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2. On Pharmaceutical Empire: AIDS, Security, and Exorcism
- University of Washington Press
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❒ 2 ❒ ON PHARMACEUTICAL EMPIRE AIDS, Security, and Exorcism Exactly when they came to be known as complex humanitarian emergencies and who gave them that name is not clear, but by 1990 many senior disaster managers had begun using the term. —Andrew S. Natsios, U.S. Foreign Policy and the Four Horsemen of the Apocalypse THROUGHOUT THE 1980S A NEW CONSENSUS GRADUALLY TOOK HOLD OF the international political community. The AIDS epidemic was no longer a global public health issue (as UNAIDS had tried to establish under the leadership of Jonathan Mann) but rather the preeminent security threat of the twenty-first century. In all its sexual and social complexities, AIDS was to be confronted as a military emergency. The first step toward this reconfiguration of AIDS was made in 2000, when the UN Security Council, which had traditionally been oblivious to health issues, dedicated its inaugural meeting of the millennium to the growing impact of AIDS in Africa. At about the same time, and from an avowedly self-interested perspective, the United States commissioned two reports on the national security implications of infectious disease. In one report the National Intelligence Council warned that “new and reemerging infectious disease [would] pose a rising global health threat and [would] complicate U.S. and global security over the next twenty years” (National Intelligence Council 2000, 1), while a document jointly issued by the Chemical and Biological Arms Control Institute and the Center for Strategic and International Studies predicted that in the aftermath of the Cold War cross-border contagion was set to become the number-one international security risk (CBACI and CSIS 2000).1 Both reports placed particular emphasis on the dramatic rise of HIV/AIDS infections in sub-Saharan Africa. In retrospect, it could be countered that the transformation of AIDS into a 51 security issue didn’t come totally out of the blue. Rather, it was consistent with a wider redefinition of strategy that throughout the 1990s, tended to merge war with humanitarian intervention and public health crises with military emergencies . Crucial to these developments was the growing consensus that the paradigmatic military threat of the post–Cold War era was no longer to be found in the formal declaration of war between sovereign states but rather in the irruption of so-called complex emergencies—natural or human-made disasters characterized by the implosion of the state, the breakdown of essential public infrastructures (sanitation, water, power, and food supplies), and the prevalence of infectious disease.2 For infectious disease was undoubtedly back, despite the long-held belief that the modern pharmaceutical industry would see to the near total elimination of infection-related deaths by the beginning of the millennium. Nowhere was the stark discrepancy between the promise of biomedicine and the obstinate , inexplicable endurance of infectious disease more apparent than in the case of the AIDS pandemic. The development of AIDS drugs in the late 1980s, followed by the powerful antiretroviral therapies of the mid-1990s, had seemed to signify that AIDS too, the newest of infectious diseases, would succumb to the inexorable advance of the miracle drug. In the richest countries of the world, historians of the disease were proclaiming that AIDS had morphed into a chronic condition like any other, to be taken in charge on a life-long basis by the pharmaceutical industry. But despite the blunt fact that AIDS mortality could now be significantly reduced, the promised health transition from death sentence to chronic condition failed to materialize in many developing countries. This is particularly true of sub-Saharan Africa, where the numbers of people infected with the disease has continued to escalate. In South Africa alone it is estimated that five million adults between the ages of fifteen and forty are infected with HIV/AIDS, the largest absolute number of any country in the world. Very few of these people have access to the new antiretroviral treatments. Yet in the face of such self-evidence and despite the recommendations of its own security advisers, the United States has made every effort to prevent the South African government from designating the AIDS epidemic as a state of emergency. Beginning in the mid-1990s—the watershed decade that saw the end of apartheid and the introduction of antiretrovirals (ARVs)—the United States has consistently tried to dissuade South Africa from utilizing the emergency clause that would allow it to override World Trade Organization (WTO) 52 On Pharmaceutical Empire ❒ rules on the importing of low cost...