On a continent with many challenges to development, no issue is more pressing in Africa than the heavy toll of the AIDS epidemic. In addition to the staggering costs in terms of social upheaval and human suffering, AIDS cuts down workers in their prime years of productivity. Their deaths and illneses take a financial and emotional toll on businesses operating in Africa.
"This is not just a disease we're talking about. This is a disease that has the power to destroy economies," said Harvard Business School Professor Debora Spar, the panel moderator. The discussion took place at the 5th Annual Africa Business Conference at Harvard Business School on March 8.
Much of the debate over AIDS in Africa has surrounded the high cost of the drugs that have turned the deadly disease into one that patients in the West can now live with for many years. But another challenge in Africa, according to panelists from the healthcare field and the pharmaceutical industry, is delivering drugs that are donated or available at reduced prices to patients who need them.
Dr. Konji Sebati, a physician with the pharmaceutical company Pfizer, said she questioned the priorities of some governments that say they simply can't afford to purchase drugs for their AIDS-stricken populations.
"It has to start from the top. Governments have to put money toward HIV and AIDS," she said. "If a government can put $500 toward guns and ammunition and $10 behind health care, there's a problem."
Dr. Pride Chigwedere, an Oak Foundation Research Fellow at the Harvard AIDS Institute who worked as a physician in Zimbabwe, said the policy issues begin with difficulties designing prevention and treatment strategies based on scientific fact.
"How do you control an epidemic that is sexually transmitted?" he asked the group. "People have suggested all sorts of things," some fairly outlandish. One suggestion he recalled was simply encouraging people to have sex less often.
"I think the role of the government is to sift through all that...and come up with clear policy," he said. But he agreed with Sebati that some governments are committed and others are not.
Clear policies have been hard to come by in much of Africa, according to the panelists. Professor D.A O. Orinda, director of Abbott Diagnostics Division's operations in East Africa, noted, "We don't even have set policies on testing for HIV."
We can donate drugs. But if there is no infrastructure to distribute those drugs, we can't do any good.
— Ngozi Edozien,
Mukesh Mehta, managing director for Phillips Pharmaceuticals and a thirty-year veteran of the pharmaceutical industry in East and West Africa, said that while it is unlikely that many governments will suddenly find more money for fighting AIDS, they must focus the resources they do have.
"The reality is, [governments] have limited resources. When we have limited resources, how do we use them most effectively?" he said. Governments can use two avenues for education without spending more money, he said. Through the media, the government can insist on precautions. In Kenya, for example, half the population is younger than 15. By training teachers to talk about AIDS prevention, the government can use a built-in educational infrastructure.
Ngozi Edozien, vice president of PPG Planning and Business Development for Pfizer, said the lack of a delivery infrastructure for medicine has rendered the company's donations of drugs meaningless in some cases. "We can donate drugs. But if there is no infrastructure to distribute those drugs, we can't do any good," she observed. "I don't think the answer is necessarily about first slashing prices or having the generics on the market."
Edozien said Pfizer has formed partnerships with governments and businesses that can provide public education, health worker training, and support.
One pressing question remains: How much support should employers provide? In addition to covering the cost of employees' medication, for example, should they also cover their families? And how broadly should family be defined?
"Businesses, as far as they have resources and profit, have a responsibility to employees and, if possible, to their families as well," said Mehta.
Euvin Naidoo, a fourth generation South African and an HBS MBA candidate, said companies that depend on migrant workers such as the mining industry must consider the social dynamic created by men working away from their families many months out of the year. The sex trade in which those men participate has been blamed for helping the spread of AIDS in Africa.
"Should families be moved with the male work force? I think it's something companies have to address," Naidoo said.
According to Chigwedere, businesses need to think beyond their employees and families in formulating policies to address AIDS where they operate. "AIDS has destroyed education, it has destroyed agriculture...it has destroyed the entire fabric of society," Chigwedere said. Treating only one company's workforce is tantamount to finding a high spot on a sinking ship, he added. "The ship is still going to sink," he said, "and you're going to sink with it."