At the start of this millennium the HIV pandemic was largely under control in the west but was still wreaking havoc in sub-Saharan Africa. The number of cases were rising at our TB hospital in Macenta, Guinea and there was little that we could do apart from palliative care. The required drugs would have cost over $5000 per patient per year and were way beyond the budget of a small NGO to pay.
Amazingly all that changed after a long fight between activists and pharmaceutical companies generic medicines became increasingly affordable for low income country programs but external funding was still required. Bono, from U2, had visited a hospice in Uganda where patients were sleeping and eventually dying three in a bed , the sisters who served there were simply overwhelmed, what could he do to help?
He recounted to Q magazine,
“I went to speak to Christian fundamentalist groups in America to convince them to give money to fight AIDS in Africa. It was like trying to get blood from a stone.”
His frustration and anger pours out in the lyrics to the song
Where you live should not decide
Whether you live or whether you die
Three to a bed Sister Anne she said
Dignity passes by ...
You speak of signs and wonders
I need something other
I would believe if I was able
But I'm waiting on the crumbs from your table ...
Thankfully HIV is now a treatable disease in sub-Saharan Africa. There are still hurdles of societal prejudice and shame to be overcome, but even in remote places like Bardai where we practice medicine in a Ministry of Health hospital, we have a good supply of tests and triple therapy available free. Unlike other parts of Africa HIV/AIDS is not the major health problem here but for those individuals that need treatment for themselves or to protect partners or their as yet unborn child, the medicines are still essential.
Some of the same frustration that Bono sang about is building now around the response to Covid-19. The Peoples Vaccine Alliance have spoken of the weak efforts to vaccinate lower and middle income countries with charitable donations as crumbs from the table. Last week the WHO was talking of the disparity between the high vaccination rates in the rich nations (56% of the UK population fully vaccinated) and the 1.5% of the African population. It has been suggested that as a minimum, all medical personnel and vulnerable people throughout the world should be vaccinated before we start administering 3rd booster doses of vaccines in the rich nations. Sadly it seems likely that this call for some sort of equity will be ignored and the government will continue to talk of its financial support for COVAX and vaccine donations from the UK, rather than addressing fundamental questions of vaccine equity.
This week the UK has at last started to send 9 million Astra Zeneca vaccine doses manufactured in the UK overseas. The first of 30 million doses promised at the G7 summit are to be delivered by the end of this year, with a further 70 million by June next year. That sounds a lot but it is only enough to vaccinate 50 million people. The problem is that we live on a planet with a population of 7 billion, so that is only enough to vaccinate a mere 0.7 % of the world population. About half of doses announced will be given to COVAX and will be distributed according to an equitable plan, the other half will be given directly as a gift from the UK as the government engages in ‘vaccine diplomacy’ supporting friendly nations with whom we have or aspire to closer ties. All this amounts to crumbs from the table, albeit gratefully received.
The Foreign Secretary, who along with his advisors decides where the doses should go, said “ We are doing this to help the most vulnerable, but also because we know we won’t be safe until everyone is safe”. Meanwhile at the same time the UK and Germany are lobbying the World Trade Organisation’s against a TRIPS (patents) waiver, this blocking the historic move, supported by a majority of nations including France and the USA, that would allow scaling up of manufacturing across the world, and the production of the billions of doses needed in a quicker and less costly manner. Crumbs from the table charity is being used as an excuse not to talk about and implement just policies such as the TRIPS waiver that would be the real solution to the problem of vaccine equity.
It is not unknown for the government to selectively quote the bible when speaking, so if reading the Bible is going to inform government policy perhaps ministers should read about some biblical principles in story form starting with the rich man and Lazarus in Luke 16:19-31. It is quite a shocking story, both for a first century and a contemporary 3rd millennium audience, and it speaks equally well to economic systems and individuals.
Meanwhile the reproach from Bono about injustice and indifference towards HIV/AIDS remains relevant during the current pandemic. Whether we like the music or not the words cut us to our hearts.
Where you live should not decide
Whether you live or whether you die
Three to a bed Sister Anne she said
Dignity passes by ...
You speak of signs and wonders
I need something other
I would believe if I was able
But I'm waiting on the crumbs from your table ...
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