief agenda among its allies. Washington should also work with African leaden and their peoples to ensure a concerted and consistent focus on the AIDS epidemic. Without dictating their actions, the U.S should work with African governments to ensure movement in the following areas: (1) allocation of more money by African nations to fight AIDS; (2) sustained political reforms to encourage pluralistic political and multi-sector campaigns against AIDS; (3) end corrupt practices that siphon foreign aid and investments; and, (4) encourage the emergence of more civil society involvement in politics and non-government programs at community levels.

The international community led by the U.S. should not turn its back on 25 million Africans living under a death sentence. The international cooperation that has fought against oppression and tyranny since World War II should not permit the AIDS killing fields to continue in Africa. A strong case can be made that the AIDS pandemic in Africa represents a direct threat to U.S. national interests and national security because of associated political instability, economic downturn, and the intercontinental spread of infectious diseases. In the end, however, U.S. citizens and U.S. policymakers face a moral imperative and should ask: Have we done all we can to save 25 million fellow human beings from an avoidable death?

Melvin Foote is President/CEO of the Constituency for Africa (CFA), a Washington, DC advocacy organization. CFA is promoting an AIDS Marshall Plan for Africa. Chinua Akukwe <[e-mail]> is a board member of Constituency for Africa, and Adjunct Professor at George Washington University School of Public Health.