Pharmageddon Chapter 5

Durban South Africa 08:00 Monday 3 January T+29hrs

King Edward VIII Hospital in Durban is a huge, sprawling campus of buildings built over three quarters of a century, ranging from the original four-storey red-brick edifice, to rows of prefabricated wooden wards erected just a few years ago to cope with the growing tidal wave of humanity that arrive every day looking for help.

KEH is the largest hospital in the biggest city in South Africa’s most populous province – which also happens to be the province with the highest HIV prevalence in the country with the world’s biggest AIDS epidemic. In other words, this hospital is ground zero for the global AIDS epidemic.

When the rate of HIV infections exploded in the 1990s, KEH – like everyone else – was caught napping. Suddenly most of the medical cases they saw were manifesting one or another of the symptoms associated with AIDS, leading the hospital’s head of medicine to tell a gathering of Rotarians that ‘we used to see the occasional case of AIDS – now we don’t see anything else.’ His audience knew that this was hyperbole, because KEH was already infamous as a referral center for stabbings and gunshot wounds which, during the same period, escalated almost as fast as HIV infections, but far more visibly.

The nineties were a time of great instability in this part of South Africa, as opposing political factions made their feelings known to each other in the most brutal way. Researchers later came to believe that, while government focused on establishing a new political order they fatally neglected the business of public health. Indeed, some researchers speculated that returning political exiles unknowingly imported the virus from Zambia, Tanzania and other countries that had been their homes during the closing years of apartheid. With political salvation they brought with them the seeds of destruction.

As political killings diminished around the turn of the century they were replaced by the casualties of crime, as the have-nots finally gave up waiting for the politicians to hand over the keys to a new house and a BMW and decided instead to help themselves. And while the carnage of crime filled the emergency rooms, AIDS filled the medical wards and unleashed a torrent of people who wanted to find out if they, too, had the virus. During the first decade of the new century the number of people coming forward for HIV testing and treatment doubled, redoubled and doubled again.

This Monday morning was no exception.

The voluntary counseling and testing center – the point of first contact between the hospital and people who suspected they were infected – had the usual long queues, although today there were more young men than women, a reversal of the usual situation.

While the news of the destruction of ARV plants in India the previous day was the subject of much discussion in the nurses’ station, nobody had told them to do anything different so they opened the doors of the VCT center as usual, about 20 minutes after the official opening time of 8am.

Without a word a group of young men rose from the queue and barged into the center, producing hand-guns and knives and shouting at the nurses to get down on the floor, like a bad movie of a bank robbery. From the cacophony of yelling the nurses were able to make out a common thread: ‘Give us the ARVs!’

Nurses in South Africa are a formidable bunch. Often the most qualified, and frequently the best-paid members of their extended families, at home they are expected to behave with deference to all the men of the household, but at work they are unquestionably In Charge.

The senior nurse pushed through her colleagues, raising her voice even higher than the wired youths. ‘Be quiet!’ she yelled, and for an instant they were. ‘There are no ARVs here! We do not treat people here – we test them! If you want to be tested, get in the queue like everybody else!’

The other nurses squealed with joy at the sister’s brave words, but their joy turned to screams of terror as the young men resumed their yelling and began trashing furniture and equipment. After a few seconds of mayhem one of the thugs fired a shot into the ceiling, and the others quietened. The shooter approached the senior nurse.

‘Sister, where are the ARVs?’ he said in a stage whisper.

‘They are not here...’ she began. In a flash he held the gun to her head. Her courage deserted her and she turned pale. The line between threats and murder is easily breached in South Africa.

‘Ayee – I can tell you – we send everyone who tests positive to the HIV clinic in Block E,’ she pointed to her right. ‘They test them there for CD4, to see if they need ARVs, and if they qualify they collect their medications from the pharmacy.’

‘Ja, so where is this pharmacy?’

‘It is there – in the main building, next to casualty.’

The youth turned to his colleagues. ‘Let’s go,’ he commanded. ‘But get their phones.’ Immediately the gang collected mobile phones from each of the nurses. One was hit when she said she did not have a phone – an unlikely occurrence in South Africa – and finally produced a small Samsung.

The gang rushed for the door and across the courtyard to the main building – all subterfuge abandoned, guns drawn and yelling as they ran into the casualty reception area, and straight into the arms of a large group of policemen who, alerted by the noise, were waiting with their own guns drawn.

A great deal of screaming ensued as patients in the packed waiting room stampeded towards the exits until a huge voice rose above the din. ‘Everyone... stand still!’ And they did – patients, the youths and the policemen. For a moment the scene looked like a still photograph.

‘Put down your guns or you will all die this morning,’ said the same voice, from a police officer clearly in charge of the others. ‘Now!’ he bellowed, and the thugs complied, schooled in the choreography of defeat by Hollywood.

‘But... we want ARVs,’ said the gang leader, as though this explained everything.

‘Well, you’re in luck,’ said the officer. ‘It is the policy of the prison service to give ARVs to prisoners. Oh, no, what am I thinking? There are no ARVs anymore. Well, at least you will get three meals a day until you die.’ Then, turning to his colleagues, ‘On second thoughts, men, collect their weapons and let them go – we have more important things to do. Sergeant Sithole, go into the pharmacy and collect the ARVs. Ngomezulu – bring round the vehicle.’

‘Yes sir!’ the men echoed.

A keening sound emerged from the press of patients, a wail from an emaciated young woman with a baby tied to her back with a blanket. ‘But, sir, what about us. We are here for ARVs...’

The officer turned to her. ‘Sorry my sister. Come back tomorrow,’ he said in the universal language of dismissal. ‘Maybe you will be lucky.’

Through the hatchway to the pharmacy came a sudden cry and the sound of something hard meeting flesh and bone. A moment later the sergeant returned to the group. ‘Sir, they only have a very small amount of ARVs here – the pharmacist says they draw their stocks from the government dispensary in Sydney road.’

‘Are you sure, sergeant?’

‘Yes sir. He knows we will come back.’ 

‘Right. Take what they have and let’s go.’

The government dispensary is only a five-minute drive from the hospital. The building is the distribution point for drugs and medical supplies to every government hospital in the district. Many of the drugs would be worth a considerable sum on the street, so the installation is as secure as any prison or bank vault, with electrified fences and armed guards.

However, when the police director’s black Mercedes and the police bus arrived they had no difficulty persuading the private security guards to let them in, or the frightened officials inside to stand back while they took away cartons of antiretrovirals ‘for safekeeping’.

When chief storeman Vincent Veersamy asked for a receipt he was told one would be forwarded to him. Like everyone else he was aware of the sabotage of ARV plants in India, but he was in no position to argue with a senior police officer and 20 men.

What Veersamy could do, however, was to sell his story to The World Online. This story should be worth plenty of stringettes, maybe enough to buy one of the latest generation iPhones – the one with a high-res video camera, which was perfect for surreptitious recording of news-clips for TWO.

As he clicked the send-button on his desk-top computer, Veerasamy was unaware that one of the nurses at KEH was doing the same thing on her cellphone, which she’d recovered from one of the disarmed and embarrassed thugs, or that one of the police constables would follow suit in the next half hour, as soon as he’d finished unloading cartons of ARVs at the police director’s home. And none of them knew that hundreds of similar stories were being posted from hospitals and government dispensaries around South Africa, and in many other third-world countries.

Johannesburg South Africa 10:00 Monday 3 January T+31hrs

Oh jeee-zus! I hadn’t set an alarm, or asked for a wake up call. The heavy drapes kept the room dark, the double glazing shut out the drone of traffic, and I’d slept through till ten.

Well, shit, so what? Then I realized that I hadn’t brushed my teeth before I crawled into bed. God, I must honk like a sailor on shore leave! I staggered through to the bathroom to reduce my yuk factor, only to find I didn’t have a toothbrush. The Michelangelo sent up a free Oral B, closely followed by a groaning and incredibly expensive breakfast trolley. My own fault for asking for a ‘bit of everything’.

Suitably reborn I skyped Em. She looked and sounded bright and happy. Kenan the barbarian, as we had nicknamed her ripped but soft-spoken nurse-aide, had just finished getting her dressed and ready for the day, so we minutely compared the details of our ablutions, clothes and breakfast. As usual we each decided we’d prefer to be in the other’s... well, maybe not shoes, considering Emily had no use for them.

Listening to her easy laughter and seeing her sitting in the day-room in Fenerbahçe, with its wonderful views over the marina to the west and the Princess Islands to the south, I felt... full. I’ll never forget when I first pushed her buggy into that room and told her to open her eyes. For a time she didn’t say anything, but when the silence grew I walked around to face her – and found her face soaked with tears. It took me a moment to realize they were happy tears. And another moment to understand that she didn’t need to say any more. Or couldn’t.

She’d arrived ghostly and exhausted the previous night but now, after a good sleep and a bit of a cry, she was reborn, and her face was a picture as she steered her buggy across the room and out onto the deck, soaking up the view and the unfamiliar sounds and scents.

When Emily insisted she wanted to relocate from the Cotswolds to Istanbul I’d found this villa with no stairs and four bedrooms so her friends could come and hang out for as long as they wanted. Using the internet Em recruited Kenan, as well as a general factotum (she said butler was too elitist!), a cook and night nurse, using her laptop and her growing mastery of Turkish.

All of our staff spoke perfect English, fortunately for me. Em had an incredible capacity for languages, even if her willful tongue could no longer shape them, while I struggle in anything other than Strine and its various dialects. Weird that I make a living from words, but there you are.

Em’s first day in Fenerbahçe ended with Jim’s arrival, clutching a chilled bottle of Veuve Cliquot. He had known her much longer than he’d known me, and they were as close as a brother and sister. Maybe closer.

‘Jim, I owe you,’ she said, when she thought I was out of earshot. Jim was also used to the way she spoke, since her multiple sclerosis had lurched southwards, and they chatted on the phone several times a week. He could have emailed her but he preferred to talk, even though verbal communication was a slow business for her, and Jim’s life redefined the meaning of busy.

‘Emily, you owe me nothing,’ he said, understanding her perfectly. ‘Gip deserves everything she’s got. Except maybe you. Nobody should be that lucky.’

They sat smiling at each other, their eyes bright with tears. Not joy or sadness, just... understanding. I was bawling my eyes out in the study, but I made sure neither of them saw. I guess we all knew this would be Emily’s last home. But we also knew she would be in beautiful surroundings, and among people who loved her, until the end.

Pretoria South Africa 12:00 Monday 3 January T+33hrs

Miu Andersson turned out to be in her late forties, about five-five, square figure, short gingery hair streaked with grey, bright blue eyes and a sprinkling of freckles across her nose and cheeks.

She took me on ‘the scenic route’ through UNICEF’s open-plan offices, stopping to introduce me to several colleagues before we arrived at the top-floor cafeteria. The glass walls of the modern building gave an impressive view over the capital city of Tshwane – which everyone still called Pretoria – and the seat of government, the Union Buildings, not far away. Above us a glass roof showed pillars of cloud building up to one of the impressive electrical storms which add spice to many summer afternoons in this part of the world.

‘It’s quiet here – at least until lunch starts in half an hour,’ she explained, then she hooked a thumb at the ceiling. ‘Unless it starts to hail. Coffee? How about iced tea? They make a good one here.’ As we shared a pitcher of iced honey-bush tea I confirmed that Miu was the link between the UN’s central drug-purchasing service and the ministries of health in the five countries of southern Africa. Even though her area of specialization was children’s rights.

‘How did you get from children’s rights to AIDS drugs?’ Always ask – you never know what you’ll find.

She smiled. ‘It’s not a big jump, really. So many children’s rights are threatened by AIDS, mainly because the people who are supposed to look after their rights are getting sick and dying from AIDS...’

‘So you have to persuade the governments to keep those adults alive – for the children’s sake?’

‘That’s right. Well, to be precise, we keep reminding them that they are duty bound to do it, because they are all signatories to the Convention on the Rights of the Child. And it’s not just a matter of keeping them alive. As you know AIDS doesn’t kill parents right away – first they get sick, then they discover they have AIDS, which brings...’

‘An avalanche of shit?’

Miu laughed, showing a perfect set of white teeth. ‘Exactly! They’re stigmatized, can’t get work, can’t afford medical care, have to borrow money, sell everything, take the kids out of school, swallow weird herbs.’

I nodded. I’d written plenty of stories on the collapse of families and communities as their productive members were mowed down by the virus. ‘So how is it going?’

‘Well, we were just beginning to believe that universal access was achievable in South Africa...’ She broke off, pursed her lips and shook her head. ‘It really is too bad. This is the wealthiest country in Africa, yet it took so much... so long... to persuade them to make ARVs available to everyone. And now... this!’

On an impulse I reached over and put my hand on hers. She put her other hand on top of mine, patted it and gave me a grateful look.

‘But is it really that bad, Miu? Surely if the supply of ARVs can be restored in a few weeks, this’ll all blow over?’

She shook her head impatiently. ‘I’m not sure we have weeks.’ 

‘What do you mean?’

‘The police are stripping hospital and government dispensaries. Your own site has a list of them. Treatment has stopped completely...’

‘Yeah, but surely they can be re-supplied? The pharmaceutical companies must have ARVs ready for distribution, and ingredients to keep making them for a while...?’

‘I don’t think it’s that simple. If you put the ARVs back into government pharmacies they’ll just vanish again. And it’s not only ARVs...’

‘What do you mean?’

‘The police are taking every kind of drug they can find. Right now government doctors can’t treat anything – pneumonia, TB, diarrhea, fever, pain. They are writing prescriptions to private pharmacies but I’m sure you’ve heard they’ve also closed their doors until government assures them they will be protected...’

I saw her think twice about what she was going to say next. ‘What is it?’ She just shook her head and took a sip of iced tea. I knew the signs. ‘You want to go off the record?’

Miu looked relieved. ‘You’ll have to get this elsewhere, Gipsy. We can’t afford to lose our credibility with the government. I... saw a memo this morning from the chief of police to the private pharmacies, saying the only way he can guarantee their safety is if they hand over all their ARVs. Voluntarily.’

‘Are you kidding me? Did he say why? Or what they would do with them?’

She shrugged. ‘He’s not denying they’ve taken all the drugs from hospitals, but he’s saying his men are holding them for safekeeping. The implication is that they’ll be returned in due course, but he didn’t say so directly. And of course they’ve not given the hospitals any paperwork – no court orders or government instructions, no receipts.’

I’d seen the analysis that Zvonimira was putting together at TWO as new reports came in – a table showing every incident of ARV looting around the world. Hundreds of raids had been reported across Africa this morning alone. A few were said to be the work of gangsters or insurgents of some kind, but far more were attributed to the police and army.

Miu continued. ‘I heard the pharmacists are planning to do what the commissioner is demanding. Better to be without ARVs than closed down altogether.’

I had an overwhelming sense of unreality. It was simply bizarre that a government could tolerate the looting and effective closure of their hospitals and pharmacies. Maybe I was being affected by the black storm clouds which I could see through the skylight above us, muttering and flickering. Miu stared back at me with a ‘what can I say?’ expression.

‘So, getting back to the government hospitals...?’ I prompted, hoping she would understand this also meant ‘getting back on the record’.

‘Yes. I’d think it will take them a week or two to restock their pharmacies with everything except ARVs. Hopefully the private pharmacies will share their stocks of antibiotics and other meds in the meanwhile. Or we’re going to see a lot of avoidable deaths.’

‘And what’s going to happen to AIDS patients?’

‘Well, you know the medical prognosis better than I do, Gipsy. I’m more concerned at what this will do to health care generally. A lot of doctors are saying there’s no point coming to work if they have no drugs. And patients will stay away, too. The question is whether they’ll ever come back.’

‘Who – the doctors or the patients?’

‘Both. Everyone here knows that most illness is AIDS related. Without ARVs the number of people falling ill from opportunistic infections will increase very quickly, and they’ll be difficult to treat. And, well, Africans are strange that way – if they don’t think they can be cured, they just give up and wait to die. Some think it’s a curse, or judgment day.’

This business about waiting to die sounded a bit far fetched, but I had to respect the UNICEF officer’s experience and obvious sincerity. Maybe try a different tack.

‘Listen Miu, I know South Africa has hosted a lot of medical trials relating to AIDS. I’ve reviewed as many studies as I can find, but I can’t see anything on large-scale treatment interruptions. Do you know of any data?’

She nodded, then shook her head. ‘Not primary research, no, but we’ve been funding a meta-analysis of structured treatment interruptions. They were all small-scale, but there’ve been quite a few of them in the last decade. The report isn’t finished but this morning I spoke to the guy who’s doing it. He says it’s impossible to predict with any accuracy what’ll happen when hundreds of thousands of people stop taking the drugs at the same time.’

‘Why would it be any different to what happens in smaller groups?’ I had a pretty good idea of the answer, but I needed to hear it from her. My handheld and headset were recording every word.

‘Oh, lots of reasons. A big one is psychological. With structured interruptions, which are done for research purposes, there are medical staff working with every patient to monitor their condition. You make sure the patient understand what can happen – for example that their medications may need to be changed afterwards because their old ones probably won’t work. And of course every patient knows they’ll get treatment afterwards. But with this... pharmageddon of yours...’

‘Whoa! It isn’t my pharmageddon!’

She laughed and flicked my arm. ‘I know, I know! But you gave it that name, didn’t you? Anyway, it’s completely different to a controlled study. The patients aren’t prepared. They don’t know when – or if – their treatment will start again. There aren’t enough doctors in the world to monitor their condition, or test them for drug resistance. And when ARVs become available again... that’s when it’ll get really crazy!’

‘How so?’

‘Well, obviously we can’t screen two million people to see who’s developed drug resistance, like in a clinical trial. We’ll have to put everybody on a standard second-line cocktail and wait to see who gets better and who doesn’t.’

‘So you’re saying that everyone should be put on second-line drugs?’

‘I can’t see it working any other way, can you? If we put them on a first-line regimen again and they don’t respond, they’ll be dead before a doctor sees them again.’

‘So... you’re saying there’s not much point in restoring the supply of the existing first-line drugs?’

‘Not unless this looting of drugs can be reversed in the next day or two, no. And of course there’ll be a rise in incidence.’

‘How do you mean?’ Again, I knew what was coming, but I needed her words.

She gave me a confused glance. ‘Well... when you stop taking ARVs the virus multiplies rapidly in your system, and you become much more infectious. There’ll be a spike in new infections, and a rise in prevalence...’

‘Assuming treatment isn't restored soon,’ I prompted.

‘Yes. Otherwise there will be...’ I watched her computing the scenario, and the shock creeping into her face. ‘Herregud! It would be as if every person with HIV is in their most infectious phase, all at the same time. It would be catastrophic!’

I tried to take the edge off it. ‘Except that most of their sexual partners are already infected, so there is a limit to the number of new infections, surely?’

It helped a bit. ‘Yes, but still...’ Then I saw the light bulb come on. ‘Oh, is that what you meant? When you asked about research into large scale treatment interruptions?’

‘Yes. Someone needs to think it through in detail. Crunch the numbers. Plot scenarios on a timeline...’ 

‘You’re right, Gipsy. I’ll see what I can organize.’

‘Great. Promise you’ll share the preliminary results with me?’

She smiled again. ‘How many of those stringettes will you give me?’

‘Enough to make your dreams come true.’ It was the wrong thing to say. I watched the distress flash across her face. ‘Oh god, I’m sorry Miu. Most people have easy dreams, like a date with Brad Pitt. A better future for all the world’s children is... a little harder.’

‘It really is fucked up, isn’t it?’ She stared at me, but I knew she was seeing something else. Welcome to my nightmare. 

I had to ask. ‘So... what do you think? Is there a solution?’

The UNICEF officer was looking at her hands, shaking her head slowly. ‘If there is...’

‘Tell me what you see.’

After a moment she looked up at me, and smiled sadly. ‘An old Vietnam war movie. Oliver Stone, Stanley Kubrick. Hundreds of army helicopters flying out of the sunrise. But instead of soldiers with guns, they are carrying doctors with ARVs. It’s... more George Clooney than Jean-Claude van Damme.’

I caught another look in her eyes. ‘In other words, we need a miracle?’

She nodded, and said something that was drowned out by the sudden roar of hail-stones on the glass roof above our heads.

Johannesburg South Africa 14:00 Monday 3 January T+35hrs

Enoch was waiting for me when I got back to the Michelangelo. We’d arranged to have lunch before the editorial conference. Over a draught beer and German sausages for him and a salad Niçoise and a glass of sauvignon blanc for me I told him about my interview with the UNICEF adviser, and asked how he’d spent his morning.

‘I went to Chris Hani Hospital in Soweto. I grew up near there, Gipsy – it was called Baragwanath Hospital back then. It was the biggest hospital in Africa. But now it’s like... going to a school during the holidays. Almost deserted. I found a few doctors treating people for injuries, and a few patients in the intensive-care wards. The ones who couldn’t leave. But most of the doctors have stayed away. They have no medicines to treat their patients.’

‘Yeah, I heard.’

‘Outside there was a huge crowd of students, toyi toying.’

‘Doing what?’

‘Dancing. It’s like a political dance. They chant and dance. They use it when they are celebrating or protesting...’

‘What are they protesting?’

He shook his head. ‘It’s not a protest. They are celebrating. Celebrating the end of ARVs.’

‘What?’

‘They are saying those bombs were an act of god. Saving us from the poison. White man’s poison.’ 

‘Enoch, please tell me you’re having me on!’

‘They made up a song. About a fire that makes us stronger. That delivers us from evil. The burning bush...’ 

I was beyond speechless. ‘But... I was just checking the forums. I didn’t see anything like that.’

He raised his eyebrows. ‘What are they saying? In other countries?’

‘Not much... some looting. People being turned away from hospitals. Desperation. Definitely no celebrations.’

‘Ayee. South Africans... we’re a bit different! A few years ago the people in our squatter camps attacked foreigners... Africans from other countries... and drove them out. Even though their countries welcomed us when we were fighting apartheid. And this business of ARVs – we are the only country that resisted them.’

‘So, Enoch, do you think this... celebration in Soweto is an aberration, or something we might see elsewhere?’

He looked serious. ‘That crowd was political. It was organized by the Youth League. When you listen to them, you hear the words of our future politicians. They really do believe ARVs are poisoning the people, and they are convinced this... event... is proof of that. That it shows president Mbeki was right all along, and everybody else was wrong. I know how it must look to you, but... don’t you believe in things that nobody else does?’

I laughed. ‘You mean like – money can buy happiness? Crime does pay?’

He laughed too. Or maybe it was a sob. ‘Hau! You would make a good South African!’ 

+++

We have our editorial conferences on Mondays at 3pm Istanbul time, which is the same time as Johannesburg. That’s seven in the morning in New York, and ten at night in Tokyo. And if you’re unlucky enough to be in California, or in New Zealand, it will definitely mess with your sleep. But at least we can do it from anywhere there’s broadband. Like a hotel bedroom.

I watched as the faces of my colleagues filled the little squares on my computer monitor, wishing each other happy new year. Enoch was in the hotel room with me, but using his own laptop.

‘OK, we’re all here, let’s get to it.’ Jim looked all business but I recognized the undertone of excitement in his voice.

‘I don’t need to tell you all that Gip’s pharmageddon story is... huge. Or that we’re right where we like to be – at the head of the cavalry. Of course that also means we’ll be the first to see our asses unless we’re careful, so we need to keep our shit together.’

The editorial team were very still. Usually there’s a lot of bull flying around, but this story impacted on all our beats – politics, economics, military, even sport and the arts, since so many of their stars were living with HIV. Jim was obviously thinking the same.

‘We’re going to need to pace ourselves, boys and girls. This story is very broad, and it could be with us for a while. Right now we need to look at scenarios and decide which horses to put our money on. But before we do, is there anything new?’ He meant any breaking news which hadn’t made it onto our radar yet.

‘I may have something, boss.’ 

‘Yeah Linus?’

‘I’ve heard on the grapevine that the UN approached the American government a couple of hours after the bombings to get hold of as many antiretrovirals as they could, and to store them in US embassies.’

‘They what?’ I was so surprised I couldn’t help myself.

‘Ja, Gipsy, it looks like they understood right away that some people would try to grab the drugs, so they asked the US to use their embassies to keep them safe. They have extraterritoriality status, of course, and they’ve been very well protected since the first Al Qaeda attacks in East Africa in ’98.’

Something was wrong with this picture. If the UN expected looting of ARVs, why didn’t they ask the media to play down the fact that these particular drugs were the common denominator? And why didn’t they ask Shan and his colleagues in Hyderabad to do the same?

‘So what happened?’ Russ asked.

‘Ach, nothing much. I don’t know whether the US government thought seriously about doing it, but as soon as Gipsy broke the story it was too late.’

‘Linus, are you saying our story – my story – prevented the Americans from safeguarding the drugs?’

In his little square on my computer screen Linus looked surprised. ‘Oh no, Gipsy. If we didn’t break the news, somebody else would have. It must have been obvious to a lot of people what those factories had in common.’ He hesitated a moment. ‘I hope you don’t mind though, I borrowed your word for my story. Pharmageddon.’

Jim chuckled. ‘You’re not the only one to follow Gip’s lead, Linus. I hear several of the cable channels and wire services are using it.’

Oh great, I’d baptized a fucking global disaster! I still felt unsettled about Linus’ news about the UN and the American embassies, but Jim pressed on.

‘Okay, scenarios?’

This was always Jim’s next question. It’s how we work. To get ahead of the competition we have to anticipate what’s coming instead of simply reacting to what’s happened. And to do that we construct scenarios.

‘Well, I’m thinking Al Qaeda.’ Linus was on a roll. 

‘Let’s hear it, Linus.’

‘Ja, well I was throwing this around with some guys who... well, let’s just say they spend a lot of time thinking about Al Qaeda. They have a theory that these bombings are their way of attacking the US and western governments.’

‘Go on.’

‘Okay, it goes like this. The USA is a major producer of ARVs, and these days American companies even make money from copies of their drugs. Also the American government is by far the biggest buyer of ARVs through their foreign aid program. So some of the guys were saying Al Qaeda sees AIDS as the will of Allah – that God wants people with AIDS to die – and that Americans, with all their drugs are... you know... interfering with the will of God.’

I saw a lot of eyes grow wider on my screen, and a few heads shaking. I ticked off one item on my own list. 

Jim prompted again. ‘So Al Qaeda’s motive would be...’

‘To stop America messing with the will of God. And making money from the misery of others.’

The team sat in stunned silence as they tried this theory on for size. Finally Georghe spoke up. ‘My problem with that scenario is that Al Qaeda risks killing many thousands of people – mostly in countries they have no argument with – just to score a point against America.’

‘No, Georghe – they’ve only killed a few cleaners and guards.’ Mandy Jones cut in, surprising us all with her vehemence. ‘It would be God killing people with AIDS, not Al Qaeda. I think Linus... your guys are on to something.’

Jim read the mood. ‘OK, this is a possibility then. Linus, do you need someone to share the load?’ 

‘Well, if Mandy could help with the religious angle it would be a big help. Not my thing.’

It took just a few seconds to allocate responsibilities and then Jim asked for more scenarios.

‘I’m thinking white supremacists.’

‘Take us through that, Russ.’

‘It seems like Africans – black people – are by far the worst affected by AIDS. If you are crazy enough to want to kill blacks, disrupting the production of generic ARVs would be a good way.’

The thing about the little lenses set into our laptops is that you can’t see what people are looking at. But I’d guess we were all looking at Enoch, our only African colleague, who was nodding and looking glum. I resisted the temptation to turn and look at him across the room.

Russ continued. ‘I also think it would be a mistake to underestimate the willingness of these white supremacist groups – neo-Nazis, Ku Klux Klan or whoever – to kill. A lot of people thought they were responsible for the bombing of the federal building in Oklahoma City, which was the biggest act of terror in the USA before nine-eleven.’

‘But...’

‘Yeah Ume?’

‘Russ, I thought the Oklahoma City bombing was the work of just one or two men?’

‘Uh huh, Timothy McVeigh and Terry Nichols. But there was evidence that others were involved – possibly neo-Nazis and even Islamist terrorists. The court refused to hear that evidence. In fact this scenario could easily overlap with Linus’ theory on Al Qaeda.’

‘God help us if white supremacists have linked up to jihadists,’ Jim cut in. ‘But I agree we need to look into it, Russ. Will you take that on?’

That settled, Jim asked yet again for scenarios. I had the sense that Jim had something specific in mind and was pushing on until someone presented it.

‘Oi! Can I play too?’

‘What position do you want to play, José?’ This was José and Jim’s usual game.

‘I prefer to watch this game on TV, vagão.’ We certainly needed some levity, and our sports editor frequently provided it. I saw some of my associates stretching and easing their frown lines.

‘Please go ahead, José.’

‘How about the Americans?’

The levity evaporated. I put a third tick on my list and watched Jim’s face.

José continued. ‘You may not know this, but my own government was the first to commit itself to universal access to antiretrovirals, and the first to issue compulsory licenses for generic ARVs...’

‘Compulsory licenses?’

‘Yes – our government overruled the patents on those drugs, so we could make affordable generics. And in the process we met Satan himself. He wore the face of the big pharmaceutical companies, and his body was the US government.’

José leaned close to his laptop. The lens in his computer struggled to focus, and he spoke in a low voice. ‘We heard a rumor that pharma was blackmailing George Bush, saying they funded his election campaign and now it was payback time.’ He imitated an American accent. ‘If you can’t stop Brazil and India copying our drugs, Mr president, then you’ll just have to buy our drugs yerself and give ‘em away for nothing.’

Georghe cut in. ‘I heard another story – that big pharma were almost bankrupt, so they leaned on Bush to bail them out, by purchasing vast quantities of ARVs with public money.’

‘I also heard that one, companheiro. Either way George Bush got Congress to fork out billions of dollars for AIDS drugs. That’s a fact.’

I thought for a moment that my connection had broken, because none of the faces on my screen were moving. Then I saw José’s mouth move again.

‘Today the Americans have a new president, who has inherited a situation where vast amounts of money go to foreign generic-drug producers. And there will be no end to this, because the epidemic isn’t getting any smaller. It’s just a big hole that they are pouring tax dollars into. So, somewhere between the White House and pharma, someone may have decided to... end it.’

I was expecting shock from my colleagues but most of them looked... thoughtful. We were all fairly cynical about pharma, even though one of them paid our salaries. The exception was Jim. Despite the tiny image on my screen I could see he was pale and his eyes were round. We all knew he was a close friend of the new president.

‘Jesus – it’s just... unthinkable. But... what’s your take on this, Georghe?’

Our politics editor didn’t look up from his doodling, and made no attempt at levity. ‘Well, Jim, it’s theoretically possible, of course. It could have originated in the administration, as a way of getting out of a funding black hole, or it might have come from pharma themselves. Keeping the money at home by blowing up their foreign competitors. It’s possible, but I wouldn’t describe it as likely.’

Once again the connection was silent, apart from a few sighs and mutterings.

I decided to throw in my two cents. ‘If pharma or the US administration did it, then it would be a business decision, not an ideological one. So they’d target critical equipment, rather than people – they’d pick a time when there are as few people around as possible, like when a factory is closed for the holidays.’ I saw the shock on Jim’s face as he saw the logic, and a small nod from Georghe. José looked vindicated.

Then I added: ‘Still... it doesn’t necessarily support José’s big pharma scenario.’ 

‘Aaargh. Why don’t you just push a knife into my heart, Gipsy?’

‘Sorry, Jay. I actually asked Shan whether the bombs could have been planted by big pharma and he said there was no point. They’d know that other generic companies would take up the slack, and I doubt they are into empty gestures. But the “funding black hole” scenario is interesting...’

‘Gip, do you seriously think the American government would do something... like this? Place so many lives in jeopardy? Lives that they’ve spent billions to save, until now?’

‘Jim, until yesterday I wouldn’t have thought that anyone could do this at all. But somebody did. Now we just have to write a name in the blank space.’

‘Yeah, fair enough. Who takes the lead on this one? Gip?’

‘Jim, I’d really prefer to focus on what happens here in Africa, rather than in Washington. Effects, rather than the causes. Any chance that Georghe could run with it?’

‘Georghe – how do you feel about that?’

‘Sure, Jim. I love conspiracies. But chief, can you... talk to your friend in the White House?’

Our executive editor was obviously distressed but he responded without hesitation. ‘That’s exactly what I’m going to do, Georghe. Any more theories?’

I took them through the idea which I’d thrown at Shan over lunch in Shimla – that the bombings may simply have been a demonstration, a precursor to blackmailing other industries or even governments. Georghe agreed to look into it as well. Then Jim started to wrap up.

‘Okay folks. Let’s get together again same time tomorrow to see what we’ve got. Any last thoughts, anyone?’

‘Jim, I have one more scenario.’ Enoch’s interjection seemed to surprise Jim, but he recovered quickly. I couldn’t help turning to look at Enoch, sitting at the hotel desk while I was propped up on the bed. Our graying education editor looked at his hands for a moment, and then said in a low voice: ‘It could be my own government.’

This one was not on my list, and it looked like my colleagues were beyond surprise. I’d had a sneaking suspicion at lunch that Enoch was working up to something like this.

‘Please go on, Enoch.’

‘This is difficult, Jim, but listening to the other scenarios, perhaps it is no harder to believe.’ Enoch paused. Nobody said anything. With a deep sigh, he continued. ‘Before we had these drugs, these ARVs, many people died. Every week we buried someone. Then HIV prevalence reached some kind of stability, a plateau. We thought we had reached the turning point, and it would go down. But then we got ARVs, and suddenly the number of people living with this virus was going up again. It seemed like the more we used these drugs, the more people we came to know were living with this virus.’

I saw Georghe’s head come up, but he held his question. Enoch continued. ‘For several years nearly 20 percent of our adults were HIV positive. Now it’s over 30 percent. I read somewhere that at this rate, in five years more than half of our adults could be living with the virus. That’s... a majority of the voters. And half of all our parents.’

Enoch’s voice was rising. ‘Africans are now in the power of whoever controls those drugs. They hold the power of life and death over us. We are becoming a nation, a region, of... slaves! It is... the one thing we cannot do. Again.’

‘Jesus H Christ,’ Jim breathed. ‘Enoch... are you saying your leaders would rather... what are you saying exactly?’

Enoch swung his head from side to side, like he was trying to evade a persistent fly. He looked a little crazy.

‘Truly, Jim, I do not understand why these drugs seem to be making things worse. But what I do know is that after today, nothing will be the same again. Right now they are celebrating the end of ARVs in Soweto. Celebrating!’

‘Phew, man. That’s just... incredible.’ Jim looked stunned. ‘Tell you what, Enoch, can you tease this thing out a little before we talk again tomorrow?’

Another minute and the meeting was over.

+++