On Wednesday evening, the O’Neill Institute and Doctors Without Borders hosted a film screening of Fire in the Blood, followed by a panel discussion. This post provides a recap of the main themes of the film. A video recording of the panel discussion that followed is available at the end of the post.
Director Dylan Gray’s film dramatically portrays the gross inequities in access to medicines that existed in the early days of the AIDS pandemic. When the disease first emerged, there were no effective treatments—the disease was a death sentence for nearly everyone infected, with only palliative care available. With the approval of Zidovudine (AZT) in the late 1980’s, effective treatment was finally possible. HIV-positive people given this antiretroviral treatment could extend their lives by many years—and more such drugs soon emerged to extend healthy life even longer. However, with the pandemic concentrated in the developing world, treatment was far beyond the reach of the vast majority of people living with AIDS. A year’s supply of AZT, for instance, cost around $15,000 – a huge burden even for a middle-class person in a developed country. For the vast number of patients living on less than a dollar or two a day, it might as well have cost $1 million.
The film offers a searing indictment of the greed of pharmaceutical companies during that period. The unit cost of producing a drug was far less than the price companies charged (the film shows a generics manufacturer, Cipla, offering to manufacture a combination of three such drugs at less than $1 per day). Moreover, virtually no one in these countries would have been able to afford the drugs at full price, meaning that the companies would have lost little by offering the drugs at cost, or by simply allowing generics manufacturers to produce the drug for use in developing countries. Instead, worried about profit margins in the developed world and concerned over a (dubious) slippery slope of eroding IP protections, pharmaceutical companies dug in at the cost of at least 10 million lives. Governments, in particular that of the United States, were complicit. For instance, the U.S., acting at the behest of Big Pharma, threatened a variety of sanctions against countries who did not strictly uphold U.S. patents on AIDS drugs.
While the film offers a scathing rebuke of Big Pharma and Western governments, it also sounds a hopeful note about the power of public health activists and civil society organizations to effect change. Despite the enormous economic and political power stacked against them, activists were able, through persistence and self-sacrifice, to force companies to provide drugs at low cost, or to allow generics to manufacture them. Their campaigns also provided the catalyst for large-scale aid programs, such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The fight, however, is far from over. The film notes a trend toward greater IP protections, often at the expense of health. The World Trade Organization TRIPS Agreement, which constrains the ability of countries to tweak IP protections to protect health, increasingly is being supplemented by even stricter IP requirements in so-called “TRIPS-Plus” Agreements, which set minimum floors, often at levels far higher than the TRIPS Agreement requires. The panel discussion, below, provides further discussion of these continuing challenges to access to medicines.
The film offers an excellent record of the clash between public health and commercial interests. It also serves as a sobering reminder that the fight for affordable medicines is far from over, with new fronts constantly emerging. But perhaps most importantly, the film shows the power of individuals and civil society organizations to successfully fight the most powerful companies and governments in the world. In the end, Fire in the Blood should convince public health activists that no matter how high the obstacles or entrenched the power structure, there is always hope for change.
The following remarks and panel discussion, feature: • Congressman Jim McDermott (Democrat- WA-07) • Rohit Malpani, Policy Director, Doctors Without Borders/Médecins Sans Frontières (MSF) • James Love, Director, Knowledge Ecology International (KEI) • Dylan Mohan Gray, Director of Fire in the Blood • Moderator Jason Beaubien, NPR Global Health and Development Correspondent
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.