28.02.2013
Film review: Priced into dying
Jim Moody reviews: Dylan Mohan Gray (director) 'Fire in the blood' (general release)
One of the crises facing humanity recently has been caused by transnational pharmaceutical companies - ‘Big Pharma’ - refusing to provide medicines at an affordable price.
This was illustrated at its starkest when HIV and Aids took hold around the world and antiretroviral (ARV) drugs became available (from 1987). But the ARV drug treatments required then cost $15,000 a year, which very clearly limited their use to well-insured or relatively rich western patients. As millions became infected by HIV/Aids in Africa and Asia, they were effectively sentenced to death by pharmaceutical companies, whose sacrosanct profits had to be upheld over and above any other concerns, such as alleviating human suffering.
Dylan Mohan Gray’s Fire in the blood painstakingly exposes Big Pharma’s - thus ultimately capitalism’s - inability to meet this crying human need. South Africa Constitutional Court judge Edwin Cameron,1 who was the first high official in that country to declare himself living with HIV/Aids, explains on camera how his life was turned around within two weeks after receiving ARVs ... and then is seen becoming active in public as an advocate for repricing the drugs so that everyone who needs them gets them.
Zackie Achmat’s Treatment Action Campaign, founded in 1998, continues to attack the profit-driven patenting of ARVs. The campaign reported on February 24 2013: “It is estimated that 5.6 million South Africans live with HIV. In 2010, there was an estimated 380,000 new infections. Young women between the ages of 15 and 34 are disproportionately affected. Together, HIV and poverty are fuelling the tuberculosis (TB) epidemic (with an HIV/TB co-infection rate of 70%).”2
So, while HIV/Aids scourged Africa in the 1980s, its management was initially completely out of reach: those hit by ‘slim’ were just expected to go away and die. And millions, denied medication, did die.
But activists, some of whom appear in Fire in the blood to testify against drug companies’ denial of cheap medicine, were determined that this state of affairs should not continue. First, the Pfizer patent for fluconazole (used for treating Aids-related fungal infections) in South Africa was deliberately broken by importing it from India. The price per capsule in South Africa stood at $40, while in Asia it was 5 cents. With Africa hosting two-thirds of the world’s HIV/Aids cases, this kind of action made an impact politically.
When it came to the ARVs themselves, initially 90% of pharmaceutical companies’ sales were in Europe and North America, and only around 1% in the whole of Africa. Their business model just did not need Africa or Asia. In the film, former Pfizer CEO Peter Rost states the obvious - that drugs companies are only “there to make money for shareholders”. What do they care how many Africans die?
Prices for AZT3 officially started at $25 per pill in South Africa until TAC got on the case. Putting his life on the line, Zackie Achmat staged a personal but very public boycott of the ARV, forcing South African president Nelson Mandela to support TAC’s demand that the South African government make the drugs available to all. Thanks to former Prime Minister Indira Gandhi’s 1970 patent law, the drug could be made to the highest technical standards (a fact denied by a black propaganda campaign of the western drugs companies) in India. In 2000, encouraged by Bill Haddad, CEO of Biogenerics, Yusuf Hamied’s Cipla generic pharmaceuticals company agreed to produce ARVs that would cost patients $1 a day - at $350 a year this was less than a 40th of the cost demanded by western drugs companies. (This followed a European Commission meeting, where Hamied trod on western corporate toes by talking about ‘patents or people’ and, shockingly, came up with an initial $800 per annum cost for ARVs, which unfortunately was still too high for mass use in Africa; Cipla followed up by writing off its technical costs.)
Fire in the blood debunks the Big Pharma argument of expensive development costs: in fact, marketing budgets in drugs companies are very much higher than those for research and development, which averages a measly 1.3% of expenditure across top pharmaceutical companies. In fact, 84% of research and development worldwide is carried out by government and public bodies, whereas pharmaceutical companies contribute only 12% and account for only three out of every 10 new drugs invented.
However, despite Hamied’s company offering a three-ARV combination at $1 per day, this still proved too costly in Africa, where drug rationing was subsequently instituted by agencies distributing Cipla’s products. In Uganda, Dr Peter Mugyenyi took direct action in defiance of national patent law; soon after, when his large Cipla consignment arrived at customs it was impounded and Dr Mugyenyi was arrested. However, resulting public pressure then forced the Ugandan government to allow in Indian ARVs, which were soon all over Africa.
UN secretary-general Kofi Annan presided over the setting up of the 2002 Global Fund and a year later US president George W Bush announced a 10-year, $15 billion anti-Aids campaign. However, after a Big Pharma counterattack, an ex-Eli Lilly executive was appointed as Bush’s pharmaceutical drugs tsar: he made it clear that the $15 billion was only going to be spent on high priced Big Pharma drugs, certainly not massively cheaper generics.
Neither was that the full extent of Big Pharma’s fightback: it launched a full-blown offensive. It persuaded the World Trade Organisation to supplant individual countries’ patent laws with its own pro-transnational restrictions on generics. A new domino theory was posited by Big Pharma: after South Africa would come India and so on throughout the whole developing world, and that could not be countenanced. After India’s government adopted the WTO’s Trade-Related Intellectual Property Rights (Trips) patent regime, initially covering agriculture, food and pharmaceuticals, it was all over for generic pharmaceuticals. Big Pharma might have lost out over the earlier anti-Aids drugs, but that was only a temporary setback, from which it learnt well: it finally won handsomely with Trips. For the future, unless and until another, more forceful challenge is mounted, this means that pharmaceuticals will continue to be grossly overpriced. CEO Hamied says in the film: “People are going to die. That is genocide.” But then, Big Pharma is quite happy to see millions of deaths in order to keep patent law - and its inflated profits. After all, an estimated 10 million people perished between 1996 and 2003 thanks to denial of drugs by Big Pharma. And all the while the medicines were just sitting there ... out of reach of the masses.
Fire in the blood concludes with cautious optimism. While Pfizer ex-CEO Rost rightly asks, “Why would anyone who benefits from the system want to change it?”, Zackie Achmat polemicises: “The rich world didn’t care until poor people mobilised.” As James Love of the Washington-based Knowledge Ecology International4 makes plain, “We don’t have to accept a pessimistic future. We can change things.” And the ongoing struggle to fully access all aspects of healthcare - a democratic fight if there ever was one - is certainly going to be ceaseless while capitalism rules the roost.
Notes
1. Witness to Aids: www.witnesstoaids.com.
2. www.tac.org.za.
3. Although azidothymidine was invented in 1963, it was not used until 1985, meaning its patent ran out only in 2005.