Last Article in Washington Post Series Examines Bristol-Myers Squibb $100 Million Drug Initiative
On May 6, 1999, Bristol-Myers Squibb, the third-largest pharmaceutical company in the United States, announced the launch of "Secure the Future," a five-year, $100 million charitable initiative aimed at fighting HIV/AIDS in Africa. In the final installment of its "AIDS, Drugs and Africa" series, the Washington Post reports on the development and implementation of the program, which is credited with creating a public relations "bonanza" for the drug company. Although it started out showing "long term promise," the initiative has received mixed reviews, with critics contending that the initiative has "touch[ed] few" of the 25 million sub-Saharan Africans suffering from HIV. While Bristol-Myers initially estimated that 20,000 people in South Africa, Botswana, Namibia, Lesotho and Swaziland would receive free AIDS drugs in clinical trials, the company now declines to give a figure and instead concentrates the program's efforts on medical research and the education of African and U.S. health workers. Seventy-seven percent of Secure the Future funds have gone to medical research institutions and U.S.-based charities. Critics such as Nathan Geffen, spokesperson for the South African AIDS activist group Treatment Action Campaign, charge that Bristol-Myers drew up the initiative "to ensure that criticism from important sources is silenced." Company representatives "strongly disagree," insisting that the program "was not business-driven," but was instead spurred by the fact that the company had no charitable programs in sub-Saharan Africa, where the majority of HIV-positive people reside. Critics also point out that $33 million of the program's total funds were already earmarked for charitable causes and that the company is reducing the actual cost by valuing donated drugs at wholesale rather than manufacturing prices.
A Fruitful Flight
The idea for Secure the Future was born on a 1998 transatlantic flight from New York to Johannesburg, South Africa, when Bristol-Myers sales executive James Sapirstein met "mining mogul" and diamond merchant Maurice Tempelsman. Sapirstein, who ran the company's HIV/AIDS business, was on his first trip to South Africa. During their conversation, Sapirstein was struck by Tempelsman's desire to help his African workers, many of whom were infected with HIV. Several months after the flight, Sapirstein offered Bristol-Myers executives a plan to sell the drugs Videx and Zerit at "deeply discounted" prices in developing countries. He proposed teaming with African governments and multinational corporations to offer discounts of 10% to 60%. It was a "break-even model" designed to reach 3.5 million people with HIV. Company executives debated several options that ranged from donating drugs to offering deep discounts -- which raised the possibility of "a backlash from HIV patients in Western countries" -- to funding clinics and clinical trials and training health care workers. In November 1998, the company asked Sapirstein to design a charitable rather than a business plan for Africa. The figure of $100 million was decided on in March of 1999.
'Resistance' in South Africa
Secure the Future faced some challenges, especially in South Africa, where global conglomerates like Bristol-Myers were seen as "historical enemies" because of their opposition in the 1970s and 1980s to economic sanctions against the nation's apartheid government. South Africans were also distrustful of a white-dominated industry coming to the aid of a largely black HIV-positive population. South African officials objected to proposed clinical trials using "AIDS drugs that were unaffordable to most South Africans" and disagreed with the plan to send African doctors to the United States for training about "how to deal with HIV in the developing world." For those reasons, South Africa has lost out on much of the grant money, receiving only 10% of the $44.2 million that has been committed thus far. Eighty-five percent of the program's money has gone to Botswana, where almost 36% of the adult population was infected with HIV by the end of 1999.
Program in action
Bristol-Myers' "first impulse" was to donate antiretroviral drugs, but the company changed its focus to prevention and education efforts because of "limited health care resources" in Africa. Mark Ahn, senior director of Secure the Future, said, "It's very clear that prevention and education is the first and most impactful tier. Then voluntary testing and counseling. And then treatment. In that order." The program's architects also decided that Secure the Future would be directed exclusively at women and children because they are "most vulnerable from a biological, social and economic standpoint" and because it was a "softer political area to work in." The company wanted to avoid dealing with cultural issues of patriarchy and power structure. The program also funds a $19.6 million clinical trial in Botswana run by the Harvard AIDS Institute. Beginning this winter, researchers participating in the trial will examine the effect of different medications on the HIV subtype 1C, found mainly in Africa and Asia, that has killed more people than any other strain of the virus. The grant also provided funding for Botswana's first AIDS research lab. Some Bristol-Myers executives say that it is still too soon for Secure the Future to "have produced meaningful results." And Sapirstein, who has since left Bristol-Myers, said that through programs like Secure the Future, Bristol-Myers and other drug manufacturers are "doing a high-stakes balancing act, between profits and charity, between saving lives now or later" (Brubaker, Washington Post, 12/29).