COMMENTATOR (COMM): Previously on Life . . .

MARK MALLOCH BROWN: Globalisation isn't just about capital flows, but about a global ethic.

FRED SAI: I think the power of a community organised to care of its own needs and its own people has not been exploited.

NITIN DESAI: What you're getting now is multinationals which no single government can influence on its own.

EVELYN HERFKYNS: Obviously the moral message has not been enough!

COMM: It's the developing world that has been hardest hit by the AIDS epidemic. 90% of the people infected with HIV live in developing countries, most don't have access to the drugs that could keep them alive. The cost is way beyond their reach. In the West, the cost of drugs that inhibit the AIDS virus, anti-retroviral drugs, has radically changed the outlook. Hospices and hospital wards have closed. HIV remains ultimately fatal. But is now a chronic disease that can be treated. Most anti-retroviral drugs are still under patent to the multinational companies, who make huge profits in the West from them, but for AIDS sufferers in developing countries their costs are a death sentence.

DR ERIC GOEMAERE (Médecins sans Frontières): This is the worst, probably, "epidemic", mankind has ever faced. If we really want to tackle it as we have been able, or we are busy to do in the North, here in the South, we have to make those treatments available.

COMMENTARY: An educational campaign has helped slow the spread of AIDS in Thailand. But they still have one million HIV+ people. Thailand and South Africa are two of the countries that can't afford drugs for their HIV patients. Both are now campaigning for the right to essential drugs at affordable prices. Pramote is 29 and has AIDS, if he'd been able to afford anti-retrovirals he would not be paralysed and bedridden today. But Pramote is one of the luckier ones. With the help of a project, his family is able to care for him at home. A great improvement on the treatment afforded most HIV and AIDS patients. The homecare nurse and doctor visit regularly, giving support to his family and supervising the treatment of the kind of infections that attack HIV and AIDS patients.

Dr TIDO VON SCHOEN-ANGERER (Médecins sans Frontières): There's a lot of things that one can do, you can treat all these opportunistic infections and people can live longer and have a better quality of life.

COMMENTARY: Without this help the family couldn't cope.

PRAMOTE (AIDS patient): I don't want others to be like me. I sometimes suffer but I don't feel hopeless. I worry about my sister and her children: that they learn to be safe.

COMMENTARY: Anti-retroviral drugs are not an option for poor families like Pramote's.

Dr VON SCHOEN-ANGERER: If we had been able to start with anti-retrovirals earlier on he wouldn't be in the situation as he is now.

WILBERT BANNENBERG (WHO South African Drug Action Programme): In 1977 the World Health Organisation realised that the world was not getting a good deal and they made this model essential drug list which is basically an example for countries to actually do it themselves.

COMMENTARY: Essential drugs are defined as those that meet the health needs of the majority of the population. The drugs that are essential for life. It's vital that these be cheap, safe and efficient. Generic versions of most drugs on the World Health Organisation's Essential Drugs List can be produced cheaply, because they're no longer under patent.

Dr VON SCHOEN-ANGERER: Anti-retroviral drugs are essential drugs although they're not on the Essential Drugs List yet, and that's where the problem starts.

COMMENTARY: They're not included, because of high costs. The only anti-retroviral drug on the essential drugs list is AZT, and that only to prevent mother to child transmission of HIV.

WILBERT BANNENBURG: The problem is we don't really know the what the real costs of those anti-retrovirals is. We do know however that in certain countries where at the moment they don't have to abide by those patents that the anti-retroviral drugs can be made much cheaper.

COMMENTARY: Pharmaceutical companies remain reluctant to provide information on the cost of producing specific drugs.

INTERVIEWER: How much does it cost to manufacture these drugs, do you know?

VICKI EHRICH (Glaxo Wellcome - South Africa): Pass.

PHANGISILE MTSHALI (Bristol Myers Squibb, South Africa): I'm sorry again because I may not be able to talk directly to that.

VICKI EHRICH: There is no requirement of any company to divulge their costs, it is not part of the system.

COMMENTARY: In the Southern African region it is estimated that 22 million people are HIV positive. In South Africa alone, 4.2 million are affected by HIV. Last year, more than 100 000 South Africans died of AIDS related diseases. Sister Abigail is a community nurse in Kwa-Zulu Natal, She has a large family of adopted children, who fill every corner of her house.

SISTER ABIGAIL: I've got 14 children, 3 of them are orphans from the AIDS epidemic which is affecting our country, both mother and father are dead.

COMMENTARY: She makes sure that no part of their upbringing is neglected.

CHILDREN: Thanks for food and Thanks for love and hugs, Thank you Lord, Amen.

COMMENTARY: Underberg, the town where Sr Abigail runs the government health clinic serves a large rural population. Patients from outlying areas travel long distances to the clinic. Her community has already been severely affected by the AIDS epidemic

SISTER ABIGAIL: When I take ten bloods six come back being HIV positive, but it's not a full picture because it's not everybody who comes up for testing. The impact of HIV and AIDS has really put a heavy load on me, because it's not only during the working hours that I'm dealing with these problems.

COMMENTARY: She's taken on the responsibility of trying to care for orphan families in the district.

SR ABIGAIL: I've got many families like this, this family is typical of what we see across the country due to this diseases -it's really affected. There are 3 members of the family that died, they were also breadwinners. Two sons and one daughter, in all, the orphans that are here are seven, and they are being looked after by an old lady, who is on pension. It's the old people who look after these young children. And for how long are they going to look after them? Are they going to be able to educate them? To give them they mother love or the father love that they're supposed to get? Nurture them in such a way that they are groomed for the future?

We have lost a high number of teachers, nurses, school children, farm workers even miners, who have come back from Johannesburg, as corpses all, just about to die. But I think it would be much easier if we could get the anti - retroviral drugs, free of charge. Because when I weigh the expenses of looking after orphans with no breadwinner and then getting the drug, I think it's much, getting the drug would make a big difference.

COMMENTARY: Until recently Sr Abigail's small town had no undertakers. Now it has four.

WILBERT BANNENBERG: To treat one patient for a year with anti-retrovirals using the, what we call the triple treatment or the cocktail, 3 drugs which we consider scientifically the best, was costing us more than 70 000 rands per year, or 7 000 pounds. We have 4 million people who are infected, so if we were to treat all 4 million, the South African government would have to fork out 28 billion pounds.

COMMENTARY: 28 billion pounds would be ten times the total cost of South Africa's annual health budget. In 1997 South Africa tried to pass a law which would allow it to produce generic drugs and so have treatments at affordable prices. They relied on compulsory licenses and parallel importing, practices which had been agreed under World Trade Organisation guidelines.

WILBERT BANNENBERG: What happened was that South Africa developed a very good national drugs policy, which said that there should be equitable access to all essential medicines for all South Africans.

COMMENTARY: The pharmaceutical companies condemned this as piracy, they said it would violate patents and so undermine their profits. They intervened directly and sued, South Africa was threatened with trade sanctions. The Trade Related Aspects of Intellectual Property Rights, the TRIPS agreement as it's known, allows member countries of the World Trade Organisation access to cheaper drugs.

CAPTION: TRIPS AGREEMENT Trade Related Aspects of Intellectual Property Rights Article 31: The law of a World Trade Organisation member country can allow for "other use" of the drugs under patent without the authorization of the patent holder if, prior to such use, that country has made efforts to obtain authorisation from the patent-holder on reasonable commercial terms and conditions and that such efforts have not been successful within a reasonable period of time. This requirement may be waived by a member-country in the case of a national emergency; or other circumstances of extreme urgency; or of public, non-commercial use. In the case of medicines, this allows for: 1. "compulsory licensing", whereby countries are allowed to authorise manufacture of generic drugs, paying only a royalty to the patent-holder; and 2. "parallel importing", whereby countries are allowed to import cheaper medicines from other countries.

COMMENTARY: Article 31 of TRIPS says that 'in a national emergency, or in other circumstances of extreme urgency, a member country can use a compulsory license to manufacture generic drugs, and may import medicines more cheaply from other countries.'

Dr SUWIT WILBULPOLPRASERT (Ministry of Public Health, Thailand): Because when you produce drugs without patent, generic drug without patent, you'll be 200 times cheaper.

COMMENTARY: In 1998 Thailand attempted to use the TRIPS agreement to manufacture cheap generic anti-retrovirals, the United States threatened to block Thai exports to America.

Dr VON SCHOEN-ANGERER: The US government is the main 'customer' so to say, for Thailand, a lot of export goes to the United States, so trade sanctions would hurt the Thai economy very seriously.

WILBERT BANNENBERG: It's economically very important for the US to actually protect this big industry that they have, it's a very profitable industry, it produces a lot of taxes.

Dr VON SCHOEN-ANGERER: Of course we're always talking about the US government, we should not forget to say that the European Union is not any better at all.

COMMENTARY: Most major multinationals are satisfied with annual profits of 4 - 5 %, but the pharmaceutical giants regularly record profits of around 22 %, only 1 % of their turnover comes from sales of drugs to Africa. They do make contributions to community based projects in developing countries, they also make large annual donations to the American political parties. Some people suggest this means they exert undue influence on governments.

Dr WILBULPOLPRASET: Not only pharmaceutical industry, all the multinational industry, they are controlling the life of the people in the world. They are controlling the government, they are controlling the international finance organisations, they are controlling banks, everything.

PART TWO

COMMENTARY: Activists around the world have been waging campaigns to try and get access to cheaper drugs, they feel that the prices set by the drugs companies are not justifiable. The Thai activists are campaigning for their government to be allowed to produce a generic version of the drug DDI, marketed as DIVIR in Thailand. Bristol- Myers Squibb keep the price of DDI high, the National Institute of Health, in the US, developed this drug, and handed the marketing rights to them.

PAISAN TAN UD (Network of People Living With AIDS): The DDI campaign, that is the first action we have, I mean demonstration, that is the first time for people with HIV and AIDS to come together and to sit in front of the Ministry of Public Health.

Dr KRISANA KRAISINTU (Thai Government Pharmaceutical Organisation): They got a lot of attention from the Press, and it was good. And especially from international press as well.

TAN UD: That was difficult for us, but we have to do, I mean DDI is so expensive in Thailand.

Dr VON SCHOEN-ANGERER: Bristol - Myers Squibb has said that repeatedly, you know: why do we fight for DDI, it is available. Well yes it's available if you can afford it.

COMMENTARY: Bristol-Myers Squibb were unavailable to provide anyone in Thailand who could comment.

Dr KRAISINTU: Actually I have a problem on doing research on anti-retroviral drugs. So it is very very difficult for me to find the raw materials - I sometimes was blocked by drug manufacturers from getting access to the raw materials.

COMMENTARY: In May 2000, President Clinton issued an executive order stating that the United States would no longer try to block countries using the TRIPS agreement, so as to make cheaper drugs for AIDS treatment more accessible and affordable.

BILL CLINTON, US President: The United States will henceforward implement its health care and trade policies in a manner which ensures that people in the poorest countries won't have to go without medicine they so desperately need. I hope this will help South Africa and many other countries, that we are committed to support in this regard.

WILBERT BANNENBERG: Clinton basically confirmed what the South African government says, has been saying all along. That is that South Africa and all other developing countries have a right to actually use compulsory licensing , because that is agreed to in TRIPS.

COMMENTARY: Some health experts argue that its too complicated for patients in developing countries to use anti-retrovirals. Pharmaceutical companies have given this as a reason for not making the drugs available.

Dr VON SCHOEN-ANGERER: Here in Thailand we live very closely together with people living with HIV and trying to improve access to treatment and care.

COMMENTARY: Ta Na Pohn is 6 years old. He was born HIV positive. When his mother died two years ago he went to live with his grandmother. He receives antiretroviral drugs as part of a home care project. Since he's been on the drugs, his health is good and he will soon start school.

Dr VON SCHOEN-ANGERER: Living conditions here are not easy, but as you can see with this boy it doesn't mean he is not able to take medicines regularly. One of the mistakes also in this discussion is always to talk about, either nobody has the drugs or 100% of people with HIV should have the drugs. I think we have to start somewhere in the middle, because if some of these drugs become cheaper available many of these people will start to be able to afford those drugs. By next year 30% of people who have HIV the drugs, maybe 5 years 100%, I don't know.

COMMENTARY: In South Africa's rural areas access to basic health care is often limited to mobile clinics. Not all developing countries have the infrastructure to administer anti-retrovirals, but health workers in several countries are confidant that they could handle the associated problems.

SISTER ABIGAIL NTLEKO (Community Nurse - Kwazulu Natal): I think that that would be dealt with easily because the people are already are on multi-dose therapy for TB, which they are managing so well. And we can even use the traditional healers, the shop owners, ministers and relatives.

Dr ERIC GOEMAERE (Médecins sans Frontières): This country, South Africa, is used by the pharmaceutical companies to test all the new drugs, so if they can test the new drugs, why wouldn't they be able to administer the old anti-retrovirals?

WILBERT BANNENBERG: The World Health Organisation and UNAIDS have constantly been pressing drug companies to lower the prices and have said the developing countries especially should actually pay less because they can afford less.

COMMENTARY: While we were making this film the pharmaceutical companies actually announced a reduction in the price of anti-retrovirals. But the move was received with caution.

WILBERT BANNENBERG: Even if it was a 75% price reduction, it would still be impossible for the South African government to afford all these anti-retrovirals, even at the lower prices.

Dr J H PRETORIUS (Department of Health, South Africa): The reality of the situation is that from our preliminary calculations, we will not be able to afford it.

COMMENTARY: In Thailand and many other countries, AZT is routinely given to prevent mother to child transmission . It's cost-effective too. Looking after a child born with AIDS for 5 years costs almost 20 times more than the cost of treating the mother with AZT in pregnancy. Treating mothers with AZT isn't yet national policy in South Africa. Although there are pilot projects like this one in Khayelitsha, a large township near Cape Town. The project was started in a government primary health care clinic in partnership with Médecins sans Frontières.

Dr GOEMAERE: The project of Médecins sans Frontières in South Africa is twofold. First, action for treatment of people living with HIV. And the TMTC programme: prevention of transmission from mother to child. So that's one fold. The other is political action, lobby to push the government and pharmaceutical companies to make cheaper drug available in the country for HIV related diseases.

COMMENTARY: In this community it's estimated nearly one in four people is HIV positive. Developing countries know that drugs are only part of the answer to the AIDS epidemic. Education and changes in behaviour are essential to prevent the spread of the disease.

BENJAMIN MTWANA (Khayelitsha Clinic Nurse): I think they really want education about HIV and AIDS, that's where we can conquer it.

COMMENTARY: Nomfundo Dubula is one of the women in the Khayelitsha project, she learnt she was HIV positive when she took a voluntary ante-natal test

NOMFUNDO DUBULA: It was very difficult for me, for first two days or more. But I just accepted that I was positive and then nothing happened. Like I just, I was normal as before.

Dr GOEMAERE: The great news is that people here accept to go for testing. 75% accepted the test, when a test for them is something terrible. And to those mothers we tell: afterwards we will not drop you, we will give you a bit of follow up, treat you for the opportunistic infection and hopefully, at the end of the day, treat you with anti-retrovirals.

DUBULA: I was pleased, very much pleased, because since I was counselled, and told that my child could be negative if I used the AZT, I preferred to because I wanted the child.

Dr GOEMAERE: This country produces 65 000 new born HIV positive per year, each year. So at least let's start with preventing the transmission from positive mother to their child. Because, if you don't do anything the transmission rate is about 30%, if you do something, the transmission rate for the moment, with AZT, can be dropped to about 10%. And we have to make it like they managed to do in Uganda, where to be positive becomes more or less something normal, acceptable I would say. Bringing hope helps the people to enter into, with, the reality of AIDS.

COMMENTARY: Drugs are not the only solution to the AIDS epidemic, but having them prolongs life and makes people more aware of the disease, and so more open to education.

Dr KRAISINTU: Everybody is human being, so everybody should have access to the drug, wherever they are, whatever stage they are. So I feel this is not right to say that for poor people or for people who are illiterate cannot get access to the drug, that's not that's not right.

Sr ABIGAIL: If you give somebody hope, they live day by day, for a day.

COMMENTARY: With affordable drugs, people with HIV and Aids could remain healthy and live longer, more productive lives. Anti-retrovirals are essential drugs. By reducing their profit margins and allowing poorer countries to manufacture generic versions of them, pharmaceutical companies could make a real contribution to containing this devastating epidemic.

END