• Global health inequalities took center stage at the 2022 International AIDS Conference.
  • Organizers called it an “incredible loss.” present from Art Global South was denied the Canadian visas needed to attend the conference.
  • The researchers found that complicated visa requirements and exorbitant travel costs prevented many delegates from poor countries from attending health meetings held in wealthier countries.
  • A study of 20 years of such events found that fewer than four in 10 participants are from poor countries with the highest burden of disease.

The world’s biggest AIDS event, the biannual International AIDS Conference, should never again be held in Europe or the United States, says Ayoade Alakiya, co-chair of the African Union Vaccine Delivery Alliance. The organization, which was created during the Covid-19 pandemic, is working on the equitable delivery of vaccinations.

Alakiya was speaking in an interview on the first episode of Bhekisisa’s new TV show, A health blow.

Most people with HIV live in the Global South, which is where the most important new HIV research needs to be collected, according to Alakija. The Global South is an umbrella term for low- and middle-income countries, typically in Africa, Asia, Oceania, Latin America, and the Caribbean.

Researchers who analyzed more than 20 years of global health conferences found that 96% of such events took place in high- or middle-income countries. Fewer than four out of every 10 delegates came from poor countries, despite the fact that the diseases discussed at such conferences are much more common in countries of the Global South.

This year the AIDS conference was held in Montreal, Canada, but the African delegates had difficulty obtaining visas to enter the country – so much so that most of the speakers at the closing of the conference had to participate virtually.

Even those who had the appropriate documents competed for the conference.

Winnie Byanyima, Head of the Joint United Nations Program on HIV/AIDS (UNAIDS), only allowed to board her plane to Canada after airport officials made several calls and “thoroughly checked [her visa documents] again and again.’

And South African activist Tian Johnson spent over R330,000 on visas and flightsbut only made it as far as the United States border before flying home after being denied a plane to Montreal.

The next meeting will be held in Brisbane, Australia.

The drama is the latest in a series of grievances African researchers have faced during the Covid-19 pandemic. For example, in 2021, South African researchers who identified the Omicron variant of Covid-19 were shocked that their transparency was quickly met with a travel ban to South Africa and other African countries, but not to other countries in the Global North, where the variant was already appeared circulated.

Alakiya spoke with Bhekisisa about what she saw as a dangerous double standard in the health care world.

  1. ViiV Healthcare has granted a voluntary license (so that cheaper generic versions of the product can be produced) for two months Cabategravir for HIV prevention. It will take years to produce generics, but in the meantime they will be selling branded jabs in 90 countries at a lower price. But history tells us about it pharmaceutical companies are not transparent about money. What is happening now?

We applaud the fact that they caved in to the pressure, because they really did. It’s giving in to pressure that reminds us why we put pressure on health injustices in this world. But it’s also very blurry. [ViiV healthcare] they said they would give it to a [lower] the price. But how affordable is this price? They have provided a list of 90 countries in which they will make the patent available through the Medicines Patent Pool, an organization that works with pharmaceutical companies to make medicines more affordable. This is a step in the right direction, but the underlying issues are inequality and the fact that we have to beg and scream and shout for the right to basic health care [are things] need to ask more.

  1. Pharmaceutical companies introduced prices in low-income countries (where they test their drugs) before antiretroviral drugs became available. Do you think African governments should negotiate more with pharmaceutical companies?

Absolutely yes. It’s not just about negotiations with pharmaceutical companies. I have called for this before when high income countries like the UK and others shut down South Africa and others [the] Omicron [variant] was first discovered.

African governments must understand that our lives are at stake. And it is not only about negotiations with pharmaceutical companies, but also about using our geopolitical power in such a way that we will be reckoned with. At the moment there is none in the world [take us seriously] because we do not oppose them. I would say that our leaders need to recognize how important they are in terms of the broader global quality of nations. We have a President [Emmanuel] France’s Macron is visiting African countries because there is competition over who Africa will lean towards.

  1. You talk about international relations and Africa’s bargaining power, and it sounds like you believe that there is more to correcting this inequality than simply negotiating with Big Pharma. What needs to change now?

It is about the safety of our health as a whole. It is about our broad peace and security. This is about our broader food security. We have a leadership problem, so the world takes us for granted as people. It gives the impression that living in Abuja costs less than living in Alberta, Canada. It shouldn’t be like that. Living in Cape Town should cost as much as living in Connecticut. But at the moment the world is telling us with these drugs and the lack of access to drugs that our lives are not worth the same. And it’s not only in pharmacy. It’s on us. It’s up to our management. Activism will only go so far, but we need political change.

  1. If the president of Africa came to you today and said, “I’m meeting with a big pharmaceutical company.” How would you advise the president to counter the campaign?

If the president of Africa came to me, I would say, “Mr. President, I would advise you to tell these people who refuse to buy or support our own pharmaceutical industry that until they do, we no longer want what you want from are. We will find our procurement mechanisms.”

It is not so much what I say as what I do. I think our leadership needs to start operating in these geopolitical spaces, whether it’s at the United Nations or the various assemblies they attend. They make speeches, but they have to start making demands.

Charity model [of international relations] no longer works. We need a global multilateral partnership, not global charities mostly controlled by people from the high-income countries of the world telling us who should live and who should die. This is wrong.

  1. As you point out, inequality manifests itself in many ways. Just last week, at an AIDS conference in Canada, many people from Africa were unable to attend because of high travel costs or visa denials. How does this affect who the world takes seriously when it comes to global pandemics like HIV or Covid-19?

I myself could not attend this conference due to the high cost. I have friends who were denied boarding [after] paying over $20,000 to get visas and buy tickets to make their voices heard. Winnie Byanyima, the executive director of UNAids, who is originally from Uganda, was almost denied boarding for the conference, which is basically her main business in Canada, because she is a black woman. Institutional racism is a problem.

One day we will have a conversation about why we are still in a pandemic because institutional racism meant that when the Director General of the World Health Organization, who was an Ethiopian man named Tedros Adhanom Ghebreyesus, said that we, the world, were problem, and the presidents of high-income countries refused to believe him. Therefore, it was not taken seriously in the rest of the world. What if Tedros from Ethiopia was Ted from Colorado? Would they take Covid more seriously?

  1. At the AIDS conference in 2022, we saw a situation where people from the Global South were shut out of conversations that addressed the challenges they faced. How do we avoid this happening again?

I urge people to stop holding these conferences in these places. You can’t talk about us behind our backs. Most of this disease is on our countries – mainly because you refuse to give us access to medicine; refuse to give us access to HIV testing. It makes no sense to have these conversations behind closed doors with people from high-income countries who will once again decide for us what we should do in their own countries.

It’s time for our leadership to say, “We’re not going to have an AIDS conference in Canada. We’re going to have these conferences in the Global South so we can make decisions together.” Only when this world acts together as one will we have equality and justice and true health security for the entire planet.

  1. Researchers from low-income countries often help colleagues from richer countries conduct research on things like new medicines. But they do not receive the same recognition as their counterparts from the Global North. How to change it?

We have to shake this world up. It’s not about getting upset because then they’ll call me an angry Black woman. We cannot leave this world to our children. I am the mother of a girl who does not have to fight [same battles] that I fought as a woman. And I don’t want to go into the room and keep my voice down so they’ll let me stay in the room because they shouldn’t feel threatened.

It is the institutions that have power that will say to someone like me, “What do you think about this?” on the phone when they have 10 research assistants writing down everything I said and then helping them publish it as their own. People still do it because I don’t have the time or the money.

We’re dealing with blackouts, we’re dealing with security issues, so we don’t have the time or space to rethink this world. What we need is to rethink the world of global health and the world of global development. We need to think about what justice looks like and talk about the institutional racism that says your voice has more value because you’re male or because you’re Caucasian.

The questions and answers have been edited for length and clarity.

Watch the full interview on Health Beat with Ayoade Alakiya.

This story was produced by Bhekisisa Health Centre. Subscribe to the newsletter.

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