Review: Fire In The Blood – Medicine – Monopoly – Malice

Every 20 seconds someone dies of an AIDS related death and every minute, a new woman becomes infected with the virus.(1)World wide there were approximately 1.8 million new cases of HIV in 2016. Sub-Saharan Africa has the largest proportion of HIV and AIDS cases worldwide, accounting for roughly 64% of all new HIV infections.(2)

Our monthly review ‘Secluded’ will discuss a documentary that falls under our (Solutionism) remit in relation to politics, economics or social issues.

Fire In The Blood (FITB) primarily focuses on the way in which, western pharmaceutical companies utilised patent laws subsequently this prevented some of the worlds poorest from accessing life saving HIV/AIDS treatments. FITB examines the Western reaction and response to the developing world’s AIDS crisis in the 90s, which the film’s website proclaims “the crime of the century,”

FITB specifically shines the spotlight on how African AIDS patients, activists and academics fought against the monopoly on life saving HIV/AIDS treatments which were dictated by the global pharmaceutical industry. Thailand and India were creating low cost generic versions of HIV/AIDS treatment. Patents laws sentenced millions in the developing world to a painful, degrading and unnecessary death.

This documentary delves deep into the murky relationship between pharmaceutical companies and western countries, who in tandem dictated terms surrounding patents on antiretroviral drugs, which indirectly resulted in the death of 10 million people.

Helpless and frustrated cannot begin to sum up how doctors, patients and activists collectively felt faced with never ending restrictions and obstacles during early 2000s when they attempted to combat HIV/AIDS crisis, in Sub-Saharan Africa.

These inhibiting factors were dictated by developed countries and western pharmaceutical companies and enforced by the WTO (World Trade Organisation). For example, the WTO’s enforcement of the Trade-Related Aspects of Intellectual Property Rights (Trips agreement), nations such as India were pressured to adopt patent laws on medicines as a condition of membership.

Fire In The Blood highlights the potential danger for poor people living in poor nations due to the enforcement of western nations’ patent laws and notes a trend toward greater IP (Intellectual Property) protections, often at the expense of health. The WTO TRIPS agreement constrains the ability of countries to change their IP protections to protect health, subsequently this has only became stricter due to the introduction of the so-called “TRIPS-Plus” Agreements, which set minimum floors, often at levels far higher than the TRIPS Agreement requires. (3)

The first effective treatment to HIV came in 1996, which was years after the worlds first documented case which can be traced back to 1959. The creation of a three-part antiretroviral (ARV) “cocktail” changed everything for AIDS patients. The treatment was extremely affective extending HIV patients lives by approximately 10-40 years, where as untreated diagnosed patients were expects to have a life expectancy of 6-19 months.(4)

The treatment for HIV/ AIDS patients was effective but costly, as the market was dictated by the western pharmaceutical companies. The costly expense of the treatment meant most people were unable to afford these pharmaceutical.

A justice of the Constitutional Court in South Africa, Edwin Cameron opens up about when he was diagnosed with AIDS in 1980s and became gravely ill in the late 1990s. Cameron continues to outline his situation explaining that he was spending one – third of his judicial salary on three daily pills.

This life-saving pharmaceutical cocktail was sold for just over $10,000 per patient per year, which was out of the reach for most people in regions hit hardest by the AIDS epidemic.

A simple question is put forth by James Love, a lawyer interviewed in the documentary “How much does it actually cost to produce an HIV/AIDs treatment?” Unfortunately no one could give him a simple answer.If American patients knew the actual cost of creating these life saving drugs would they not question why they paid so much or why people in developing countries were being denied a cheaper viable alternative to the branded drugs on the market at the time.

In a 1998 lawsuit brought against the South African government, a coalition of Western pharmaceutical companies sought to prevent legislation that would allow badly needed cheap generic drugs available to South African AIDS patients.

At the time the cost of a years supply of branded ARV cocktail was approximately $10,000, in contrast the ingredients required to produce a generic cocktail were only $350. Pharmaceutical companies argued that the removal of patents or any means to circumvent current legislation in relation to generic drugs would only discourage further research and development.

 84% of worldwide research for drug discovery is funded by government and public sources. Pharmaceutical companies fund just 12% of such research.

At the turn of the millennium there were three major changes in the the fight against HIV/AIDS. Firstly, Yusuf Hamied, chairman of Cipla, an Indian generic drug manufacturer, who announced that they would sell a three-part ARV cocktail to government and NGOs, in the developing world for $350 per patient, per year. (5)
This only occurred due to India’s 1972 ban on drug patents and the generosity of Cipla’s chairman – Hamied, who stated in an interview with Dylan Mohan Gray the film director “We’re doing this on a humanitarian basis.”

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 believe that India needed to produce its own medicine in order to become self-reliant.

Secondly, the World Trade Organisation’s (WTO) deceleration that a nation is entitled to priorities public health over international patent and trade agreements. Between the period of 2000 and 2010, spending on HIV programs wants up from $2 billion to $15 billion.

Subsequently, rich countries began to increase the money supply for developing countries combatting the disease. Consequently ARV’s prices spiralled in 2011, with the notable change of drugs that formally cost $10,000 could now be purchased for $62 in some developing countries.

Edwin Cameron “Most people in Western Europe and North America accepted that drug manufacturers are entitled to specify price in the open market, which is a market defined by North American and Western 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 heart of this documentary it essentially questions the cost of these life saving drugs, the policies that inhibit patients from receiving the medication and global collusion at the heart of the profitable pharmaceutical system.

 

The cast for “Fire In The Blood” is a mixture of CEO’s, academics, activists and even some notable omissions from former US president Bill Clinton, which offers a dark and haunting image of the obstacles faced by HIV/ AIDS patients when attempting to attain treatment.

A recent article published on Reuters stated that pharmaceutical companies that produce generic AIDS medicine will be sending millions of pills to Africa, which are predominantly prescribed and used in rich countries.(6) This was subsequently secured after a multi-million dollar guarantee that caps prices at just $75 per patient, per year.

Potential Solutions

Philosopher, Thomas Pogge argues in favour of a Health Impact Fund, which intended to create an incentive system for pharmaceutical companies. This system would encourage pharmaceutical companies willing to produce and sell drugs at cost, who would subsequently be eligible to claim a portion of a reward pool, which is based on the impact of their drugs on global public health. (4)

Ellen’t Hoen founder of Medicines Patent Pool is actively working within the parameters of the current system to encourage pharmaceutical companies to share their patents with generic manufactures in exchange for small royalties. Both initiatives mentioned above are voluntary, so there has not been much of an uptake from major pharmaceutical companies, who are unwilling to share there most profitable patents on the cheap. (4)

 – Research Notes –

Reference 1 -https://www.cdc.gov/hiv/basics/statistics.html

Reference 2 – http://www.globalpolicyjournal.com/blog/03/09/2012/review-fire-blood-dylan-mohan-gray-documentary

Reference 3 – https://hivlawcommission.org/wp-content/uploads/2017/06/SelectedBibliography-IP-TRIPS.pdf

Reference 4 – https://www.carnegiecouncil.org/publications/ethics_onfilm/0011

Reference 5 – https://www.theguardian.com/world/2003/feb/18/aids.sarahboseley13

Reference 6 – https://www.reuters.com/article/us-health-aids-medicines-exclusive/exclusive-africa-to-get-state-of-art-hiv-drugs-for-75-a-year-idUSKCN1BW169

Link to documentary – Watch “Fire in the Blood” on Netflix
https://www.netflix.com/title/70268209?s=i&trkid=13752289

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