[Music] it was just kind of a crisis of humanity people just weren't really uh 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 and 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 torrented the loss of millions of their citizens while life-saving drugs we available [Music] 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 research [Music] i saw so many people who would have lived i saw them die pain-free excruciatingly and yet their death was not inevitable [Music] i had a small board with 10 beds [Music] and 100 of the patients inward was hiv positive and every day i saw people dying eight 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 a patient that you have this disease and we doesn't have nothing to help you look you are hiv positive and that's all bye you know [Music] [Applause] i was diagnosed with hiv in at the end of 1986 but i felt 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 [Music] in 1996 everything changed for people like justice cameron when a combination of three antiretroviral drugs or arvs proved successful in fighting hiv suddenly the most feared and destructive disease of the age was no longer a death sentence [Music] 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 joyful life returned and it was the most astonishing experience of my life the drugs he was taking were sold internationally at prices over fifteen thousand 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 specify 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 [Music] die [Music] um [Music] [Music] 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 because they're toxic and you refer to 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 the only reason we are dying is because we are poor [Music] the problem zacky 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 [Music] in 2000 one of my cousins farida abrams died of age-related illnesses and she couldn't afford antiretrovirals and in fact we'd smuggled a genetic fluconazole into the country for her which gave her an extra six months of life in which you could die a dignified death instead of a really horrible cruel death but she died because she did she couldn't afford antiretrovirals and that was a close family member the only way zaki 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 [Music] fluconazole in thailand cost less than five u.s cents per capsule and in south africa they were paying what 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 offense we don't have the intention of breaking the law what we will be doing is breaking fighters patents we will be showing the kaiser and other companies are abusing their patent we have no criminal intention our only intention is to defend people's lives [Music] away [Music] i work for a paper called the new vision i am the first journalist in east africa who declared my hiv status publicly i was almost pronounced dead i was in a coma for many days i was reduced into a skeleton the rit was very expensive and those who go for over a million insurance 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'm talking about brothers and sisters [Music] my mother couldn't bear seeing one two three four five six seven all her children perishing she was imagining she was gonna lose her eighth child she had a lost hope hope was at a premium on the other side of the atlantic as well [Music] 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 even faced hostility from some unexpected quarters a lot of american aids activists were opposed to this they didn't really care they felt felt like they had drugs if they had cheap drugs in africa they thought it might discourage r d for them that insurance you know they didn't see the pricing problem [Music] 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 they wouldn't be compliant in terms of treatment they'd uh they'd develop resistance resistance would come back and kill americans or kill kill europeans they are mostly illiterate can't read the information on the leaflets in their drugs packets and have to cope without a healthcare system that can tell them about the disease they have [Music] the biggest problem for antiretrovirals this this sounds small and and some people if you've traveled 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 [Music] uh 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 [Applause] over two million people who are reported have died in that year alone so people are 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 protesters 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 i've never seen that kind of anger which was directed at pharmaceutical [Applause] [Music] companies [Music] [Applause] in the heightened and expectant atmosphere high court justice edwin cameron took the stage please take your seat the court is in session i'm here because i'm 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 10 or 20 or 30 million africans to die unnecessarily from a disease that can be medically treated that was the turning point that durbin represented lots of people they were dying because they needed their arvs [Applause] those who didn't die they must thank god by that time there were no people who are saying that i'm hiv positive no one's saying hiv or aids you they will say lando they won't say the word you know [Music] i got married in 95 i don't like him but everybody forced me to get married and after 45 days and i came to know my status [Music] i got the result and i read and only that is eights so like i know aids means death and i know aids means immoral people will get i am not immoral like how i got the virus to my my body during that time i came to know my husband knows in the status before my marriage seven months later he died [Music] in this country people think that they are all let's say 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 little touched roof on the side of the road because no hospital wanted to admit them we're fighting desperately to try to uh convince pete and holder the the the main pharmaceutical company glaxosmith's client finds a boring language and we said listen none of our clients here are using new drugs and we'll probably ever be able to use utrecht can you please allow us to uh import generic tricks and uh the answer to us very quickly and the answer of course was no [Music] 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 [Music] and aids is happening in the developing world 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 u.s government and the industry work hand in hand aid from the u.s is rarely given without strength 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're pulling the strings [Music] it had taken nearly 40 years for the united states government to put apartheid south africa on a sanctions watch list but it took less than three years to put democratic south african trying to make medicines affordable to its people onto a sanctions watch list at the behest of drug companies [Music] donald mcneil covers global health for the new york times the actual price of the pill has nothing to do with what it cost to manufacture the pillow 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 25 appeal 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 when you will maximize revenues that means you're going to lose some patience 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 [Music] when the doctor tell me this i was hiv positive now i cried and i cried and i cried for an hour firstly she was diagnosed with the meningitis and then pneumonia everyone was very scared to touch her that's when i started to get angry and i just told myself okay why am i keeping quiet of this [Music] as the symptoms of his own hiv infection worsened and his health deteriorated zaki ahmad 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 gonna have it having made up his mind zaki ahmad 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 was at one point was saying please take the drugs when he phoned up and said i'm 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 fatal for me to come to him to say i want you now to change 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 work for the national security council i talked to the world bank talked to unaids i talked to the world health organization the office of aids for the united states government and i kept asking the same question i said if if you didn't have to worry about paths what would it cost to create a treatment for aids for people in developing countries and i used to tell people look at if there was the 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 um you know it wouldn't just be kind of a you know the unasked question it would be the most important question you could possibly imagine and i was just shocked at the lack of information [Music] the man who got love his answer was former journalist adviser 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 are not going to get the and i called up agnes was a friend and a big importer of raw materials and she said call dr hamid he's an iconoclast he's not afraid of multinationals he's the one you need to talk to yusuf hameed was a cambridge educated indian chemist who ran a company called sipla based in mumbai which his father had founded in 1935. [Music] sipla had begun making generic antiretrovirals in the early 1990s at the request of the indian government and within 20 minutes i knew he was the person i had to see in august 2000 haddad and love met dr hameed in london along with a hand-picked group including denny brune a leading french expert on aids in [Music] and it africa supposed to be a very secret meeting i was in who at the time i remember taking leave going in hiding to london i asked dr mead i said look at what we're trying to figure out is uh you know rock bottom prices what would it cost to get 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 hamid 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 the ride for a lot of us it was a kind of a 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 hameed's father was a devotee of mahatma gandhi who had studied pharmacy in berlin at gandhi's urging and later established zipla in line with his mentor's firm belief that india needed to produce its own medicine in order to become self-reliant we learned a very important lesson from mahatma gandhi and that was that every country has to decide for themselves their own destiny [Music] yusuf hamid 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 will be free of patents and there will be no profit hearing from life or death until 1970 india had some of the highest drug prices in the world and india average life expectancy was for a man was in his 40s 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 the society [Music] the reason we set up the system we have today from a drug industry's perspective is to maximize 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 a free market is made up [Music] 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 favor exclusive rights to this invention for a period of 20 years the patent laws are not international they are national laws and need based for the country each country's needs are reflected in the patent laws that they make [Music] you know the paying system it has been perverted a great deal especially in the last quarter century [Music] we make them because we believe 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 act should not be used on its own is useless should not be used it should be used in combination with lamivudine that patent runs out in 2017 that means directly and indirectly is a tea the first anti-retroviral drug invented in 63 has been covered under monopoly for 54 years is that what patenting is all about in september 2000 hameed 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 simply was sitting between merck and glaxo first time they ever put a generic company there and everybody made their traditional speech and all of a sudden doc damir 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 800 per patient for a year apart from us 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-age cocktail at 800 two we would give the know how to produce anti-age 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 freight 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 you know taking their breath in though hamid's offer sent shockwaves through the political and pharmaceutical establishments no one took him up on it nobody took her seriously and i was absolutely disillusioned [Music] [Music] foreign [Music] foreign foreign foreign [Music] no industry has made more profit over the past several decades than brand name pharmaceuticals [Music] at the time of hamid's offer in brussels the 10 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 [Music] 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 amount of that money is spent on dividends to shareholders vast amounts of money are spent to entertaining doctors and on huge salaries to the uh to the to the heads of the companies and it's all coming off the backs of the people who buy these drugs [Music] they sell the drugs they don't 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 [Music] 84 percent of worldwide research for drug discovery is funded by government and public sources pharmaceutical companies fund just 12 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 public funded research should be free for the public but while the drug companies and politicians paid little attention to hamid 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 hameed and the reason it's important i think is because up until then whenever you talk 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 always nobody would say but they always have the impression these are pirate drugs these are 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 realized 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 and legends saying you know if you allow this drug law to pass it will it will allow counterfeit drugs into the countries that'll kill our children [Music] as the year 2001 began the architects of the offer made in brussels were confounded as dwight had found no takers or even vocal support within the global aids community [Music] sensing they would only have one more chance james love called up yusuf hameed i said look at i need a very dramatic price for us to really take the 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 hameed 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 that i'll tell you never being at 65 cents a day and three tc at 35 cents a day and i'll throw in d4t for free because it's so cheap to make so that'll be a dollar a dollar a day [Music] that was a watershed event suddenly the price went from fifteen thousand dollars a year down to three hundred and dollars a year and that was just the damn breaking donald mcneil put it on the front page of the new york times in 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 that 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 simply didn't take that step and that is what we must acknowledge of announcing a 350 a year regimen we would not have had medicine in the way that we do [Music] you know if it was the lives of white people at stake [Music] 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 cost 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 work for this little ngo what was really going on is the who didn't want to know what it cost to make an aids cocktail unh 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 uh 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 a it was just a completely morally repugnant situation [Music] [Music] okay [Music] 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 who were able to get onto antiretrovirals yet so many people had to succumb [Music] 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 decide 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 good job after hearing all that i mean is it okay with him [Music] [Music] appalled by the relentless carnage peter mujeni director of the continent's largest aids research and treatment center decided to take matters into his own hands how many patients do you have i wrote simpler in india and said would you please supply us with anthropovaro drugs i knew where drugs were and as a doctor it was my job to try and save my patients lives [Music] 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 mujini 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 save lives something had happened in the united states a few months earlier which gave dr mujeni a reason for hope 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 u.s government had cited a public health emergency as valid legal cause for suspending the patent on an essential drug called cipro [Music] 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 [Music] but a very different set of rules seem 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 it says you're violating the wto back at antebe with peter mujini 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 [Music] 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 [Music] unprecedented so 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 was the political consequences if americans saw that they had to pay ten thousand dollars for a year's treatment and somebody in another country was paying 150 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 u.s government the u.s representative said that if they bought generic drugs with that money the us would pull out its commitment [Music] 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 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 get 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 asked the congress to commit 15 billion over the next five years to turn the tide against aids in the most afflicted nations of africa and the caribbean peter mujeni had been consulted on the plan i was right there seated next 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 anti-retroviral drugs can extend life for many years and the cost of those drugs has dropped from twelve thousand dollars a year to under three 300 a year seldom has history offered a greater opportunity to do so much for so many they mentioned the generic price i mean everyone paid attention to it because they thought that was really a signal bush appeared to be endorsing the same generic arvs which the u.s 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 eight shrugs 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 they could buy from indian suppliers [Music] uncharacteristically the white house had not consulted the powerful u.s 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 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 could be saved by the program [Music] 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 [Music] in 2003 the clinton foundation began consolidating drug orders from numerous governments and aid organizations 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 could buy generics and 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 the world 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 one hundred dollars per year [Music] so what's your message to the developed countries who refuse to give low-cost drugs to five days [Music] we could be treating three four times as many people without any increase in funds maybe even more so [Music] 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 of money 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 start antiretrovirals i'm not lying you they survived you are expecting them to die but they disappoint you when she was a year elisa started the arvs [Music] she started changing beat by beat step by step now she can talk very very loud she's walking she's a child like she's a normal child like the other children was very nervous very very nervous but the only side effect i experienced was the fact that i started scrubbing floors nothing else i could concentrate i could read i could work and i changed it everything changed zakiy ahmad 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 [Music] [Music] [Music] the medicine is giving in the new life to me doctor told me that i can leave only for two years or something like that and after that i will die till now i am leaving so i'm not dying [Music] people continue five years out to take you know almost 100 to their doses and remain virally suppressed on the same regimen it's extraordinary the so often 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's because they were actually better than in the western world which was unbelievable [Music] 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 had the aivs [Applause] [Music] foreign [Music] number eight [Music] [Music] is [Music] 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 mobilized 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 [Music] the protocol they use 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 interest of the advanced industrial countries for the pharmaceutical industry but do not reflect the interest of those in developing countries [Music] 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 it 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 warnings for thousands of people in the developing countries that's not what 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 was the indian system [Music] the drug companies might have lost a battle over aids drugs but with trips they won the war [Music] 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 [Music] so for the next generation of drugs needed drugs which people desperately lead 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 [Music] 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 okay we'll let our citizens die so you can keep your patent monopolies and your prices up seems to be immoral [Music] 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 [Music] 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 trip's 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 [Music] 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 now they're just africans let them die 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 who could continue providing health care at the levels and costs that exist because of drug company and health technology company profiteering so the problem's not going to go away there's general motors running bankrupt because they can't afford their health care 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 8 000 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 10 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 [Music] 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 of course it's under a hundred dollars a year now so there we are it's and i i i tell you the truth i have dreams about [Music] kind of for a minute all those people who had 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 mobilized 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 [Music] 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 [Music] 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 trip 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 [Music] 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 [Music] clearly once you have a system that appeared to work first but then all of a sudden excludes millions of people in the u.s 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 and tweak something here and then you get into the trouble is why would anybody who is benefiting from this system want to change or tweak it none of the people who make money off of it none of the people who drive power off 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 [Music] [Music] um [Music] um [Music] um [Music] [Music] um [Music] um [Music] um