Kerry Cullinan: Frank Chikane’s whitewash of Mbeki is an ahistorical disgrace

This opinion piece by Kerry Cullinan appeared on the Health-e News Service:

OPINION: Doctors call them Thabo’s children – the thousands of kids infected with HIV by their mothers at birth who still fill hospital paediatric wards, suffering from a range of debilitating infections.

When many of them were born, they did not get antiretroviral medication that could have prevented their mothers from passing HIV on to them. This was because then-president Thabo Mbeki had decided that ARVs were “toxic” and somehow less desirable than a fatal, incurable virus.

But by 2000, at the height of Mbeki’s AIDS debating society, four independent studies had shown that two ARVs, AZT and nevirapine, could cut HIV transmission from mothers to babies by up to 50%.

Also by 2000, research showed a radical change in the death patterns of South Africans with a peak in young women and men, rather than the elderly, that could only be explained by AIDS.

It is well documented that some 330,000 people died under Mbeki’s watch because his government delayed the introduction of ARVs.

What is less known is that Mbeki’s refusal to accept that AIDS was caused by a viral infection caused his government to under-fund health services at the very time that hospitals were starting to see a surge in AIDS patients. They closed nurses’ training colleges and flat-lined health budgets to save money, hastening the collapse of health services that we see today.

Yet in a series of articles published in Independent newspapers countrywide recently, Mbeki’s loyal director general, Frank Chikane, has tried to portray his former boss as a deep thinker who took a principled stance after thorough research. Chikane’s criticisms of Mbeki are mild – painting his bizarre refusal to accept that HIV causes AIDS as a bit of a public relations blunder requiring some spin-doctoring – rather than a criminally irresponsible academic obsession that caused death, suffering and hardship for hundreds of thousands of South Africa citizens who depended on their president for leadership.

Chikane constructs his defence of Mbeki on three pillars. Firstly, that Mbeki believed that ARVs (especially AZT) were “toxic” and were being foisted on poor countries by evil pharmaceutical companies. Secondly, that he was defending “the historically disadvantaged” from “racism”. Thirdly, he was defending his own right to “think independently” of Europe and the US.

According to Chikane, “there could be no disagreement about AZT’s toxicity”.

However, he fails to spell out that four trials had shown that a four-week course of AZT and a single dose of nevirapine were safe and had been able to cut mother-to-child transmission by up to half – potentially saving 150,000 of the 300,000 babies born HIV positive annually at the time.

The first of these trials was carried out in the US as early as 1994, while two others were in Thailand and the fourth in South Africa in 2000.

In any medical treatment, risk is balanced with the seriousness of the condition. Chemotherapy is not acceptable to treat a cold but it is to treat an almost incurable disease such as cancer. Ditto ARVs: there are side-effects but the side-effect of HIV is death, so the risk is justifiable.

Chikane argues that Mbeki felt South Africa was “being asked to do what no developed countries were no developed country was doing” – namely to use AZT and nevirapine, “as monotherapy rather than as a combination of drugs”.

Chikane adds that Mbeki was disturbed that the World Health Organisation (WHO) approved of the use of single-dose nevirapine to prevent mothers from passing HIV to their babies in developing countries.

He fails to mention that, at a meeting in 1999 between then health minister Nkosazana Dlamini-Zuma and the Treatment Action Campaign (TAC) two months before Mbeki became president, Dr Zuma said that price of AZT was the major barrier to introducing it to prevent mother-to-child HIV transmission.

Chikane also fails to mention that the South African Medicines Control Council (MCC), despite all manner of political contortions to rob the body of its independence from government, found in 2000 that the benefit of using ARVs to prevent mother-to-child transmission outweighed the risks.

Time and again, Chikane raises the bogeyman of big bad Pharma – the all-powerful pharmaceutical companies – as being at the forefront of the “war” against Mbeki in a bid to safeguard their profits.

Yet at a time when Mbeki could have formed a powerful alliance with organizations like the TAC to fight for cheaper ARVs, Mbeki turned on them with viciousness, accusing TAC’s Zackie Achmat of having CIA links and the TAC of being a pawn of the pharmaceutical companies!

In addition, he fails to recall that Boehringer Ingelheim, the manufacturers of nevirapine, offered the drug free to South Africa for five years – an offer spurned by government because its president believed it was poison!

Describing the attacks on Mbeki as “ferocious” and unexpected, Chikane says “we” were forced to ensure that the Cabinet had to make compromises on HIV/AIDS and Mbeki was absolved from taking responsibility. So much for leadership!

In describing Mbeki’s inner circle’s discomfort at having to confront the then-president about his position on AIDS, Chikane inadvertently reveals Mbeki’s dictatorial manner, his narcissism and his inability to accept criticism.

He tells us few “could risk” raising Mbeki’s HIV stance with the president; that Mbeki felt those who wanted him to back down were “cowards” and that “there was no one bold enough to take on this cause” than himself.

It is hard to have sympathy for such a man, let alone such a president. Nowhere is there mention of the impact of Mbeki’s bizarre views of those living with, or affected by, HIV. Nowhere is there sympathy for the current president and health minister, who are trying valiantly to address the irresponsible legacy of the Mbeki regime. Instead, all Chikane offers is puff, paranoia and conspiracy – vintage Mbeki but wholly out of touch with current reality. – Health-e News Service.