[Congressional Record Volume 149, Number 69 (Friday, May 9, 2003)]
[Extensions of Remarks]
[Pages E908-E910]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




ADDRESS BEFORE THE STUDENT GLOBAL AIDS CAMPAIGN, MIDDLEBURY COLLEGE, VT

                                 ______
                                 

                          HON. BERNARD SANDERS

                               of vermont

                    in the house of representatives

                         Thursday, May 8, 2003

  Mr. SANDERS. Mr. Speaker, I wanted to share with you some excerpts 
from remarks I gave at Middlebury College on May 2, 2003 regarding the 
international AIDS crisis:

       Hello and thank you for inviting me to address this very 
     important gathering. While I am most certainly not a great 
     expert on this issue, I am appreciative that I have this 
     opportunity to exchange a few thoughts with you.
       The HIV virus respects no boundaries. In every corner of 
     the world, it strikes young and old alike. Especially tragic, 
     those infected include staggering numbers of children. Here 
     are some numbers which should sober us all:
       Last year, over three million people died of AIDS.
       That represents nearly 8,500 persons dying each day from 
     AIDS.
       Last year alone, five million previously healthy people 
     were infected with HIV.
       Today, there are over 42 million people living with HIV/
     AIDS across the world.
       No part of the world knows the devastation of HIV/AIDS more 
     than Sub-Saharan Africa. Of the 42 million people living with 
     the disease worldwide, over two-thirds--29 million people--
     are in this poverty-stricken region. 8.8 percent of the adult 
     population in sub-Sahara Africa is infected with HIV/AIDS. 
     And that number is growing: Seventy percent of the estimated 
     5 million new infections globally last year were in Sub-
     Saharan Africa. Unbelievably, in Swaziland, 38.6 percent of 
     adults are infected.
       Although the increase of AIDS/HIV infections has flattened 
     in our own country, it still remains a crisis here. In North 
     America overall, over one half of one percent of adults 15 to 
     49 years of age are infected, including an infection rate in 
     the Caribbean of nearly two and a half percent.
       How did the AIDS crisis get so dire? Part of the answer has 
     to do with a failure in the American political system, a 
     failure that was often mirrored in other political systems 
     around the world.
       The HIV virus was first identified in the United States 
     over 20 years ago. Public policy is supposed to identify 
     problems in society and come up with ways to make things 
     right. But owing to a great failure on the part of many of 
     our political and religious leaders at the time, the disease 
     was not considered a matter of concern: On the contrary, it 
     was met with ignorance, fear and, often, complete 
     indifference. Tragically, many public figures used the 
     appearance of AIDS as an opportunity to make political gains 
     among right-wing voters by espousing the hateful and 
     destructive rhetoric of homophobia. Some prominent religious 
     conservatives framed the epidemic as a divinely-ordained 
     blight upon gay men, while some reactionaries in Congress 
     went so far as to consider bills proposing to quarantine gay 
     men.
       During these critical years, at the dawn of this pandemic, 
     President Ronald Reagan remained silent. Although his 
     supporters liked to call him ``The Great Communicator,'' it 
     took President Reagan seven years to publicly acknowledge the 
     existence of the disease. AIDS, which in 1981--the first year 
     of Reagan's term in office--had been diagnosed in roughly 335 
     people and took the lives of 158, exploded exponentially 
     while he and his administration maintained a regime of 
     silence in the face of the growing pandemic. Six years later, 
     in 1987, when President Reagan finally uttered the word 
     ``AIDS'' in public, over 71,000 people had been diagnosed in 
     the United States and over 41,000 of them had died. In those 
     shameful years of silence, the number of HIV/AIDS diagnoses 
     had jumped 21,000 percent; the number of AIDS deaths had 
     jumped 25,900 percent.
       The failure of U.S. leadership, as well as political 
     leadership around the world, at the outset of this crisis was 
     blatant and unforgivable. Ignorance and denial and a stark

[[Page E909]]

     homophobia squandered our best chance to face up to the 
     threat, and control its devastating effects on our nation. My 
     point here is not to be ``political'' or to make gratuitous 
     criticism. It is to make the point that prejudice and silence 
     are not the way to face up to huge threats to civil society. 
     This is true whether the situation is SARS in China, or AIDS 
     in South Africa, or arsenic-laced water in Bangladesh, or 
     women's illnesses in a male-dominated medical culture. It is 
     the responsibility of political leadership to courageously 
     address problems even when they are politically 
     uncomfortable.
       Today, while we are not entirely free of the irresponsible 
     and destructive rhetoric of two decades ago, while some still 
     proclaim that AIDS is God's punishment for homosexuality, the 
     AIDS landscape is considerably better. The government 
     estimates that 40,000 Americans are infected with HIV each 
     year, a figure that has remained roughly stable for over a 
     decade. This figure was nearly offset each year by AIDS 
     deaths, so the total number of Americans carrying the virus 
     stayed level for a number of years. Today, however, with new 
     drug treatments which stave off the effects of AIDS, deaths 
     have plunged from around 40,000 annually to about 15,000. As 
     a result, new infections are outstripping deaths. Although 
     the United States does not keep national records on who has 
     HIV and AIDS, the Center for Disease Control estimates that 
     almost a million people--900,000--are infected with the AIDS 
     virus. One quarter of them do not know they are infected; 
     another quarter are receiving no care or treatment for their 
     infection.
       There is some good news on the horizon, even if the world-
     wide view is bleak. Yesterday, I voted for the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003--which won in the House by an overwhelming vote. This 
     bill will authorize $15 billion over the next five years to 
     fight these terrible diseases in Africa and the Caribbean--
     the regions struck most severely by this scourge--through 
     treatment and prevention on an unprecedented scale. This is 
     certainly a very large step in the right direction. Although 
     I do not often find myself in agreement with President Bush, 
     I am heartened that he supports this initiative. The outcome 
     of this legislation is that, with the participation of other 
     wealthy nations, it is estimated that 2 million HIV-positive 
     Africans will be provided some sort of treatment, and 7 
     million needless new HIV infections will be prevented.
       However, a word of caution about this legislation which has 
     not yet passed the Senate! While the House bill authorizes $3 
     billion a year for five years, an authorization is not 
     an appropriation. It's not real money. Right now, despite 
     the President's very public support of the legislation, 
     the President asked for only $1.7 billion for global AIDS 
     in his 2004 budget proposal and, according to The New York 
     Times today, appropriators say that it will not be easy to 
     find the rest of the money. What this means is that the 
     pressure must stay on Congress and the President to 
     actually allocate these funds at the level so publicly 
     trumpeted and called a ``moral Imperative'' by President 
     Bush this week.
       Yet, despite this legislation, we continue to have a 
     failure in leadership from the White House and the Congress. 
     While the new legislation passed this week is certainly an 
     important step in the right direction, most of the forty 
     million people infected with HIV/AIDS, and the millions more 
     who are being infected each year, live under a virtual death 
     sentence.
       This need not be the case. Government-sponsored research, 
     in this country and abroad, has made giant steps forward. 
     Biochemists and physicians have developed effective 
     antiretroviral medicines that enable people to live with HIV 
     and avoid the onset of full-blown AIDS. They provide a 
     reasonable quality of life to those who would otherwise face 
     nothing but suffering and death. Yet many of these medicines 
     are priced so high that, while Magic Johnson and those with 
     Cadillac health care plans may be able to afford them, most 
     of the afflicted cannot afford the medicines which would 
     promise them life, instead of death.
       And now, let me touch upon a key element of the whole AIDS 
     discussion--an element that deals with fundamental questions 
     of morality, justice, economics, and politics: and that is 
     the role of the pharmaceutical industry in the AIDS crisis. 
     As I mentioned a moment ago, because of efforts of the 
     federal government and the pharmaceutical industry, major 
     breakthroughs have taken place which are saving countless 
     lives. And we applaud those scientists and researchers, both 
     in the public and private sector, who have done so much to 
     advance the treatment of those with AIDS. But the question 
     here is not just the issue of research, but who benefits from 
     that research? And in that regard, I must tell you that I 
     have some very, very deep concerns about the behavior of the 
     pharmaceutical industry--the most profitable industry in the 
     United States.
       The profits of the drug companies come, in large part, from 
     making drugs available to those who can afford to pay high 
     prices for them. Drug prices are set to maximize profits, not 
     to make needed medicines available to the widest number of 
     people. (And in that regard I should point out that the 
     United States is the only industrialized country not to 
     regulate the prices of prescription drugs). This is true for 
     most pharmaceuticals: it is especially true for AIDS 
     medications. Despite the gravity of the AIDS crisis and the 
     horrendous pain and suffering of those dying from AIDS, the 
     drug companies in most cases have continued to put their 
     desire for large profits above the pain of millions of people 
     who suffer unspeakably around the globe. I wish I could tell 
     you otherwise, but I fear that high profits and high CEO 
     salaries are often more important to these companies than 
     saving lives.
       Let me use one example to illustrate this. Last month drug 
     giant GlaxoSmithKline announced that it would reduce the 
     price of its drug Combivir in the developing world from $1.70 
     per day to $0.90 per day. The same treatment costs $18 per 
     day in the United States. Some might say that this is 
     evidence of Glaxo's commitment to serve people over profits 
     and, clearly, Glaxo's recent announcement will provide some 
     real relief to those struggling to treat their infection. 
     Yet, while this recent announcement surely makes for good 
     public relations for Glaxo, which had net profits before 
     taxes of $9.7 billion in 2002, we must ask ourselves some 
     hard questions: Why have they done this? Is it enough? 
     Will it help?
       Why have they lowered the price of Combivir in the 
     developing world? Well, two years ago pharmaceutical 
     companies in the developing world figured out how to make a 
     generic equivalent of Combivir at a much lower price. Today, 
     for instance, India's Ranbaxy Laboratories offers the same 
     treatment at 73 cents a day, in a tablet approved by the 
     World Health Organization. So, in an important sense, Glaxo 
     is not cutting prices as much as meeting competition. 
     Although Glaxo has stated in the past that it would not sell 
     AIDS drugs at a profit in the developing world and that its 
     recent price cuts were made possible by continuing 
     improvements in manufacturing processes and economies of 
     scale, it only dropped its prices after manufacturers in 
     India figured out how to produce the same drug at a lower 
     price. And Glaxo's price is still more than the competition.
       To understand the logic of the pharmaceutical companies 
     from this example, you have to consider a second point that 
     Glaxo, conveniently, did not include in their announcement of 
     the price reduction of Combivir. Combivir is but one of a 
     number of effective anti-retroviral medicines: many of them 
     have their most significant impact when they are taken in 
     combination with other medicines, i.e., cocktails.
       It turns out that Combivir is most effective when taken in 
     combination with a protease inhibitor called Agenerase. 
     Agenerase--also produced by Glaxo--is still priced at $8 per 
     day, or nearly $3,000 per year, making it completely 
     unaffordable to many poorer patients. In Africa, for 
     instance, most people earn less than $500 per year. So what 
     Glaxo offers with one hand, it undercuts with the other. It 
     is still not providing the necessary anti-AIDS cocktails that 
     people in the developing world need if they are to survive. 
     While there is some indication that Glaxo may reduce the 
     price for this drug, it makes no sense for this drug to 
     remain at an unaffordable price for those who need treatment. 
     To put this in context, we should remember that in Swaziland, 
     where the infection rate is 38.6 percent, the per capita 
     income is $140 per year.
       The issue that we're discussing now is a profound moral 
     issue. Should people die from a disease that can be treated 
     because they cannot afford the medicine that will save their 
     lives? Should large drug companies make billions in profit 
     each year, and pay their CEOs exorbitant pay, while they 
     charge outrageously high prices for their products?
       It is my belief that health care is a right, not a 
     privilege. That is why I believe that the United States 
     should join the rest of the industrialized world and develop 
     a national health care program guaranteeing health care to 
     all people, regardless of income.
       The same logic means that, as part of the world community, 
     we must demand nothing less than full access to all available 
     means of saving the lives of those afflicted with AIDS. The 
     predominant right here is not the right of drug companies to 
     make obscene profits because an uncontrolled marketplace may 
     allow that. The right we must uphold is the right of every 
     human being, if imperiled, to access the medicines which can 
     save his or her life. With over 40 million persons suffering 
     from HIV/AIDS across the world, with 5 million new 
     infections annually, with over 600,000 children under the 
     age of 15 dying of AIDS last year, that is a right we must 
     insist upon and fight for.
       We have the technology to save these AIDS-threatened lives 
     now. In this day of unprecedented global distribution 
     networks, with a real commitment from the United States and 
     other wealthy nations to begin funding this epic battle, the 
     pharmaceutical companies must stop putting profit before 
     people. And if they will not do it on their own, then the 
     government of the United States must insist they do so. 
     Pharmaceutical companies get all sorts of government support: 
     tax breaks, government-funded research, patent protection, 
     etc. In return, they must be required to provide medicines, 
     at cost if need be, to combat the AIDS pandemic.
       Any serious, comprehensive approach to fighting AIDS in the 
     developing world must [also] include an unprecedented debt-
     forgiveness program. We must call on the World Bank and the 
     IMF to write off the debts of the impoverished nations, not 
     only in Africa, but in the Caribbean, in Central America, in 
     South America, in Asia. As a requirement for writing off 
     these debts, we can insist that the countries involved commit 
     adequate resources to AIDs education and the fight

[[Page E910]]

     against AIDS, as well as to building a society where fighting 
     disease and want and malnutrition and lack of education is 
     paramount.
       Obviously, there is a lot of work to do. Every student in 
     this auditorium has an opportunity to do something. The range 
     of roles you can play is very broad--whether working directly 
     in the delivery of healthcare services or prevention programs 
     through relief organizations or public health programs; 
     working in international development or finance for sane 
     policies that actually benefit struggling communities and 
     developing nations rather than policies that simply serve to 
     further line the pockets of already-rich multinational 
     corporations; or working in politics or public policy here in 
     the United States for approaches that recognize the 
     immeasurable global impact of every foreign policy and aid 
     decision made in the U.S. Congress.
       In whatever role you end up playing, it will be paramount 
     to remember this: Even during our present economic slump--and 
     especially when the world economy is so-called ``roaring''--
     the biggest decisions made here and globally are about the 
     allocation of resources. We have the resources to wage a 
     successful war in the prevention of HIV/AIDS. We have 
     medicines available today that can substantially alleviate 
     the vast human suffering over 42 million persons are enduring 
     right now, this minute. One of the great tests of our day--
     the battle against HIV/AIDS--will ultimately be measured by 
     the yardstick of how we allocated our resources.
       Our nation must insist that the pharmaceutical industry 
     provide life-saving drugs to suffering millions, rather than 
     providing tens of millions of dollars in salaries, stock 
     option and retirement bonuses to its CEOs.
       Let me conclude with a very hard, and very important truth. 
     The United States, and its government, will not address the 
     major problems which face us unless you demand we do so.

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