All language subtitles for Fire in the Blood (2013)eng

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It was just kind
of a crisis of humanity.

People just weren't
really stepping up

to the magnitude of the problem.

They weren't really human for a moment.

The many people that
I have lost in my family

the many people that I nursed
and who have died of AIDS

could have been spared.

People are dying and
the medicines are in my briefcase!

It's fine for people
in rich countries to say

this is what it ought to be.

They don't have to live
in these little villages

and watch people die like flies.

Let me put it this way.

There is no developed country

which would have tolerated
the loss of millions of their citizens

while life-saving drugs were available.

If it is true that
one death is a tragedy,

and a million deaths a statistic.

This is a story about statistics.

The millions of people
in poor countries

who died needlessly of AIDS

while giant pharmaceutical companies

blocked access to the low-cost medicine

which could have saved their lives.

This was the most
catastrophic emergency,

Africa and the world
has ever seen.

There were non-stop funerals
taking place on a daily basis.

The orphans' population had exploded.

The backyards of most
homesteads were full of graves...

all of them, recent.

I saw so many people
who would have lived.

I saw them die painfully, excruciatingly.

And yet, their death was not inevitable.

I had a small ward with ten beds

and a hundred percent
of the patients in ward were HIV positive

and every day I saw people dying...
eight to nine patients a day.

When you are with the patients and
you see patients dying in your hand...

You know, it is difficult
to say to the patient

that you have this disease and
we don't have anything to help you.

''Look, you are HIV positive
and that's all, bye...'' You know?

I was diagnosed with HIV in...
at the end of 1986.

But I fell very ill with AIDS about
11 years after my diagnosis, in 1997.

I was unable to walk
a simple flight of stairs

I was severely ill...
I faced death from AIDS

because I had four or five
of the defining symptoms of AIDS.

In 1996, everything changed
for people like Justice Cameron

when a combination of three
antiretroviral drugs, or ARVs,

proved sucessful in fighting HIV.

Suddenly the most feared and
destructive disease of the age

was no longer a death sentence

I started on the drugs
having been enormously ill

and within two weeks

I could feel that my life
had been given back to me.

It's what some AIDS doctors
call the 'Lazarus Effect'.

My appetite returned,
my strength returned,

my energy returned,
my joy for life returned

and it was the most astonishing
experience of my life.

The drugs he was taking
were sold internationally

at prices over 15,000
dollars per patient per year.

far beyond the reach of
tens of millions of people

living with HIV/AIDS.

The drugs were enormously expensive.

They took up a third
of my judicial salary.

Most people in Western Europe
and North America accepted

that drug manufacturers
are entitled to a specified price

in the open market,
which is a market defined by

North American
and Western European conditions

and if that price is unreachably high

to people in the developing world...

Africa and Asia,
South America, that's just too bad.

Those people must die.

At the moment we had
our political freedom

HIV came along and
robbed people of life.

It's in many ways worse than
what happened under apartheid.

Zackie Achmat had
grown up fighting against

white minority rule in South Africa.

In 1998, now HIV-positive

he founded the
Treatment Action Campaign

to address the problem
of access to AIDS medication.

...and the only reason we
are dying is because we are poor

The only reason we are dying
is because we are poor.

The problem Zackie and
other South Africans faced

was both simple and brutal.

The drugs they needed
were made under patent

by multinational
pharmaceutical companies

and the patent made it illegal
for others to make, sell or

import unpatented generic drugs

which typically cost far less.

In 2000, one of my cousins

Farida Abrahams, died
of AIDS-related illnesses

and she couldn't
afford antiretrovirals.

And in fact, we'd smuggled

generic FIuconazole
into the country for her

which gave her an
extra six months of life

in which she could die
a dignified death

instead of a really
horrible, cruel death.

But she died because
she couldn't afford antiretrovirals

and that was a close family member.

The only way Zackie could help
his cousin was by breaking the law

American pharma company Pfizer
sold patented Fluconazole

which could alleviate
extreme pain in those suffering

from AIDS-related infections

under the brand-name 'Diflucan'.

Its patent gave the company
a monopoly in South Africa

enabling it to charge
astronomical prices.

A generic version was available
at a tiny fraction of the cost,

but that was in Thailand.

Fluconazole in Thailand, cost
less than five US cents per capsule

and in South Africa, they were
paying 30 dollars a capsule.

And there's no difference in quality.

The generic from Thailand,
made in a government factory

was indistinguishable
from the branded drug

being sold in South Africa.

Pfizer's patent, however,
made importing it, a criminal offence.

We don't have the intention
of breaking the law.

What we will be doing
is breaking Pfizer's patent.

We will be showing that Pfizer

and other companies
are abusing their patent.

We have no criminal intention

Our only intention is
to defend people's lives.

I am a journalist by profession.

I work for a paper
called 'The New Vision'.

I am the first journalist
in East Africa

who declared his HIV status publicly.

I was almost pronounced dead.

I was in a coma for many days.

I was reduced into a skeleton.

Anti-retroviral therapy
was bloody expensive

A dose would go for over a
million shillings, you couldn't afford.

If I had died, I would have been

the eighth member of the same
family to be claimed by AIDS.

I don't mean relatives,
I am talking about brothers and sisters.

My mother couldn't bear seeing

one, two, three, four, five, six, seven...
all her children perishing...

She was imagining she was
going to lose her eighth child.

She had lost hope.

Hope was at a premium on
the other side of the Atlantic as well.

Desperate to build
awareness among Americans

about the fact that millions
of people were dying of HIV/AIDS

even though there were drugs
which could save them

intellectual property activist,
James Love

found few people
in Washington willing to

so much as discuss the issue

and was surprised by the response
of some he thought would join him.

A lot of American AIDS activists
were opposed to this.

They didn't really care...
they felt like they had drugs.

If they had cheap drugs in Africa

they thought it might
discourage R&D for them.

They had insurance,
they didn't see the pricing problem.

Many in the West feared that
treating people in the Third World

could cause the AIDS virus to mutate

and become resistant to the drugs.

The rap was, you couldn't
give drugs to people in Africa

because they would misuse them.

They wouldn't be compliant
in terms of treatment.

They'd develop resistance...

resistance would come back and
kill Americans or kill Europeans.

They are mostIy illiterates

can't read the information
on the leaflets in the drug packets

and have to cope
without a healthcare system

that can tell them
about the disease they have

The biggest problem
for antiretrovirals

this sounds small and some people...

if you've travelled to
rural Africa, you know this.

This is not a criticism,
just a different world.

People do not know
what watches and clocks are.

They do not use Western means
for telling the time, they use the sun.

In July 2000, four years after
the combination therapy breakthrough

had changed the outlook for people
with HIV in the rich West

the biennial International
AIDS Conference

was held for the first time in Africa

the continent with more than
two-thirds of the world's HIV cases.

Over two million people were reported
to have died in that year alone.

So people were fed up
with being called to a conference

told how AIDS can be treated

and at the end be sent home

to watch their people
dying without treatment.

Where are the drugs?

That's where they are...
the drugs are where the disease is not!

And where is the disease?
The disease is where the drugs are not

Protestors directed their anger
at pharmaceutical companies.

New drugs promise to prolong life

but they are too expensive for
the 23 million Africans dying of AIDS

The power of the drug companies
is strong, they have money...

I've never seen that kind of anger

which was directed at
pharmaceutical companies.

We are never going to stop
until everyone in Africa

everyone in Asia, everyone in
Latin America has access to drugs.

But we will not forget
the poor people in Europe

and the poor people in
North America...

In the heightened and
expectant atmosphere

High Court Justice
Edwin Cameron took the stage.

Please take your seat,
the court is in session!

I am here because
I am on antiretroviral therapy

I can afford my medication.

Now why should I have the privilege

of purchasing my life and health

when 34 million people in
the resource-poor world are falling ill

feeling sick to death, and are dying?

We need to change the facts

that are going to lead to the deaths
of 25 million people in Africa.

We will change that fact.

We will challenge the future,
and we will intervene in it.

Thank you very much.

You may not do this.

You may not leave ten or
20 or 30 million Africans

to die unnecessarily from a disease
that can be medically treated.

That was the turning point
that Durban represented.

Lots of people were dying
because they needed the ARVs

Those who didn't die,
they must thank God.

By that time, there were
no people who were saying that

''I am HIV positive.''

No one was saying HIV or AIDS,
they would say,

"Don't say, don't say the word",
you know?

I got married in 1995.

I don't like him, but everybody
forced me to get married.

and after 45 days
I came to know my status.

I got the result and I
only read that it's AIDS.

So I know AIDS means death.

And I know AIDS is what
immoral people get...

I am not immoral...
How did I get the virus to my body?

During that time,
I came to know

my husband knew his status
before my marriage.

Seven months later, he died.

In this country, people think that...

they are all saints,
and those who get HIV are sinners.

There was no doctor who wanted
to touch people with HIV.

We used to admit them in a little
thatched roof on the side of the road

because no hospital
wanted to admit them.

We were fighting desperateIy
to try to convince patent-holders,

the main pharmaceutical companies

GlaxoSmithKline, Pfizer,
Boehringer-Ingelheim...

...question of access
to treatment, which...

and we said, "Listen
none of the clients here

are using your drugs,
and will probably

ever be able to use your drugs.

Can you please allow us
to import generic drugs?

And they answered to us
very quickly...

and the answer, of course, was 'No.'

While the death toll
in Africa continued to rise

AIDS was now largely seen
as old news in the West

where mass demonstrations
for access to drugs in poor countries

went all but unnoticed.

HIV and AIDS is happening
in the developing world

the so called 'Third World'

which has always, as it were,
been at the bottom of the pile.

Although low-cost generic ARVs
were now being made

in a few more developed
countries like Thailand and Brazil

quietly acting to curb
their own epidemics

governments in the poorest
and hardest-hit countries

backed away from challenging
Western patents on AIDS drugs

having been repeatedly warned
by the United States and others

that doing so would lead
to severe consequences.

The US government and
the industry work hand in hand.

Aid from the US is rarely
given without strings.

It's given to further
American interests.

Those interests are in line
with the companies because

quite frankly, at the end

the companies are running
the US government.

I mean they are pulling the strings.

It had taken nearly forty years

for the United States government
to put apartheid South Africa

on a sanctions watchlist

but it took less than three years
to put democratic South Africa

trying to make medicines
affordable to its people

onto a sanctions watchlist,
at the behest of drug companies.

Donald McNeil covers global health
for the New York Times

The actual price of
the pill has nothing to do

with what it costs
to manufacture the pill.

They could pretty much set the price
of the pills at anything they wanted

they were still making
a profit at five cents

but they were charging
the same twenty-five dollars a pill

in South Africa that they
were in the United States.

So I began to see more how completely
screwed up and unfair the system was

The drug industry
like any other private corporation

is there to make money.

It's there to make money
for its shareholders.

The concept is to set the price

at the level where
you will maximise revenues.

That means you are going to lose
some patients because it's so high

but you're making up for it

because the others are forced
to pay that very high price.

With life-saving products,
it is a terrible mistake

to put shareholder value

above the lives and livelihoods of

millions of people
who will die as a result.

Branded pharmaceuticals
had for decades

been the most profitable
business on earth.

Even though the industry
made almost all its money

in rich Western countries

with half of all revenue
coming from the United States alone.

The continent of Africa as a whole

accounted for just
one percent of sales

While Africa was only of
marginal interest as a market

the drug industry feared
that relaxing its patent monopolies

in the poorest countries
could set a bad precedent

one which might threaten
future profit margins

in major emerging markets
like China and India.

My God, I mean, the
sales were practically zero.

The sales were essentially
a rounding error

for the whole continent of Africa.
It was ideological.

Africa wasn't going to make
any difference to them anyhow.

When the doctor
told me Lisa was HIV+

I cried and I cried
and I cried for an hour...

Firstly she was diagnosed with
meningitis, and then pneumonia

Everyone was very scared to touch her.

That's when I started to get angry

and I just told myself, ''Ok,
why am I keeping quiet of this?''

As the symptoms of
his own HIV infection worsened

and his health deteriorated

Zackie Achmat took
a momentous decision.

As an internationally-known activist

he would surely be able
to access ARVs.

But for all those around him
the story was entirely different.

If my sisters or brothers
or cousins had HIV, or had AIDS

and needed medicines,
they wouldn't have been able to get it

and I grew up in a house
where your mum said

"If all the kids can't have chocolate
one is not going to have it."

Having made up his mind,
Zackie Achmat announced that

he would boycott antiretrovirals

until the South African government
made them available to everyone

I think, that probably
made a big difference.

Even Mandela at one point was saying
''Please take the drugs...''

When he phoned up and said
''I am coming to your house

and you're going
to take your medicines'',

I said to him, ''No, sorry,
that's not how I do business.''

He is a role model

and his action is based
on fundamental principle.

It would have been futile
for me to come to him to say

''I want you to change now,
to take drugs''

because his position

is that, as long as
drugs are not available

to everybody, especially the poor,
he will not take them.

I talked to people that worked
for the National Security Council.

I talked to the World Bank,
I talked to UNAIDS

I talked to the
World Health Organization

the Office of AIDS for
the United States government

and I kept asking them
the same question

I said, ''If you didn't
have to worry about patents

what would it cost to
create a treatment for AIDS

for people in developing countries?''

And I used to tell people
''Look, if there were

30-40 million white people
that didn't have access to treatment

somebody would know
the answer to that question.

Somebody would ask that question.

Some Member of Congress
would want to know.

It wouldn't just be kind of

the unasked question.

It would be the most important
question you could possibly imagine.

And I was just shocked
at the lack of information.

The man who got Love his
answer was former journalist,

advisor to President Kennedy

and pioneering advocate
for generic drugs, Bill Haddad.

They wanted to know
where you could get the raw materials

to make the AIDS medicines.

Then I called up Agnes Varis,
who was a friend

and a big importer of raw materials
and she said, ''call Dr. Hamied...

he's an iconoclast,
he's not afraid of the multinationals

he's the one you need to talk to.''

Yusuf Hamied was a
Cambridge-educated Indian chemist

who ran a company called Cipla,
based in Mumbai

which his father had founded in 1935

Cipla had begun making
generic antiretrovirals

in the early 1990s at the
request of the Indian government.

And within twenty minutes
I knew he was the person I had to see.

In August 2000, Haddad and Love
met Dr. Hamied in London

along with a
handpicked group including

Denis Broun, a leading
French expert on AIDS in Africa.

And it was supposed
to be a very secret meeting

I was in WHO at the time

I remember taking leave
and going in hiding to London.

I asked Dr. Hamied...

I said, ''Look,
what we're trying to figure out is

at rock bottom prices.

What would it cost
to get an AIDS drug?''

The key to pricing in medicines

is the price of the active
pharmaceutical ingredient

If you can get that cheaply,
your end product is cheap.

Hamied explained in detail
how an antiretroviral cocktail

could be produced for
a small fraction of the prices

prevailing at the time.

I felt the whole of Africa
was being taken for a ride.

For a lot of us, it was
a kind of cultural revolution.

Treatment for AIDS
was something for the rich.

It was something which
was unthinkable for Africans.

He was just transforming
the whole landscape

and we decided to help
as much as we could.

Hamied's father was
a devotee of Mahatma Gandhi

who had studied pharmacy
in Berlin at Gandhi's urging

and later established Cipla
in line with his mentor's firm belief

that India needed
to produce its own medicine

in order to become self-reliant.

We learnt a very important lesson
from Mahatma Gandhi

and that was that every country
has to decide for themselves

their own destiny.

Yusuf Hamied had
been the driving force

in persuading
Prime Minister Indira Gandhi

to rewrite India's
patent laws in the late 1960s

so as to reduce
the country's dependence

on costly patented
medicine from the West

My idea of a better ordered world

is one in which medical discoveries
would be free of patents

and there would be no
profiteering from life or death.

Until 1970, India had some of
the highest drug prices in the world

and India's average life expectancy
for a man was in his forties.

They changed the law and
the drug prices fell dramatically.

Drugs were available,
life expectancy shot up

and a lot of other things
improved in society.

The reason we set up
the system we have today

from the drug industry's perspective

is to maximise lives for humankind.

That's why we have patents,
that's why we have a free market.

These are not natural forces
born out of Mother Earth

it's something we made up...

patents are made up,
the free market is made up.

Patent laws typically
give the inventor of a product

such as a drug

a legal monopoly
over its production and sale

for a fixed number of years.

The state gives the inventor
of a new drug, like

a prize, a grant of a favour.

Exclusive rights to this invention
for a period of twenty years.

The patent laws are not international.

They're national laws
and need-based for the country.

Each country's needs are reflected
in the patent laws that they make.

The patent system has
been perverted a great deal...

especially in the last quarter-century

We make them because we believe that
when they are appropriately designed

they will promote innovation
and societal well-being.

But when they're not
appropriately designed

they will result in people dying

and they will result in
a suppression of innovation

and it's happened over and over again.

I always give the
example of the first drug

for AIDS-AZT.

It was first invented in 1963.

'63.

The first usage of AZT
in AIDS was 1985.

Patented.

So that patent lasted till 2005.

Now, just before 2005, Glaxo says

"AZT should not be used on its own.

It's useless, should not be used.

It should be used in
combination with Lamivudine.''

That patent runs out in 2017.

That means, directly and indirectly

AZT, the first antiretroviral drug

invented in '63, has been
covered under monopoly

for 54 years.

Is that what patenting is all about?

In September 2000, Hamied was invited
to the European Commission in Brussels

for high-level talks
involving health ministers

and heads of government
from numerous countries

along with chief executives
of major pharma companies.

The subject of the
closed-door meeting was

access to medicine in the developing
world, above all for HIV/AIDS.

Cipla was sitting
between Merck and Glaxo.

First time they would
put a generic company there

and everybody made
their traditional speech

and all of a sudden
Dr. Hamied got up and said

"Friends, I represent the Third World

I represent the needs and
aspirations of the Third World

I represent the capabilities
of the Third World

and above all
I represent an opportunity.

We all have a responsibility
to alleviate the suffering of millions

of our fellow men
who are afflicted with HIV and AIDS.

We strongly believe
that in the Third World

there should be
no monopolies for vital

life-saving and essential drugs.

We are the only manufacturer today

of one of the triple drug combinations
proven to be effective

We are ready to offer this
combination internationally

at US dollars eight hundred
per patient per year.

Apart from us, there is
a growing number...

He said, ''Will you decide
to have patents and high price

or will you decide to
have the lives of people?''

We made three proposals
at that meeting.

One was to supply anti-AIDS
cocktail at eight hundred dollars

Two, we would give the know-how
to produce anti-AIDS drugs

to any Third World government

who wanted the technology
to develop their own

and we would
give the technology free.

And third, we said that one of the drugs

which stops the transmission of HIV

mother to child, we would
give free throughout the world.

We call upon the participants
of this conference

to do what their conscience dictates.

Thank you.

It was devastating
to the group, I mean

everybody was just
taking their breath in.

Though Hamied's offer sent
shockwaves through the political

and pharmaceutical establishments,
no one took him up on it.

Nobody took us seriously

and I was absolutely disillusioned.

When I was young,
heroin was a new thing in Manipur.

The Golden Triangle is next door
and drugs were flooding in.

There was no
AIDS awareness at the time,

so we used to share needles.

When the doctor told me
I had tested positive...

I never left my house for
the next three years.

Even my close friends stopped visiting.

I felt completely abandoned.

I wanted to do something

to prove that my life
was worth living.

No industry has made more profit
over the past several decades

than brand-name pharmaceuticals.

At the time of Hamied's offer in Brussels

the ten biggest pharma companies
on the Fortune 500 list

were more profitable than
the other 490 companies combined.

These companies spend
far more money on advertising

and marketing than they do on R&D.

On average, less than one and a half
cents from every dollar in sales

goes to research
for discovering new drugs.

The pharmaceutical industry pretends

that it's spending all this money
on research and development

but in fact, vast amounts of
that money is spent on its sales force

vast amounts of that money
is spent on dividends to shareholders

vast amounts are spent
entertaining doctors

and on huge salaries
to the heads of the companies

and it's all coming off the backs
of the people who buy these drugs.

They sell the drugs,
they don't do the R&D.

They're not that good at R&D,
Big Pharma.

Big Pharma is really big
through acquisition

of other people's technology.

Eighty-four percent
of worldwide research

for drug discovery is funded by
government and public sources.

Pharmaceutical companies fund
just twelve percent of such research.

I think you could say that

taxpayers are actually paying several
times for the same drugs, yes.

If you look at the HIV drugs
that are being sold,

seven out of ten of them
were actually not invented

by the people or the companies
that are selling them.

...we're looking at the impurity profile,
it looks very good.

Public-funded research
should be free for the public.

But while the drug companies
and politicians

paid little attention to Hamied,
Donald McNeil did.

I think the story that was probably
the most important story

I've ever written
in my career was that

I went to India and
profiled Yusuf Hamied.

And the reason it's important

I think, is because up until then

whenever you talked to
the pharmaceutical companies

the implication was, ''Oh, you know

if you let the patent
barriers come down

if you get rid of
intellectual property

pretty soon those drugs from India

are going to start coming in.''

And the implication was...
nobody would say it, but they always

gave you the impression
that these are pirate drugs

these are going to be counterfeits

they're going to be dirty,
they're going to be substandard

and I think most people
sort of bought into that idea.

But when I got to India
I find spotless factories

and I hadn't realised at the time
that an enormous amount

of the generic drugs
sold in the United States

were actually sourced in India
in those same factories

and many of the active
ingredients for the

brand-name drugs were sourced in India.

A lot of his orders
came from the United States.

The American pharmaceutical industry

takes enormous pride
in the quality of our products

and there is a very
significant issue in India

with respect to the quality of
the products that are being produced.

They began to take out ads in
the South African papers which showed

crying babies and legends saying

"If you allow this drug law to pass

it will allow counterfeit drugs into
the country that'll kill our children."

As the year 2001 began, the architects
of the offer made in Brussels

were confounded as to
why it had found no takers

or even vocal support within
the global AIDS community.

Sensing they would
only have one more chance

James Love called up Yusuf Hamied.

I said, ''Look,
I need a very dramatic price

for us to really
take this debate further.

We have to show people
that things will really change

if they deal with the patent issue.''

After considering Love's appeal,
Hamied and his colleagues

took the decision to write off
all production and overhead costs

and offer the triple cocktail for the
price of its ingredients alone.

It was a losing proposition at the time

but we thought, ''Why should
one make money on things that

we know people can't afford?

Let's go ahead and do this
on a humanitarian basis.''

And he said ''I'll sell you
Nevarapine at 65 cents a day

and 3TC at 35 cents a day

and I'll throw in D4T for free
because they're so cheap to make.

So that'll be a dollar,
a dollar a day.''

That was a watershed event.

Suddenly the price went from
15,000 dollars a year

down to 350 dollars a year
and that was just the dam breaking.

Donald McNeil put it on the
front page of the New York Times

and the Herald Tribune...
and it was all over the planet.

It was clearly the magic number.

It completely changed things.

What was different is
that it wasn't a pledge

or something for the future.

You had the medicine in a little box

and it could be delivered tomorrow.

The synapse was there,
so it wasn't pie in the sky.

The breakthrough meant that
for the first time

governments and donors could
contemplate actually treating people

in poor countries for AIDS

instead of simply trying
to limit new infections.

I think if Cipla didn't take that step,

and that is what
we must acknowledge,

of announcing a
350-dollar-a-year regimen

we would not have had
medicine in the way that we do.

You know, if it was the
lives of white people at stake...

How could the international community

not know what it cost to save lives?

Why did I have to be the person
to go out and figure out

what it costs to make an AIDS drug?

I didn't work for the government.

I didn't work for the
World Health Organization

or UNAIDS or the CIA or anyone else.

I just worked for this little NGO.

What was really going on was
that WHO didn't want to know

what it cost to make an AIDS cocktail.

UNAIDS didn't want to know
what it cost to make an AIDS cocktail.

The United States government
didn't want to know

what it cost to make an AIDS cocktail,

and why didn't they want to know?

Because if the public understood
that you could make an AIDS cocktail

for two-three hundred dollars

it wouldn't look very good.

It would be an absolute

intolerable set of facts
to have out there.

So the way they were
trying to manage the situation

was to deliberately stay as
ignorant and as stupid as possible

about what the facts were.

It was just a really
deep form of racism, I thought.

It was just a completely
morally repugnant situation.

Initial excitement about
the dollar a day offer

soon gave way to a harsh reality.

Although the price of ARVs was now
a tiny fraction of what it had been

it remained largely out of reach

to poor African families
and their governments

and in most countries,
patents continued to block

production and importation of generics.

We managed to get people
onto treatment by hook or by crook

but it was really again
a case of rationing.

Only those lucky few were able
to get on to antiretrovirals

yet so many people had to succumb.

You made decisions based on
who had children to bring up,

who had opportunities.

I guess, almost sort of
playing God in a way.

That was hard, really hard

to choose who goes first,
even within a family

being forced to choose...
''Is it a husband?

Is it a wife? Is it a child?''

Now there's a group of people
here at the hospital

that decides which
patients are best suited

to receive these medicines
and your case was discussed already

and it was decided that
you're one of the people

that we would like
to give these medicines to.

After hearing all that,
I mean, is it ok with him?

I accept with all my heart.

Appalled by the relentless carnage,
Peter Mugyenyi,

director of the continent's
largest AIDS research

and treatment centre

decided to take matters
into his own hands.

I wrote to Cipla in India and said

''Would you please supply
us with antiretroviral drugs?''

I knew where drugs were
and as a doctor it was my job

to try and save my patients' lives.

He ordered the medicines
in defiance of patent laws

which still kept generic
ARVs out of the country.

At Entebbe Airport,

Ugandan customs officials
immediately impounded the medicines

and placed Mugyenyi under arrest.

They were restrained by the same laws

that were stopping drugs
reaching many other countries.

"Is there a law under which we could
let these drugs in to save lives?''

Something had happened in the
United States a few months earlier

which gave Dr. Mugyenyi,
reason for hope

It contained a brown
granular substance

that has today tested
positive for anthrax.

Now, the employee from NBC...

In response to a series of
fatal anthrax attacks just after 9/11

the US government had cited

a public health
emergency as valid legal cause

for suspending the patent
on an essential drug called Cipro.

For a moment people in the
United States were afraid about

access to medicine, and
the patent was perceived

to be a problem in the United States.

The United States government
basically went to Bayer and said

''If you don't push the price of

Ciprofloxacin-Cipro down immediately
we're just going to cancel your patent

and buy generic drugs from India.

You know, we have the right to do that.''

But a very different set of rules
seemed to apply to African countries

which were warned in
no uncertain terms that

any attempt to suspend
patents on life-saving ARVs

using the same public
health emergency defense

would be met with a ferocious response.

The United States comes down
like a ton of bricks.

It threatens all kinds of sanctions
and says you're violating the WTO.

Back at Entebbe

with Peter Mugyenyi
stubbornly refusing to stand down,

the Ugandan authorities finally agreed

to allow the generic ARVs
from India into the country,

gambling that Western governments
would ultimately not punish them

for taking steps to save their people
from dying in unprecedented numbers.

The gamble paid off, as generic ARVs
started flowing into Uganda

and the blockade of low-cost
AIDS drugs for Africa

was effectively broken.

That was a turning point.

The numbers that
could afford treatment

went up tenfold,
which is unprecedented.

The arrival of generic drugs
to fight AIDS in Africa

was cause for serious concern
to the global pharma companies

which perceived any easing
of patent restrictions in poor countries

even on humanitarian grounds

as a potential threat to their
future profits in key Western markets.

I think what they
were really worried about

were the political consequences.

If Americans saw

that they had to pay
10,000 dollars for a year's treatment

and somebody in another country
was paying 150 dollars,

they would say,
''Why do we have to pay so much?''

There's a very big fear that they would
ruin their own business model

and I think that is understandable.

Drug companies are not there
to protect the Third World

They're there to make money.
Pure and simple, that's it.

Calls for mass treatment of AIDS

in poor countries were
growing louder, however

since people now knew low-cost
generic ARVs were available

At a special meeting in Africa

United Nations Secretary-General
Kofi Annan

announced the international community's
long-awaited response.

I propose the creation
of a global fund

dedicated to the
battle against HIV/AIDS

and other infectious diseases.

The Global Fund was formed in 2002

but it soon became
clear that saving lives

was not the only priority.

The US government,
the US representative

said that if they bought
generic drugs with that money

the US would pull out its commitment.

21 million deaths from AIDS is enough!

We were working with
the drug companies

to make reduced access to medicine.

But suddenly things
took an unexpected turn.

With the United States
poised to invade Iraq

President George W. Bush's
2003 State of the Union address

was to be one of the most
closely-watched in history.

Today, on the continent of Africa

nearly 30 million people
have the AIDS virus.

Yet across that continent
only fifty thousand AIDS victims...

only fifty thousand
are receiving the medicine they need.

Many hospitals tell people

''You've got AIDS, go home and die''

In an age of miraculous medicines

no person should
have to hear those words.

I ask the Congress to commit

15 billion dollars
over the next five years

to turn the tide against AIDS
in the most afflicted nations

of Africa and the Caribbean.

Peter Mugyenyi had
been consulted on the plan.

I was right there seated
next to the First Lady

and that was the
most exhilarating moment

of my career working
in the area of HIV/AIDS.

The program, the President's
Emergency Plan for AIDS Relief

would come to be known
by its acronym, PEPFAR.

Antiretroviral drugs
can extend life for many years

and the cost of those drugs

has dropped from
12,000 dollars a year

to under 300 dollars a year.

Seldom has history offered
a greater opportunity

to do so much for so many.

They mentioned the generic price.

Everyone paid attention to it

because they thought
that was really a signal.

Bush appeared to be endorsing
the same generic ARVs

which the US government
was battling hard

in other places to keep out of Africa.

I talked to Mitch Daniels,
the head of OMB

the people that do the purse strings
for the federal government.

When the price of AIDS
drugs fell to a dollar a day

he felt that they had an
obligation to support treatment

He also said the entire decision
to do treatment through PEPFAR

was based on the idea that
they could buy from Indian suppliers.

Uncharacteristically, the
White House had not consulted

the powerful US pharma lobby
in any significant way

prior to announcing the plan.

The industry was caught
almost completely off-guard

but quickly fought back.

Within days, the
administration distanced itself

from the 300 dollar generic
ARV figure, and appointed

a stalwart Big Pharma insider
with no background in public health

to the newly-created
position of AIDS Czar.

Unfortunately, when people today say

"We ought to buy generic AIDS drugs",
they're not describing in many cases

what we imagine when we think

about generic drugs
here in the United States.

It would be a disaster
if we invested...

Rather than low-cost generic ARVs,
the PEPFAR money

would be used to buy
high-priced branded drugs

meaning far fewer lives
would be saved by the program.

If you ran the numbers
there was no way

given the available price structure

that all the money
they put in the Global Fund

and all the money
President Bush and Congress

would give to the American effort
was going to be enough to

save the number of people
that had to be saved in a hurry.

In 2003, the Clinton Foundation
began consolidating drug orders

from numerous governments
and aid organisations

to help bring ARV prices

for hard-hit developing countries
down to never-before-seen levels.

It was clear to me that no
matter how much money they put in

it would never be enough
unless they can buy generics.

We have been
partners for three years

and as a result of that partnership
an enormous number of people

are alive today in the world
who would not be alive.

We began with providing...

Though many felt Clinton had
done a poor job on AIDS as President

his foundation's high volume
ordering of generics

was critical to bringing prices
for ARV treatment in Africa

down to below 100 dollars per year.

What’s your message
to developed countries

who refuse to give low-cost
drugs to fight AIDS?

We could be treating
three-four times as many people

without any increase in funds,
maybe even more.

So I hope that my visit here will...

Gradually, the
ever-growing price difference

between generic and branded ARVs

and the sheer scale
of human tragedy in Africa

made it impossible for
donor programs to continue spending

vast sums on the
far more expensive drugs.

The Global Fund and PEPFAR
finally committed themselves

to buying generic ARVs

and the numbers of people
on treatment exploded.

It was, I can say, a miracle.

We had dying people.

Maybe this patient will die tomorrow,
this patient will die today

but once they started
the antiretrovirals

I am not lying to you,
they survived.

You are expecting them
to die, but they disappoint you.

When she was a year...
Lisa started the ARVs

She started changing...
bit by bit, step by step...

Now she can talk very, very loud

she's walking, she's a child...

she's a normal child
like the other children.

I must admit I was very nervous...
very, very nervous...

but the only side effect I experienced

was the fact I started
scrubbing floors.

Nothing else...
I could concentrate, I could read

I could work... and it
changed, everything changed.

Zackie Achmat had decided
to end his boycott of ARVs

once his government committed
itself to extending treatment

to all South Africans in need.

Generic ARVs had begun
to reach patients on a mass scale

and the impact on people
dying of AIDS was swift and dramatic.

After I started on ARVs,
I began to feel normal again.

Later I began training
to be a bodybuilder.

When I won the
Manipur state title in 2007

I disclosed my HIV status
publicly the very next day.

For someone who was
bedridden and waiting to die

winning the state title
felt like touching the sky.

The medicine is
giving me a new life.

The doctor told me that

I can live only for two years
or something like that

and after that I will die.

Till now I am living, so
I am not dying.

People continue
five years out to take

almost a hundred
percent of their doses

and remain virally suppressed
on the same regimen.

It's extraordinary.

The so oft-repeated argument
that people in poor countries

would not be able to faithfully
follow the drug regimens

was to be proven completely wrong.

A lot of journalists asked us,
"Are you sure about your data?

Are you not...?"

They were suggesting that
we were 'cooking' the data

because they were actually
better than in the Western world

which was unbelievable!

There was this sort of incredible
fierce determination

to show that in fact
not only was it feasible

but we could do it better than
many parts of the world.

I always remind them,
what was happening before

when we didn’t have the ARVs...

I wanted to show
that people like us

are just as good as
any other human being.

Thank you Mr. K. N. Pradip
Kumar Singh of Manipur.

Tag number eight...
Thank you very much.

And the 55 kg category is
in the favour of bodybuilder

from Manipur, Mr. K. N. Pradip
Kumar Singh, tag number eight.

I want to dedicate this
to my mother.

With low cost generic ARVs
now saving millions of lives

in the developing world,
many believed that

better access to all types of medicine

for the world's poor would soon follow.

The drug companies, however, had
no intention of giving up so easily.

Seeing a threat to its
monopoly system on the horizon

the global pharma industry had
already mobilised Western governments

led by the United States

to use the World Trade
Organization, or WTO

as a vehicle to force
developing countries

into adopting strict
Western-style patents on medicine.

The protocol they used to do this
is known as the TRIPS Agreement.

The international trade
agreement that was called TRIPS

'Trade Related Intellectual Property'

It was an agreement that was

for the interests of the
advanced industrial countries

for the pharmaceutical industry

but did not reflect the interests
of those in developing countries.

TRIPS effectively took
control of drug patents

out of the hands of national
governments in the developing world

and put it into those of

the Western-controlled
World Trade Organization

which has draconian powers
to punish countries

it views as stepping out of line.

This was widely seen as a
direct attack on Third World generics

by the powerful global drug industry.

The drug companies wanted
to prevent South Africa

from making medicines
affordable because

they had the 'domino effect' in mind.

South Africa goes,
India goes, Brazil goes

Thailand goes,
Argentina goes, and so on

and then of course
what about the United States?

Which is their biggest market,
the biggest market of them all

because United States consumers

have exactly the same sort of brains
that we have... in the end.

When the trade negotiators
signed the agreement

to make access to
medicine more difficult

they were signing the death warrants

for thousands of people
in the developing countries.

That's not where they were focusing,
they were celebrating

but in fact that was
what they were doing.

And they knocked out
what was the dream of the world

which was the Indian system.

The drug companies might
have lost a battle over AIDS drugs

but with TRIPS, they won the war.

Facing the full force of the WTO

India and other key developing
countries lost the legal ability

to make low-cost generic
versions of newer drugs

and the consequences for
billions of people

living in the global south are
potentially catastrophic.

So for the next generation of drugs,
needed drugs

which people desperately
need to stay alive

they're not going to be there
except at the high prices.

What is likely to happen?

People are going to die.

To me, that is genocide.

India has gone into the system of

patenting in health

which I don't think
is a good system

but they had no
alternative to accepting.

In the area of pharmaceuticals

and particularly in the
area of life-saving drugs

if you can't get the right
to that drug, your citizens die

and forcing a country to sign a law

that says, "Ok,
we'll let our citizens die

so you can keep
your patent monopolies

and your prices up"3
seems to be amoral.

When we had under
a dollar a day, it was symbolic.

We are now at one-third of it.

The question is will these
future drugs remain cheap?

Since the early 1970s,
India has supplied

low-cost medicine
to the developing world.

But this lifeline to billions
of the world's poorest people is

being severed as the TRIPS
patent provisions take hold,

with no alternative source of
affordable medicine anywhere in sight.

They have us as their hostages.

If we face an emergency
here in Africa we shall die

because the laws don't protect us.

Lack of access to medicine

increasingly affects people
in Western countries as well.

Almost half of
all Americans now say that

they are unable to afford
their prescription drugs

a number which grows
with each passing year.

In the US, to stay
healthy and well and not die

is not a basic human right

and that's why we have
the system we do have here.

The companies can't continue
to take the position

''Ah, they're just Africans,
let them die''

and it's going to be even
harder for them to take the position

''Ah, they're just old Americans,
let them die...''

There isn't a single state that
could continue providing healthcare

at the levels and cost that
exists because of drug company

and health technology
company profiteering.

So the problem is
not going to go away.

Whether it's General Motors
running bankrupt

because they can't afford
their healthcare bill

or whether it's people
who need the medicine

who will form a most unusual alliance

to either force change or
to end the system as we know it.

It is often argued that
the global drug companies

fought low-cost AIDS
medication in poor countries

because they feared
it might force down

prices for their
own products in the West.

But this fear proved
totally unjustified.

Even as ARV prices in
Africa and the global south

were continuously falling

prices in the United States
remained virtually unchanged.

The drug industry has acted based on
the financial incentives that they have

that we have set up
in the Western world.

I mean, we're all
responsible for this in a way.

We need to do some
things here to make sure

we're not just killing off
millions of people

because of a lack of access to drugs

At the beginning of the millennium
perhaps eight thousand people

with HIV in Africa had
access to life saving drugs.

Just over a decade later
the number on treatment

in developing countries
would pass 8 million

virtually all of them
taking generic ARVs from India.

In the years after antiretroviral
therapy was proven effective however

it is estimated that
ten million or more people

in the global south
died of AIDS,

because Western drug companies
and governments denied them

access to affordable
and available medication.

It's devastated countries...

it's become a major
foreign policy problem...

it's become a military problem...

and the medicines are there
and they are affordable.

It's under
a hundred dollars a year now.

So there we are, and I...

you know, to tell you
the truth I have dreams...

Cut it for a minute.

All those people
who had the power to stop it

including drug company executives

are responsible for
all those deaths...

of lives that could have been
saved between 1996 and 2003

and the rich world didn't care
until poor people mobilised.

"You fight our patent monopolies,
we will make sure you die!"

I mean, that was their attitude.

We have discovered
so many things in the world

and we cannot fail to discover

a formula where business

can continue and prosper,
and poor people

don't have to pay
the price with their lives.

As long as there are
monopolies on medicine

millions of people will continue
to die needlessly every year.

With life-saving drugs
priced out of their reach

most of those saved
by generic ARVs

will eventually need newer second
and third line drugs to survive.

But with TRIPS and ever harsher
patent measures ensuring that

few of these can
be made in generic form

millions now living healthy
and productive lives

will again face death for
lack of available medicine.

When it became
a life or death question

it's obvious that the whole TRIPS
system is going to have to be amended

so that we don't have these fights
that cause people to die

we can never let this happen again.

People have to figure out
that they don't have to accept

a pessimistic, crappy future.
They can change things.

You can change things, I can
change things, we can change things.

We have made the mightiest industry
in the world shake in its boots!

Clearly, once you have a system
that appeared to work first

but then all of a sudden excludes
millions of people in the US...

maybe billions of people
around the whole globe,

you should sit back and ask yourself

"Well, does this really make sense

or do we have to change something
or tweak something here?"

And then you get into the trouble of,
why would anybody

who is benefitting from this system
want to change or tweak it?

None of the people
who make money off of it

none of the people who derive
power out of it want to change it.

But again,
if you have enough pressure

if things get bad enough,
people do change...

and I guess this film is part of that.