"Phanzi, Pfizer, Phanzi!" "Get out, Pfizer, go!" At rallies they sing the old liberation songs, replacing the names of apartheid leaders with those of multinational pharmaceutical companies. On the streets they chant demands, no longer for the vote or a living wage or freedom, but for fluconazole and cotrimoxazole and nevirapine. Their leaders and organizers might well be human rights lawyers and healthcare professionals, but most of the foot soldiers of the Treatment Action Campaign (TAC)–which has spearheaded the campaign for affordable medicine for HIV-related illnesses in South Africa–are ordinary South African men and women, HIV-positive but too poor to afford the drugs needed to keep them alive.
For most of us, globalization remains an abstract and troubling concept, but for the TAC's activists the pharmaceutical industry's cynical abuse of international trade agreements to keep its profit margins high has meant that globalization is literally killing them. What makes their activism so compelling is that their battle for access to treatment has brought them up against the consequences of the global economy–and that they appear to be triumphant.
In mid-April, after a three-year fight, thirty-nine multinational pharmaceutical companies agreed to settle a suit against the South African government to prevent it from purchasing brand-name drugs from third parties at the cheapest rates possible. This, Big Pharma had claimed, was in violation of international trade and property agreements the South African government had signed. The withdrawal was brokered directly by UN Secretary General Kofi Annan, who had been asked by the five biggest companies to help them find a way out of what had become a public relations nightmare. Annan called South African President Thabo Mbeki, whose officials drafted a last-minute settlement that committed the country to negotiate with the multinationals before implementing its policy. The victory, however, was the TAC's: Not only had it proved that the suit was unwinnable, it had brilliantly mobilized a broad spectrum of support at home and abroad against the drug companies, which were shamed into the settlement–in effect, an honorable withdrawal.
The icon of this victory, broadcast all over the world, was the image of a large African man in the courtroom popping a bottle of champagne in a circle of jubilant celebrants. This man was Zwelinzima Vavi, the general secretary of Cosatu, South Africa's largest labor federation and the backbone of the "Revolutionary Alliance" that brought the African National Congress to power–and that keeps it there. Surrounding him was a fascinating mix of working-class activists, high-powered lobbyists from international organizations like Médecins Sans Frontières and Oxfam, and ecstatic government officials reliving, for one brief moment, the euphoria of activism.
The TAC has managed to put together the first seriously effective social movement since South Africa's transition to democracy in 1994. The keynote speaker at its first national conference, in March, was Cosatu president Willie Madisha. "There is no urgency from government," he told an audience of 500 delegates from more than 169 organizations, including major religious and healthcare groups. "Sometimes it drags its feet, at other times its HIV/AIDS work is incoherent. Broader social mobilization is essential to engage government constructively."
In 1994 most antiapartheid activists either went into government and became enmeshed in the workings of the new state or set off for the private sector to exercise their newfound freedom and follow their own interests. The result was that the broad-based social movements that brought apartheid to its knees in the 1980s ossified into bureaucracy or withered into nonexistence. The TAC offers a cogent example of the consequences: In the early 1990s, AIDS activists played a major role in the drafting of an exceptional National AIDS Plan, which was adopted by the African National Congress. But instead of mobilizing mass support to achieve the demands of the plan, AIDS activists found themselves inside the system and thus bound by the inevitable constraints of government, relying too heavily on what the TAC calls "the politics of access." Outsiders became insiders, and without the oxygen of a mass movement to keep it alive, the plan was suffocated by red tape.
But just a week before the victory against Big Pharma, TAC's chairman and chief strategist (himself a product of the antiapartheid movement), Zackie Achmat, publicly accused two senior government officials–both medical doctors and former healthcare activists themselves–of having the blood of children on their hands because they were retarding the implementation of antiretroviral programs for pregnant mothers with HIV. "We face a greater tragedy than the acts of omission of the drug companies," he said, "and that is the failure of government officials to act with courage, humility and urgency."
The accusation may have been unduly harsh–Achmat himself could be accused of understanding neither the constraints of bureaucracy nor the choices that the ill-resourced government must make–but he has a significant mass-based constituency behind him when he makes it. The TAC's brilliance was in recognizing that it had an issue that would appeal to the broad left wing of South African society not only because of the government's manifest ineptitude in the face of a horrifying pandemic (4.7 million infected out of a population of 40 million) but because the battle for treatment was a perfect vehicle for taking on the heartlessness of global capital and the perceived wrongheadedness of the ANC government's neoliberal macroeconomic policy. South Africa has been the good boy of the World Bank, the IMF and the WTO, Achmat says, and we're sicker and poorer than we've ever been.
The reason Cosatu and the left like the treatment access issue so much is that it allows them to say this; it puts flesh on their critique of the government's quest for a balanced budget in line with the World Bank's specifications, a quest that means less funding for programs like the provision of lifesaving medication. Globalization, finally, has a face. TAC activists appeared at court wearing ghostly, leering masks of Big Pharma's mandarins. Globalization is itself on trial: The masked activists were in handcuffs.
Just last year, Mbeki accused the TAC of actually being in the employ of Big Pharma because of its strident criticism of the government's AIDS policy. Now, despite the brief and effective courtroom alliance between activists and government, the same battle lines are drawn again, sharper than ever. Minister of Health Dr. Manto Tshabalala-Msimang held a press conference after the courtroom celebration at which she made it clear that providing AIDS drugs was not a government priority; the TAC shot back that it would do whatever was needed–including confronting government head on–to bring "real drugs to real people."
It remains to be seen whether the victory against Big Pharma is anything more than symbolic, whether it will have any effect at all in bringing affordable drugs to the ailing masses of South Africa. Its significance, rather, is in its creation of a mass-based, independent, critically minded social movement that takes the best of South Africa's tradition of struggle and engages it, in a sophisticated and tangible way, in a battle against the negative consequences of the global economy and the manipulation of institutions like the WTO by multinational corporations. The TAC's battle could provide the same brand of moral leadership in the global struggle that the antiapartheid movement did in decades past.