On-campus and indeed in the wider world, there are very few events that start with guessing how many condoms are in a jar. Outside the lecture theatre where this one was taking place, though, there was exactly that. While this would be out of place for most talks, in seeing attendants hold the jar up to the light, or shaking it, or just pointing it out to their friend and laughing, one sees that here, it is perfectly fitting, typifying a willingness to tackle taboo subjects with no small measure of humour.
The talk, entitled ‘Should Wealth = Health?’, was organised by the Newcastle branch of Youth Stop AIDS, a UK-based youth-led campaign movement which aims to spark conversation, take creative action and encourage positive action from governments, global institutions and corporations, with the ultimate aim of eliminating aids. The talk brought together three people of completely different backgrounds to discuss their areas of expertise, all relating to AIDS, wealth and – somewhat unsurprisingly – health to create awareness around broken research and development system in the pharmaceutical industry which disenfranchises certain groups from accessing the medicines they need.
First to speak was Carla Home, a member of Youth Stop AIDS’s steering committee and their Glasgow Campaign Group. She explains that by 2030 the group wants to eliminate the disease – whose acronym stands for Acquired Immune Deficiency Syndrome, which is the name given to the late symptoms that are caused by being infected with the Human Immunodeficiency Virus (HIV). A bold aim, it is also one she is confident in, explaining that it is “such a realistic goal” in a later Q&A. She does note, though, that AIDS has become the second highest killer of people aged 10-24, and that, to her mind, is “the worrying factor”, with some people “taking their eye off the ball”.
It is possible that this ignorance starts in our institutions, with Home relating how her school discussed HIV either in history as a problem of the past – and one just for gay men at that – or as a problem that exists now, but only in Africa. “Really, at the end of the day, it’s everyone’s responsibility”, she explains, mentioning that 25% of HIV-positive people are not aware of their condition, barely half (52%) of HIV-positive children have access to treatment, and half of them die before their second birthday. Clearly, this is still an issue that still requires attention and, as with any area of public concern, nuance of thought.
Next to speak was Channan Warmington, a HIV-positive nineteen year old. Warmington was only diagnosed after being taken into care, away from a drug-addicted mother who refused all pre-natal treatment, such that the doctors assisting in the birth had no idea she was HIV-positive (a lesser known way of catching the virus is for a mother to pass it onto her child either during pregnancy or childbirth). She then explains the long history of her treatment: she began with liquid drugs before being moved onto tablets. Currently, there are no optimal HIV drug formulations for children because pharmaceutical companies have no incentive to do the required research and development, as most children born with HIV are in the global south which is not a viable market. This meant that Warmington only had a limited range of treatments available to her. To make matters more complicated, Warmington is allergic to a certain class of drugs: at ten years’ old, her body became resistant to her existing treatment, and at thirteen, her medication stopped working and she contracted AIDS, resulting in a four month hospital spell. Afterwards, doctors tried to put her on medication to which she was previously allergic to see if the allergy had disappeared. “That failed”, she says, laughing. Finally, two years after being given medication usually only given to adult patients, she became ‘undetectable’, meaning so few ‘copies’ of the HIV virus exist in her blood that she cannot pass it on to others. Hers is a story ultimately of triumph, but she has also refused to let it define her. She enthuses about her YouTube channel and the lifestyle publication – Kychan Teen Magazine – which she presides over as CEO. HIV and AIDS is often an issue both politically charged and shrouded in misconception, but Warmington’s talk helped show the more human aspect of living with both. The difficulty she experienced in accessing treatments is something that Youth Stop Aids is currently addressing in their People’s Prescription Campaign.
Finally, there was Dan Howden – an academic from the University of Leeds – who bounces from one side of the lecture theatre to the other and, in his enthusiasm, seems to miss nothing. In noticing the 90s-style fade-ins on the PowerPoint text, he jokes they “make me feel young at least”. In introducing his area of expertise, he’s similarly self-deprecatory, describing it as “miserable economics”, a summation that eventually proved accurate. Howden explains that, while pharmaceutical companies want to make and sell drugs, they also want to maximise profit, in whatever way they can, a motive reinforced by company directors’ legal obligation to advance the interests of their shareholders. This provides incentive to bid up how much healthcare providers are willing to pay for the drugs pharmaceutical firms have developed, which is easy to do when patents help to create a monopoly, giving these firms the “ability to set prices unilaterally” in the market for each drug.
Perhaps keen to demonstrate the lack of moral fibre found in the industry, Howden also cites two instances of criminality by pharmaceutical firms. In 2007, Merck paid $4.85bn to settle lawsuits over suppressed evidence that showed that their branded painkiller Vioxx led to heart attacks and strokes. Merck were also said to be intimidating researchers who were critical of the drug, with one employee going as far as to encourage “destroy[ing] them where they live” in an email. A few years later, in 2012, GlaxoSmithKline were fined $3bn. At the time, this represented the largest settlement between the US Department of Justice and a drug firm in history, and covered a range of transgressions relating to no less than ten drugs. Howden focusses on their attempts to bribe and intimidate physicians, but also relevant to the fine was encouraging those under eighteen use two anti-depressants meant only for adults, an example of ‘off-label marketing’, which is illegal.
Howden goes onto explain that the reason pharmaceutical companies try to set prices so high is to cover costs of Research & Development (R&D), both for the drugs that make it to market and the many more that do not – with only a third of drugs passing Phase II of clinical trials – which dwarf the reproduction costs of drugs. Without patents, Howden argues, companies would be able to reproduce the drug without first having to sink millions into R&D, allowing for lower prices. Pharmaceutical companies furthermore base their prices on how much health systems in the global north like the NHS are willing to pay, and often do not take the fact that public funding goes into R&D into account. This ultimately contributes to global inequality in treatment access - leading to what is known as neglected diseases because big pharmaceutrical companies only produces medicines for diseases of the 'rich'. Howden's talk culminated in him commenting on the need for a reform of the current system with inconclusive remarks on what can be done. He seemed to suggest that rich countries could contribute through their threshold setting practices.
The talk was interesting and varied, reflected by the large crowd, on which more than one speaker commented, and the enthusiasm of the people who made it up. In chatting with the organisers, your correspondent left the lecture theatre some time after the talk had finished, but even when he did, stood outside were most of the attendants, excitably awaiting the results of the condom jar. Youth Stop AIDS was only formed last February – following a similar group closing down over a year ago – and despite its relatively short history, the eagerness and enthusiasm seen in its members inspire a certain hope for its future.