Global Business Ethics: AIDS : Global Business Ethics: AIDS GLOBAL CITIZENSHIP
Why should executives be concerned about AIDS? : Why should executives be concerned about AIDS?
HIV/AIDS : HIV/AIDS first reports of a new and deadly immunological disorder
around 225,000 people infected with HIV, the virus that causes AIDS
22 million people have died of AIDS, 40 million infected with HIV
AIDS has gone from being the scourge of relatively small groups, such as homosexuals and intravenous-drug users in rich countries, to arguably the biggest threat to life and prosperity in the developing world 1980 2004
AIDS in the West : AIDS in the West Slowly evolving from an exotic plague to a normal—and treatable—disease
Relatively small groups affected, such as homosexuals and intravenous-drug users
Dirty needles account for a third of all reported AIDS cases
For the first time since AIDS was identified, the number of Americans dying from the disease fell instead of rising in 1998.
Infection rates still rising, but treatment has improved
triple-drug therapy, at $16,000 a year
AIDS becoming a chronic, rather than an acute disease; HIV infection becoming something that people die with, rather than of.
Prevention is cheaper than treatment
The US AIDS-prevention budget (a little over $600m a year) has to prevent only 4,000 infections a year to show a profit Condoms for females Condoms for males
Slide5 : 95% of all infected with HIV live in poor countries
Slide6 : Sub-Saharan Africa
Slide7 : USAID estimates:
In 2010, the life expectancy of somebody born in Botswana will have fallen to 29
In 2010, life expectancy in Zimbabwe and Namibia will be 33
In 2010, life expectancy in South Africa will be 35
In 2020, the old will outnumber the middle-aged UN estimates:
Orphans of the storm : Orphans of the storm Arguably the epidemic’s cruellest legacy is the orphans it is leaving behind
Around 11m children in sub-Saharan Africa have lost at least one parent to AIDS. This is 11 times the number in 1990
By 2010, there could be as many as 20m AIDS orphans in sub-Saharan Africa (UNICEF Report)
In Zambia, more than two-thirds of the child prostitutes are AIDS orphans
Slide9 : Asia
Slide10 : The hydra-headed monster AIDS is the most political disease around
Exceptional disease:
Like war, kills those in the prime of life.
But it is worse than war – kills young women, too
Exceptional by creating orphans on an unprecedented scale
Exceptional, in modern times, in the attitudes of the healthy towards the infected
silence
stigma
discrimination
denial
Good science and sensible public policy can defeat the epidemic
Models for cutting off the hydra’s heads : Models for cutting off the hydra’s heads Reduce transmissibility
through sex:
use condoms
develop a vaginal microbicide
treat other sexually transmitted diseases
from mothers to their children at birth:
give infected pregnant women a short course of an antiviral drug just before they give birth
not breast-feeding to avoid infection through mother’s milk
Reduce rate of acquisition of new and uninfected partners
better education
give women more power
Reduce length of time that somebody is infectious
requires a vaccine
a 60%-effective vaccine introduced
now would stop nearly twice as
many infections as a 90%-effective
one introduced five years hence
Annual condom use in Senegal:
1988: 800,000
1997: 9 million
Science: better luck next time : Science: better luck next time The first big phase III” clinical trial of an AIDS vaccine – in the private sector – has ended in failure Issues: an AIDS vaccine is an international public good
A truly free market will not produce an AIDS vaccine for Africa – customers cannot afford the product
Public-sector research and development become the appropriate route
The public sector, however, has had 20+ years since the discovery of HIV, and not a single phase III trial has emerged from it
Are market-like mechanisms still appropriate?
a new style venture capitalists that measure returns in scientific success, rather than dollars, are needed; one such exists at the moment: the International AIDS Vaccine Initiative (IAVI)
create the right incentives for the private sector to produce a vaccine * $3 billion plus is spent on AIDS treatment drugs
in North America and Europe
* a mere $300m is spent on AIDS vaccine research A vaccine will be a crucial part
of the anti-AIDS arsenal
Slide13 : * gathers money from foundations and other donors, and signs contracts with small firms of AIDS researchers
* a successful firm can keep all its profits but there are tight restrictions on the price for which any vaccine might be sold in the poor world
* if the firm breaks the contract, IAVI can give the patents to somebody else
Slide14 : Puncturing AIDS through public policy Creating partnerships
international organizations
governments in rich countries
governments in poor countries
drug companies
other companies
charitable organizations The AIDS epidemic has risen to the top of the development agenda Anti-AIDS public-health policies:
(1) Based on the exhortation of people to behave better
(2) Based on the recognition of human frailty and
an attempt to ameliorate it
Slide15 : In your view, which type of policy would be more effective? One of the first AIDS prevention posters
in the UK, 1984 South Africa, 1999/2000: promotes a campaign to encourage
young men to stay sexually healthy by only having one partner,
so that they may have a chance of representing their country
in a large football tournament (1) (2) USA, 1986:
Highlighting the risks to drug users
Perspectives on Stakeholder Roles : Perspectives on Stakeholder Roles Private sector
The business sector can act as a lobbyist and play a vital role in bringing the issue of AIDS to the attention of government
Government
It is the government’s role to pave the way for all sectors of society to contribute to the response
Donor
to motivate the private sector to act as a catalyst to scale up health sector responses through support of national policy
to create mechanisms that accelerate the involvement of the private sector in the fight against HIV/AIDS
NGO
NGOs have the trust of the community and their main mission is in service provision and representing the interests of the community
Slide17 : In order for HIV to be effectively tackled
on an international level:
End the discrimination against people with HIV and AIDS
Educate people in safer sex and drug use, using appropriate media
Provide condoms freely to people in the developing world
Provide financial and medical assistance so that people with HIV and AIDS can be treated
Slide18 : The global effort National anti-AIDS strategies in sub-Saharan Africa
More money available (UNAIDS):
2003: $4.7 billion spent on AIDS; 1996: $200 million spent on AIDS
UNAIDS, Global Fund to Fight AIDS, Tuberculosis and Malaria (2002)
World Health Organization: plan to provide anti-AIDS medicines to 3 million
people in developing countries by 2005
US government: $15 billion, five-year anti-AIDS program
Significant boost to the prospect of providing anti-HIV medicines
World Trade Organization: compulsory licensing agreement to let poor
countries import generic AIDS drugs they cannot manufacture
pilot programs run by Medecins Sans Frontieres (Doctors Without Borders) that
have thousands of people on generic fixed-dose combination drugs
Partners in Health, a vanguard program in Haiti
pharmaceutical companies' promises to offer patented medicines free or at cost
Slide19 : * No international framework exists to
delineate public and private sector roles in
responding to HIV/AIDS
* More money needed
* Lack of administrative capacity to
absorb and properly distribute donor funds
- Donors emphasize the importance of a sound
national strategy on HIV/AIDS and seek out
programs that are aligned with these strategies Issues
Impediments to Partnerships : Impediments to Partnerships Different organizational culture and belief systems
“What’s in it for me?” syndrome
Absence of common goals / shared values
Scope and limits of the business response : Scope and limits of the business response
Major issues : Major issues HIV/AIDS is a long-term issue that requires long-term strategic responses
HIV/AIDS programs involve a spectrum of interventions that require thinking beyond treatment
Programs need leadership from CEOs and Boards
One must think strategically about the relationship between the company’s strategy and the national strategy
One must address stigma to encourage employee participation in programs
Business Involvement in HIV/AIDS: Prevention : Business Involvement in HIV/AIDS: Prevention Pros:
cost effectiveness;
primary care provision is most effective;
employee morale
Cons:
HIV/AIDS is not an occupational illness;
companies are wary of intruding into personal sphere (i.e. talking about sex) Australia, 1989
Business Involvement in HIV/AIDS: Testing : Business Involvement in HIV/AIDS: Testing Pros:
the right thing to do
Cons:
trust issues connected to confidentiality;
potentially changes the dynamic between employer and employee;
liability of false positives and false negatives South Africa, 2002
Business Involvement in HIV/AIDS: Treatment : Business Involvement in HIV/AIDS: Treatment Pros:
limited public sector capacity to provide treatment; provides space and medical equipment that can support public sector;
cost effectiveness: reduces death benefits
increases employee morale
Cons:
health care provision is not a core competency;
comprehensive care for HIV and AIDS requires primary, secondary, and tertiary care;
hard to manage employee expectations and set limits on scope of program USA, 1988
Business Involvement in HIV/AIDS: Building Public and Community Capacity : Business Involvement in HIV/AIDS: Building Public and Community Capacity Pros:
employees get better care;
business has experience building coalitions for other purposes;
public sector needs support in the short run to build greater capacity in the long run
Cons:
no road map exists;
requires huge personal commitment;
business cannot be expected to take on the responsibility of government;
companies reluctant to launch far-reaching campaigns because of the “S”-word: sex USA, 1987:
One of the most recognized
AIDS posters ever produced
World Economic Forum Business and HIV/AIDS Survey Key findings : World Economic Forum Business and HIV/AIDS Survey Key findings Of the 7,789 business leaders polled in the World Economic Forum’s Global Competitiveness Report 2003 Executive Opinion Survey:
47% of firms felt HIV/AIDS is having or will have some impact on their business, with firms more worried about HIV/AIDS than tuberculosis or malaria;
Most business leaders put their estimate of HIV prevalence rates among their workforce lower than UNAIDS figures for adult prevalence. Firms that have conducted workforce prevalence surveys report lower infection rates than those that have not;
20% of firms believe HIV/AIDS is or will seriously affect their communities, while few believe the epidemic will strike the community, but not their company;
16% of all firms provide information about the risks of infection, while 5% claim to provide anti-retrovirals for all HIV-positive staff;
Fewer than 6% have formally-approved written HIV policies;
Only 28% of executives believe their response to the epidemic is insufficient, although 56% of those who expect a serious impact on the business from the epidemic are dissatisfied with their companies’ response.
General conclusions : General conclusions Firms are not particularly active in combating HIV/AIDS, even when they expect the epidemic to cause serious problems for their business.
Businesses appear to be making decisions based on a fairly patchy assessment of the risks they face.
Firms seem to favor a broad social response to the epidemic, even if only a small number of businesses currently see themselves as an integral part of that response.
Anglo American’s AIDS Strategy in South Africa : Anglo American’s AIDS Strategy in South Africa * South Africa has more HIV positive citizens than any
other country: 5.3m, out of a population of 45m.
* 600 people dying of AIDS every day
* Heading for an economic collapse within three
generations, as wage-earners are wiped out and
parents die before they can teach their offspring the
basics of how to get on in life
* November 2003: long-term plan of the Southern
African government for treating its sick citizens with
anti-retroviral drugs
* Distribution of free anti-retroviral drugs to poor people
suffering from HIV/AIDS had been long delayed while
the government questioned their efficacy and safety
Treatment of Employees : Treatment of Employees Global mining giant, third biggest in the world, 40% of operations based in South Africa.
Employs 90,000 people in South Africa alone, where
HIV rates are the highest in the world.
20,000 to 30,000 of those staff are probably infected.
August 2002: plan to give anti-retroviral drugs to
HIV-infected employees; importance – put the government
under more pressure to follow suit for the 5 m
HIV-infected South Africans.
It now costs Anglo American $4,000 annually to treat a
worker but the company believes that gains to staff morale
and productivity will outweigh drug and other health costs.
Just 750 of the firm's 30,000 infected South African
employees now get treatment, but 97% of them are back in
full-time work, including heavy-duty physical labor
In contrast, HIV-infected workers who get no treatment
typically take 55 days of sick leave in their final two years
at work
The virus adds as much as $6 to the roughly $170-180
overall cost of producing an ounce of gold.
Why did Anglo American offer expensive AIDS drugs to its employees? It now costs more not to treat than to treat The AIDS “Tax” : Why did Anglo American offer expensive AIDS drugs to its employees? It now costs more not to treat than to treat The AIDS “Tax”
Building Public and Community Capacity : Building Public and Community Capacity October 2003: three-year $4.5m plan to pay for the rehabilitation of 900 South African clinics where HIV testing and treatments for AIDS and tuberculosis are carried out;
The expansion is seen as a “logical extension of everything we have been doing in the workplace.”
Why move on from caring for its workers to helping fund public health? : Why move on from caring for its workers to helping fund public health? Firms find it difficult to give tests, counseling and drugs to an employee, while doing nothing for his sick wife or their ailing children
Workers also fear that losing a job means a death sentence, as treatment would stop
By funding clinics, especially in rural communities where the company is the main employer, such problems can be eased
The clinics are designed to attract, test and treat young teenagers, the only age-group in South Africa that has shown, for three years running, a sharp decline in HIV infection rates. This is also the pool from which firms will have to replenish their workforces
Beyond multinationals : Beyond multinationals Source: Patrick Connelly Center for International Health and Development,
Boston University, 2003
Multinationals employ a tiny percentage of the labor force in South Africa : Multinationals employ a tiny percentage of the labor force in South Africa SMEs and the informal sector employ the vast majority of the labor force
Some SMEs are interested in providing HIV/AIDS services, but cost is a barrier
Many SMEs are not thinking enough about the long term consequences of HIV/AIDS on their business
Strategies for extending programs beyond the multinationals : Strategies for extending programs beyond the multinationals Multinationals could function as vehicles to share ideas, practices, and reduce costs among SMEs
They could provide SMEs with a means to lobby government and work with other stakeholders
Supply chains could offer another existing network through which HIV/AIDS programs could be extended
Loose umbrella associations exist in the informal sector (i.e. market associations), and could be leveraged to extend programs