Aspiring Democratic presidential candidate Al Gore, who as Vice-President Gore has commonly embraced AIDS-related causes, has been forced to defend himself recently against charges that, on one particularly desperate AIDS issue, he is a cold-hearted lackey of the pharmaceutical industry (see Nature 399, 717; 717 1999).

In South Africa, where antenatal clinic surveys conducted this spring showed 22 per cent of sexually active adults to be infected with HIV, AIDS is expected to slash life expectancy to below 40 years by 2010. The drug cocktails that have curtailed sickness and death in the developed world are unaffordable by all but the most privileged South Africans. Confronting this, the government passed a law in 1997 under which the health minister may authorize local manufacturers to circumvent patents and make far cheaper versions of these drugs, paying only fixed royalties to the rights-holder — so-called compulsory licensing. The law also allows South Africa to import the drugs from countries where drug manufacturers make them available more cheaply.

The international pharmaceutical industry has cried foul, and sued in South Africa, delaying implementation of the law. Meanwhile, Gore and the US Trade Representative have mounted what the US government itself has described as an “assiduous, concerted campaign” to convince South African officials to rewrite or overturn the law.

To be fair, the aggressive language used to depict the US effort was cooked up by the State Department last year only under pressure from congressional Republicans. Led by Rodney Frelinghuysen, a congressman from New Jersey, the home of many giant drug-manufacturers, they had written a foreign-aid bill to withhold aid to South Africa until the Clinton administration convinced them that it was acting on behalf of the drug industry.

Nevertheless, whatever its motivation, the facts of Gore's recent record remain. Using his role as co-chair, with South African President Thabo Mbeki, of the US-South Africa Binational Commission, the vice-president has repeatedly sought to force a sovereign nation confronting a disastrous epidemic to forswear one of the few means of getting medicine to its desperate people. Coming from a presidential candidate who has been preaching about the importance of “values of conscience” to US political life, this sticks in the gullet.

There are those, including some in the pharmaceutical industry, who argue that South Africa's health infrastructure is insufficiently prepared for these sophisticated drugs. Utilitarian critics also say that the country's finite resources should be used for prevention, not for treating those unfortunate enough to be infected already. Both arguments miss the point. It should not be a case of “either/or”, but “both/and”. And, indeed, South Africa's move to access state-of-the-art medicines is part of an effort to address the epidemic on all these levels.

There is one final point. Gore and the industry complain that the South African law is in blatant violation of the World Trade Organization (WTO) intellectual-property agreement known as “TRIPS”. The agreement allows for compulsory licensing in cases of “national emergency or ⃛ extreme urgency”. But there is enough fine print in the agreement, and enough ambiguity in South African law as it is written, to allow honest disagreement on whether South Africa may be in breach of TRIPS.

Here is where the hypocrisy comes in. Instead of using the WTO's well-defined dispute-settlement mechanisms (as it has done recently in disputes with Europe over, for instance, bananas), the United States, led by Gore, has found it convenient to use back-room tactics to try to strong-arm South Africa into changing its ways. This leaves one suspecting that the vice-president's critics are right when they claim that he has been more than a little influenced by the pharmaceutical kings.