The Boston Globe
WASHINGTON - Has "The West Wing" influenced Bush administration policy on AIDS in Africa?
That's the question AIDS activists are asking after two senior US officials have said that distribution of cocktails of anti-AIDS drugs would be complicated by Africans' inability to tell time.
Comments made by Andrew Natsios, the head of the US Agency for International Development, and an unnamed senior Treasury official quoted in the New York Times, closely parallel an episode of NBC- TV's acclaimed "West Wing" series aired on Oct. 25, 2000.
In the episode titled "In This White House," a fictitious US official, involved in negotiations between an African head of state and a pharmaceutical company, asserts that taking the drugs is a "complicated regimen that requires 10 pills to be taken every day at precise times."
"What's the problem?" asks Josh Lyman, the deputy chief of staff character played in the series by actor Bradley Whitford.
There is a long pause in the Roosevelt Room.
Finally, communications director Toby Ziegler (actor Richard Schiff), says, "They don't own wrist watches. They can't tell time."
Natsios, in an interview last week with the Globe and in testimony before Congress, also argued against spending much money on providing antiretroviral drug treatment in Africa, telling the House International Relations Committee:
"People do not know what watches and clocks are," Natsios said. "They do not use Western means for telling time. They use the sun."
In the April 29 edition of the New York Times, the unnamed Treasury official said Africans lacked a requisite "concept of time," implying that they would not benefit from drugs that needed to be taken on a precise schedule.
The comments come against a backdrop of a global policy battle over the best way to fight AIDS in sub-Saharan Africa, where 25 million people are infected. Many, including Natsios and other top US policymakers, worry that falling drug prices will shift global funding away from prevention efforts and into much more costly drug treatment. Others, including the activist groups Act Up, Health Gap Coalition, and a coalition of 128 Harvard University scholars, believe that rich governments must increase funding to cover treatment costs as well as prevention.
The comments by Natsios and the unnamed Treasury official assume that using the AIDS cocktails effectively requires taking a dozen pills or more at various times of the day. But global health specialists say recent advancements now allow people to take one or two pills daily that each contain several anti-AIDS drugs. This regimen, now being used in several small African trials, means there is no need to tell time.
In addition, many African specialists have pointed out that the education levels and health infrastructure vary significantly on the 54-nation continent, rendering generalizations useless.
"Africa cannot be considered in a monolithic way," said Vicki Lynn Ferguson, director of education and outreach for Africa Action, an advocacy group in Washington. "It differs dramatically from urban to rural, and within countries district by district."
Natsios, the former head of the Big Dig project in Massachusetts, who has worked on developing-world issues for more than a decade, declined to comment. He has made no public statements on the issue since his June 7 testimony to the House panel.
"He's unavailable," said USAID spokeswoman Kim Walz. "Clearly he regrets offending anyone because of his comments. He is more concerned now with getting what needs to be done going on this issue."
Three groups called on Secretary of State Colin L. Powell to fire Natsios for his comments, which they called racist.
An NBC publicist also declined to comment.
J. Brian Atwood, the USAID administrator during the Clinton administration and a friend of Natsios, suggested yesterday that it would remain an open question.
"Who knows how ideas get into people's minds, but if Andrew were to word his position today, he would word it very differently, I believe," said Atwood, who hasn't talked with Natsios since his testimony. "He must know he did not sound very sensitive to the issues."
John Donnelly can be reached by e-mail at donnelly@globe.com