History Repeats Itself: COVID-19 Vaccine Inequities Echo HIV Crisis

In 2001, Maurine Murenga was pregnant and HIV-positive. She was living in Kenya, and a counselor encouraged her to fill out a memory book. She wrote directions to her village, details about her family so that when she died, someone would know where to bury her and where to send her child.

"It was nothing like preparing," says Murenga. "It was actually preparing us for death."

What seemed so unfair to Murenga is that she knew that in the United States and in Europe, there were drugs that could save her life. Antiretroviral drugs, or ARVs, had been widely available in the West since 1997, but they were too expensive for most Africans on the continent. Murenga became a vocal advocate, publicly disclosing her status, lobbying the Kenyan government and the world to make the life-saving drugs more accessible.

"It took a lot of pushing and pulling and wishing we could inject them with compassion to save lives," she says.

Over the next few years, countries like South Africa took principled stands, fighting against patents that kept countries from making more affordable, generic versions of the drugs. AIDS activists across the world banded together to lobby rich countries to end what many scientists called a crime against humanity.

"At least the world listened," Murenga says.

In the early 2000s, the U.S. launched PEPFAR, and an international coalition launched The Global Fund. The programs pumped billions of dollars into buying ARVs to distribute in low-resource countries, saving millions of lives.

As the coronavirus spread, Murenga thought the West would have learned from the HIV experience. But that hasn't happened, she says. "As usual, we are waiting for them to finish vaccinating their people so that they can now bring aid to the people of Africa."

"I think we are repeating some of the mistakes, and that is truly unacceptable," says Allan Maleche, who advocates for the legal rights of Kenyans with HIV. He says right now, rich countries are hoarding vaccines, poor countries are paying higher pricesfor them and the central lesson of the HIV epidemic - that if one person is vulnerable, everyone is vulnerable - seems lost.

"If you don't address both the rich and the poor countries, you will not be able to win the fight, beat for HIV, beat for TB or beat for COVID," he says.

Steven Thrasher, whose upcoming book deals with how marginalized people are disproportionately affected by viruses, calls the development of antiretroviral drugs "one of the great miracles of modern science." It made HIV easier to treat than diabetes. (The Viral Underclass: How Racism, Ableism and Capitalism Plague Humans on the Margins will be published next year.)

But he views the global response – the creation of organizations like PEPFAR and The Global Fund — more critically. Millions of lives were saved, but "it's been 25 years, and almost a million people a year still die of HIV."

Thrasher says the same thing is happening with the COVID vaccine. Cheaper generic vaccines are not currently available, and Africa is being left behind. And unlike the days of the HIV epidemic, there doesn't seem to be popular pressure to end this disparity. He recalls Zackie Achmat in South Africa. He was a film director who refused to take ARVs until poorer people could access them. Thrasher says that kind of empathy is in short supply these days.

"We're certainly not saying as a country," says Thrasher, who is American. "We're not going to take it until we make sure the poorer countries get it. We've been set into a scramble of trying to — everyone trying to get it as quickly as they can.

As for Maurine Murenga, she eventually got the ARVs. Today she directs the Lean On Me Foundation in Nairobi, which is dedicated to the health, education and human rights of adolescent girls and young women.

And now the coronavirus crisis is part of her fight.

"We don't rest until ... lives have been saved," says Murenga.

It's what she did during the AIDS epidemic. It is what she'll do now.

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