US Policy and Public Health — AIDS in Africa

Ethical Questions

1) While the United States imposes sanctions on countries to both punish the countries for violating human rights and force governments to become more democratic, the United States has done nothing of the sort to African countries who are not providing adequately for their citizens' right to health nor recognizing the destabilizing impact of the HIV/AIDS pandemic.

For example, South African President Thabo M. Mbeki, who took office in 1999, has been slow to address the health needs of the almost 20% of his country's population living with HIV/AIDS. Though President Mbeki is supported in his argument that there are close links between poverty and AIDS, medical professionals and AIDS activists strongly criticize his doubts about the connection between HIV and AIDS, his past use of outdated statistics, and his government's resistance to the use of AIDS drugs to stop mother-to-child transmission and to prolong the lives of those living with AIDS.

Should the United States place sanctions on countries, like South Africa, whose administrations have not taken adequate steps to treat HIV/AIDS as a national emergency? Will sanctions on those nations only hurt the impoverished citizens more than causing their governments' policy to change? Should a government be held morally responsible for the public health of its citizens? Does the US share a global obligation to protect the right to health of other nations that are unable to provide for themselves for whatever reason?

2) Hypothetical Scenario: Imagine that you have just entered the workforce after completing your PhD in microbiology at one of the best institutions in the world. You are hired at a leading pharmaceutical company to work on the development of the most effective HIV/AIDS treatment to date. You discover that your employer has no plans to offer this badly needed medication at a reduced price to developing nations besieged by the HIV/AIDS epidemic. The company also has a long history of lobbying the US policy makers and the World Trade Organization to protect the intellectual and property rights of the pharmaceutical industry by prohibiting the production and sale of less expensive generic drugs to developing countries suffering from the AIDS pandemic. Do you continue to work for the company? Can you help change the company's policy regarding drug sales to developing countries? If so, what would you do to influence change? Would you risk your livelihood by leaving the company to work for one that provided developing countries with HIV/AIDS medications at a reduced price, but where your research may not be as useful or effective? Or to be unemployed for awhile?

3) Hypothetical Scenario: You are an American medical doctor working with a clinic in a sub-Saharan African country that has contracted to conduct clinical trials of a newly developed HIV/AIDS vaccine for a pharmaceutical company. The vaccine to be tested may prevent the HIV virus subtype that is most prevalent in much of Africa and India, but not the US. You learn that once the clinical trials are complete, the pharmaceutical company will cut off the supply of vaccine to the participants, even if it is found effective at preventing new HIV infections. Do you refuse to conduct the trial until the company agrees to make the vaccine available after the completion of the trial? Is the company ethically obligated to make the vaccine available to the whole country, to a particular state, or just to the people who live in the cities or villages where the trial was conducted? Would your defiance lead companies to find other sites to conduct their trials, taking the needed funding and resources away from your clinic?