Covid-19 Is Big Business. But Who’s Making a Killing?

Over 20 years ago, in July 2000, a group of activists, scientists, and clinicians gathered in Durban, South Africa, for the 13th International AIDS Conference. This was an AIDS conference like no other before it. Up until that summer—actually, winter in the Southern Hemisphere—no international AIDS conference had ever been held in the Global South, let alone a country in the region of the world that was the epicenter of the pandemic.

That July winter was historic too because at that moment, scientists, activists, clinicians, and politicians banded together to call out a singular and gross inequity. While powerful drugs had since 1996 transformed AIDS from a death sentence into a chronic manageable illness in richer countries, in poorer ones few had access to these medications. Well-known figures, including Nelson Mandela and Bill Clinton, stood at the podium to call on the world to redress this injustice.

But it was someone less well-known to Americans who made the clarion call to all of us. That week in Durban, Justice Edwin Cameron of the High Court of South Africa—who would later go on to become a justice of the highest court in the land, the republic’s Constitutional Court—came out to all assembled as an HIV+ gay man. But what he said that day was crucial:

If, without combination therapy, the mean survival time for a well-tended male in his mid-forties after onset of full AIDS is 30—36 months, I should be dead by approximately now. Instead, I am more healthy, more vigorous, more energetic, and more full of purposeful joy than at any stage in my life. In this I exist as a living embodiment of the iniquity of drug availability and access in Africa. This is not because, in an epidemic in which the heaviest burden of infection and disease are borne by women, I am male; nor because, on a continent in which the virus transmission has been heterosexual, I am proudly gay; nor even because, in a history fraught with racial injustice, I was born white. My presence here embodies the injustices of AIDS in Africa because, on a continent in which 290 million Africans survive on less than one US dollar a day, I can afford monthly medication costs of approximately US$400 per month. Amidst the poverty of Africa, I stand before you because I am able to purchase health and vigour. I am here because I can pay for life itself.

I can pay for life itself. Edwin’s words set off a revolution as the call for access to antiretroviral therapy for AIDS swept the globe, out of Africa to Asia, Latin America, and the Caribbean, to the states of the former Soviet Union. Within a few years, millions would be receiving these precious AIDS drugs around the globe.

On March 7 of this year, I found myself sitting in front of my desktop on another Zoom call among dozens that week. I was giving the opening plenary of another AIDS conference, the Conference on Retroviruses and Opportunistic Infections, the premier scientific meeting on AIDS and related diseases, now integrating Covid-19 into its proceedings. The plenary was a conversation with another leading South African legal figure, and a dear friend of mine, the lawyer and human rights activist Fatima Hassan of the Health Justice Initiative. Fatima and I shared an office in Cape Town for several years in the early 2000s, when we were both working to address Justice Cameron’s challenge to us in 2000 to make AIDS drugs accessible in South Africa—despite the resistance of then-President Thabo Mbeki.

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