"It’s fine for people who live in rich countries to say this is how it ought to be," says Bill Clinton. "They don’t have to live in little villages and watch people die like flies." Clinton, who has raised millions to help combat AIDS, is among the interviewees in this revealing new documentary which may make your blood boil, or even put fire in your blood.
In Fire in the Blood, writer-director Dylan Mohan Gray tells a story of greed that is almost hard to credit. Between 10 to 12 million people have lost their lives in Africa alone, due to AIDS. Two million died in one year alone.
Many of these victims of cruel neglect could still be living relatively healthy lives, if they had been given the proper life-saving medications. How could people sleep easy in their beds, you find yourself asking of the CEOs of pharmaceutical giants?
Branded drugs and trade restrictions meant significantly cheaper, generic drugs were not available to millions of Africans for years after the miracle drug AZT became available in the West.
Fire in the Blood doesn't just point the finger at pharmaceutical companies. The film shows how AIDS activist groups and government bodies ignored the plight of Africa, where in the year 2000 more than two-thirds of the world’s cases of HIV infection were to be found. The film accuses the World Health Organisation, UNAIDS, the US and European governments of complicity with the powerful pharmaceutical lobby.
Humbug and handy shibboleths abounded 10 years ago. It was easier to believe that poor Africans, Indians or South Americans wouldn't be able to even read the instructions on bottles of pills. They were illiterate; they told the time by the sun, they didn't even have clocks or watches numbered among the beliefs, promulgated by seemingly intelligent people. Generic drugs from India or Thailand might be dirty, so best stick with the dear stuff.
In fact, Washington veteran William F Haddad, a longtime advocate of the generic drug trade, discovered that the labs in which the generic drugs were being produced in India were spotless. Moreover, he discovered that the US actually imported many of its generic drugs from India anyway.
Bono and Bob Geldof are not mentioned in the film, but we do know that both men played important roles in influencing US government thinking on the AIDS epidemic. According to George W Bush in his 2003 State of the Union address, out of 30 million Africans with HIV, only 50,000 were receiving treatment. Bush's address was key to the final face-off against the drug companies. But, sadly, the story doesn't end there.
Former Pfizer vice-president Peter Rost has distanced himself ideologically from the pharmaceutical industry, where the bottom line is profit and shareholder satisfaction. Gray’s film details the tiny percentage of pharmaceutical revenues funnelled back into medical research, which remains primarily government-funded. So, as Rost remarks, the taxpayer may pay many times over for the drugs he or she buys.
Advertising budgets are exorbitant in comparison with what is spent on research and development. James P Love, an American intellectual property activist, points out that big pharmaceutical companies are usually not very good at research and development, capitalising instead on the efforts of smaller-scale research.
A central character in the film is Yusuf Hamied, the Indian scientist behind the pharmaceutical manufacturer Cipla. In an extraordinary gesture - but a totally reasonable one too, given the circumstances - Hamied promised to radically cut the cost of generic antiretrovirals being produced at his factory. He also promised to supply the governments of developing countries with the expertise and technology to manufacture their own drugs.
Hamied's goodwill offer was not taken up by the European Commission in Brussels. So he proposed to take out all overheads, charging only for the ingredients in the triple cocktail of drugs administered to patients each day for the treatment of HIV.
Dr Hamid got his way and was able to cut the cost of the triple cocktail of antiretrovirals from $15,000 a year to less than a dollar a day per patient. Millions stopped dying in poor countries because people were finally able to access these drugs.
Political and public pressure was also responsible for the end of the blockade. Dr Peter Mugyenyi, head of the largest HIV treatment and research centre in Uganda, was arrested at Entebbe airport for attempting to smuggle in generic antiretrovirals. Mugyenyi found himself explaining to the authorities the life-saving value of the drugs which had been stopped at the airport.
Eventually his detainers understood, as they had relatives and friends who were suffering from AIDS. Mugyenyi was released and the Ugandan government took a gamble with generic drugs importation, and ultimately won.
Even though he was HIV Positive himself, Zackie Achmat, a South African AIDS activist, decided he would boycott anti-retroviral drugs until the South African government made them available to everyone who needed them. "A Gandhian impulse", as director Mohan Gray describes it.
Achmat recalls growing up in a family where if his mother said that one of his siblings didn’t get chocolate, then the rest wouldn’t get it either. He came close to death - even though he could easily have accessed cheap drugs, as an internationally-known activist. But his gamble also paid off and sub-Saharan Africa benefited as a result.
Sadly, the film does not end on a positive note. The so-called TRIPs trade agreement means the industry has won the war, as one writer put it, "by enlisting the World Trade Organisation as its global bully to protect future profits" in the case of future drug requirements.
The implications are none too encouraging, not just for the Third World, but also for America, where an increasing number of citizens lack access to prescription medications.