Pharmageddon Chapter 8

Johannesburg, South Africa 15:00 Wednesday 5 January T+ 3 days 12 hrs

‘It’s bizarre, Gipsy. My minister is behaving like it never happened.’

I’d called Bettina to apologize again for fading on her earlier in the day, and to find out how her boss had reacted to her unauthorized public statement.

‘What... no medals? Not even an honorable mention?’

‘Oh no. If you do something they don’t like – and it works out – they won’t say anything. They want the world to think they supported you, or even that it was their idea. It’s okay, as long as it works.’

‘I suppose it’s better than asking for permission and being turned down, then doing it anyway...’

‘Oh ja – he would fire me for that, even if I succeeded.’

‘Seriously?’

‘Ja, but not right away. He would invent another reason.’

‘It sounds like you can be crooked or incompetent, but you can’t be disobedient?’

‘That’s so true.’ There was so much sadness in her voice. I guessed it was a reaction to the sleepless night and the adrenalin rush this morning – I was still feeling pretty hammered myself, and I’d slept most of the morning.

‘How do you put up with it, Bettina?’

She let out a long breath. ‘It comes with the job, Gipsy. I knew what it would be like before I accepted it. I can’t pretend to be innocent now.’

‘So how is it going in the hospitals? Any problems?’

She hesitated. ‘There are plenty of problems, but nothing too serious. About half of them received some drugs today, but it will be better tomorrow.’

‘What about the patients and doctors at the hospitals? Did they all pitch up today?’

‘Not all. But it should be business as usual tomorrow. I’ve authorized the delivery of fresh stocks of ARVs from the manufacturer to some hospitals, now that it’s safe.’

It may be business as usual in Bettina’s world, but I felt like someone had ripped my guts out and stuffed them back in random order, and I couldn’t decide who to blame – post-traumatic stress or room service. But if treatment resumed in earnest the next morning, the longest anyone would be without ARVs was three days – hopefully short enough to avoid resistance. And even if they didn’t respond, it wouldn’t be difficult to put a them on second line meds. I desperately wanted to believe this story was moving from news to history, but my gut simply wasn’t buying it.

‘So Betts... will you submit an inventory of your national reserve of ARVs to the UN?’ There was a short silence on the line, and for a moment I thought we might have been disconnected. ‘Bettina?’

‘Sorry, Gipsy. I have a visitor waiting...’

Something wasn’t right here. ‘What’s the matter? Do you want to go off the record?’ Another long sigh. ‘Aah Gipsy. I can’t...’

‘Don’t keep me in suspense, girl. You know I won’t tell anyone. What gives?’

‘Well, there’s good news and bad news. But...’

‘It could only have come from you, so I can’t use it?’

‘Yes.’

‘So let’s start with the good news.’

‘My minister told me to go ahead and submit an inventory to UNAIDS...’

‘Good news? That’s incredible news! My god! You must be over the moon!’

She certainly didn’t sound overjoyed. ‘It’s good news, yes. But...’ 

‘Okay, let’s hear it. What’s the bad news?’

‘Well, the minister also said that he wasn’t really worried about the UN, because our ARV factory, NguniMed, has enough active ingredient to keep us going for months. Long enough to wait for new supplies from China or India...’

‘Are you kidding me? That’s not bad news! That’s fantastic!’ I knew South Africa made their own ARVs with active ingredient from India. I was bracing myself for Bettina to unleash one of her shrieks, then admit she’d been razzing me. So when she spoke in the same unhappy tone, I didn’t absorb what she said at first.

‘... we normally export half of our ARVs to our neighboring countries. But now the minister wants us to keep it all.’

‘Oh... shit! That’s not good. But...’ Something was wrong with this picture. ‘Hang on, Bettina. How does he know how much API your factories have, when you didn’t know yourself?’

There was a long pause. ‘You swear this is off the record, Gipsy?’ 

‘Cross my heart.’

‘He’s involved in NguniMed. He’s a part owner – a majority shareholder. Through a proxy, of course. We have a lot of that in South Africa...’

I must have said something to Bettina, but all I remember is that my head flooded with questions. Minister Colin Makeba was making money from the purchase of ARVs by his own ministry. Maybe this explained why he stood with his arms folded while existing stocks were looted from hospitals – he stood to make a fortune by re-supplying them. And he knew all along that his country had sufficient reserves of active ingredients to ride out an interruption in the global supply. How did this play into Enoch’s theory that the South African government was responsible for the sabotage? And what was this about withholding exports to neighboring countries? Was Makeba, or his government, trying to build up some leverage over them? Or drive prices up?

‘Gipsy?’

‘Sorry Bettina, I was just having a melt-down. What the fuck’s going on, girl?’

‘I wish I knew. Really.’ She sounded a touch less tense, probably relieved that she’d shared her secret. ‘He told me not to ask NguniMed for details about raw materials, or to include undelivered ARVs in the national inventory for the UN – just what we had in hospitals before the looting. I don’t think he meant to tell me about their API, it just slipped out.’

‘Holy crap. What are you going to do... what are WE going to do?’

We talked it over, and agreed the only thing she could do was confront her boss. To put her neck on the chopping block, once again. I couldn’t even imagine the courage it took. She said she wouldn’t be able to see Colin Makeba until the next afternoon, because he was attending a cabinet meeting in Cape Town.

‘Maybe that’s a good thing. Give you an opportunity to catch up on your sleep, and to think about what you’re going to say when you see him?’

She didn’t sound convinced. ‘I suppose so. But... can I spend tomorrow night with you again? It was such a big help, having you and Nikki to talk to last night. I felt so much... safer.’

‘No worries, girl. I’m sure Ephraim and the kids won’t mind spending another evening with your brother-in- law.’

‘No, they had a great time – I don’t think they missed me at all!’ 

‘Excellent! So let the good times roll!’

Bangkok, Thailand 10:00 Thursday 6 January T+ 4 days 2 hrs

Staff at the check-in desk of British Airways at Bangkok International Airport are accustomed to processing one or two unaccompanied minors on each flight. It is a painstaking process because children can’t be held responsible for their actions in the same way adults can – like presenting themselves at a departure gate at the right time – but also because it would be a disaster if a child went missing, or landed up in the wrong city like misdirected baggage. It’s an expensive and fraught business, heavy on human resource and often involving anxious moments – for example when a child says they don’t know the adult who meets them at their destination. Or when nobody arrives.

Senior check-in controller Jamie Smythe frowned as she scanned the bookings schedule for the Thursday night flight to London. On this flight there were no fewer than twelve unaccompanied minors. This was a logistical nightmare for ground staff at both ends of the flight, and she didn’t envy the cabin crew or the other passengers in economy class, since unaccompanied children had to be paired up with an unsuspecting woman passenger once seated, and the younger ones often became fractious or weepy.

Smythe picked up her phone and pressed the key for the regional manager’s office. ‘Dick, I’ve got twelve UMs on this evening’s flight to London – can you send me another three girls to handle them?’ The accepted ratio was three kids to one staff member, and Smythe had only one available. She wasn’t surprised by his reaction.

‘Oh come on Dick – of course I can’t handle that number without additional staff. You know the risks better than I do. And it’s a full flight.’

He asked her whether she could give more warning next time. ‘Dick, please don’t talk to me like a novice – you know full well that we don’t see the bookings until the morning of the flight.’ He promised to do what he could, and rang off.

Within a minute the phone rang, and he was back on the line. Smythe was dumbstruck as he told her that he’d checked the bookings for the next few days, and the number of unaccompanied minors increased with every flight. The regional manager promised to put some extra staff on overtime until the situation returned to normal.

However later in the day he called again, to say he’d heard from London that a similar trend had been seen in many of BA’s destinations. They’d had one of their passenger-trend analysts look at the phenomenon and she found other intercontinental airlines were seeing the same thing. Finally she’d looked at the countries involved, connected it to the news which dominated every newspaper, and concluded that families in countries with significant HIV epidemics were sending their children to stay with relatives in first-world countries.

When the news was passed up the line to the airline’s CEO he telephoned the director of a charity for which he was a patron – an organization helping children affected by HIV/AIDS. The director was gobsmacked. Then he began to connect the dots.

‘You know Edward, I’d bet these children are the tip of an iceberg. I wouldn’t be surprised if, for every unaccompanied child, you will have nine or ten adults – or mothers traveling with children – who are running to countries with strong health infrastructures.’

‘Good god, Brian, do you mean to tell me that all of these people are HIV positive?’

‘Not the children, no, although the odd one might be. But there’s a good chance that adults traveling with children are infected. I’d do the same in their shoes. The richer parents will escape with their children to a country where they are more likely to find antiretrovirals, while poorer parents will send their kids to live with relatives, knowing that they themselves will probably be dead in a few months.’

‘I see. Can you think of any implications for the airline?’

‘Not offhand, no. HIV isn’t transmissible in normal situations, of course, so there’s no risk to other passengers or crew. But I daresay the Ministry of Health would be interested in this, since it could represent a significant drain on the national health system. And I would suspect that a lot of these people are entering on tourist visas, with no intention of leaving.’

‘Right – I get the picture. Thanks old man.’ The CEO rang off.

Within an hour, both the Ministry of Health and the Ministry of the Interior, which controlled immigration, had delegated people to look into the issue and come back with recommendations. They also passed the word to the Americans, Canadians, Australians and to the EU. Within a day, embassies in almost every developing nation were demanding proof of HIV status from visa applicants, in contravention of several UN agreements on the right to confidentiality.

‘I don’t care,’ muttered Britain’s minister of health to a cabinet colleague over lunch. ‘There’s no way we can allow them to export their problem to us. It’s a horror – but it’s their horror, not ours.’

Chandigarh 10:30 Thursday 6 January T+ 4 days 4 hrs

‘Welcome to India, Colonel Baldwin. Is this your first visit?’

Baldwin shook Gupta’s hand. The industrialist was much smaller than he was expecting – not only a head shorter than the American but fine boned, like a scaled down model of a much taller man. And Gupta’s eyes held no hint of the belligerence or fear which Baldwin expected to see in smaller men – especially when confronted by someone who looked like a heavyweight boxer – only an easy warmth.

‘It is. I’m not sure what I was expecting. It’s cooler than I thought it would be, and your drivers certainly hoot a lot!’ Baldwin had arrived in Delhi the previous evening and spent the night at the Imperial Hotel on Janpath before catching an early flight to Chandigarh. The transfers to and from Indira Gandhi International in the hotel’s cream Mahindra SUVs were not something he’d soon forget.

Gupta laughed – a spontaneous and infectious sound. Baldwin found himself laughing too.

‘Ah yes, our drivers. We like to hoot! Did you notice how many of our trucks have a sign on the back saying “horn please”?’

‘No – I was too busy trying to figure out what the rules of the road are here, and to recall if my estate was in order.’

‘Rules of the road? I didn’t know we had any! But the good news is that road accidents are much less common, and generally much less severe, than in your own country colonel. It looks like chaos but somehow it works. But I’m forgetting my manners – allow me to introduce my colleague, Dr Shyam Chaturvedi. He’s the director of our API plant. Or what’s left of it.’

Gupta’s companion stepped forward to take Baldwin’s hand. He was no taller than his boss, but much older with a pleasant scrunched up face, wreathed in smiles. He murmured a greeting, wagging his head slightly from side to side, and then stepped back. Gupta made no attempt to introduce the rest of his entourage, whom Baldwin assumed were bodyguards and secretaries. Two were talking softly on cellphones. When one caught his eye he smiled and nodded respectfully, but no more.

‘My people will take care of your luggage, colonel. Do you need anything, or would you like to go directly to the... scene?’

‘That’d be great, thank you.’

Three minutes later Gupta ushered Baldwin into the back of a Toyota Landcruiser and climbed in next to him while Chaturvedi took the front seat.

‘So gentlemen, I understand this attack on your plant was completely unexpected. No threats, demands, warnings... nothing of that kind?’

Gupta glanced at Chaturvedi, who was swiveled around in the front seat, before replying. ‘That’s right. No warning at all.’

‘In the Stockholm bombing and the failed attempt in Reykjavik it seems the devices were planted by security guards from an earlier shift. Do you have any insights as to who planted the bomb in your plant?’

Again Gupta glanced at his plant manager. This time Chaturvedi responded. Baldwin had to strain to hear his soft voice above the growl of the Toyota’s diesel engine. His Indian accent was very pronounced, but his English was perfect. ‘It could have been placed by a technician. Several of them have failed to return to work. It would be easy for them to bring explosives into the plant during a shut-down period.’

‘Are they Indians? The technicians who are not accounted for?’

‘Yes. We have two men from Europe installing control gear, and a Japanese supervising the installation of the reactors. They are not missing.’

‘Reactors?’

‘Yes. Chemical reactors. We use them to synthesize pharmaceutical molecules - the active ingredients in drugs. We have some of the biggest reactors in the world here, and we’re always installing new models, or upgrading the ones we have, so we can produce more complex API and do it faster and at lower cost.’

‘And you have no reason to suspect any of these foreigners?’

Chaturvedi’s friendly grandfather face didn’t change but his voice grew stronger. ‘Colonel Baldwin, we have no reason to suspect anyone. Some of the technicians haven’t come back to work after the explosion, and we can’t locate them. For all we know they may have heard about the explosion and decided to look for work elsewhere.’

Baldwin decided to back off.

‘Gentlemen, I don’t have any jurisdiction here. I’m not trying to solve the case or apportion blame – I’m sure your police are perfectly capable of doing that. But I would like to get a sense of whether there are international factors at play, and what they might be, so that we can anticipate and prevent another attack of this kind.’

Gupta responded – this time without looking at Chaturvedi. ‘Colonel, as I said when you first called, you can count on the complete cooperation of everyone at Maurya. Naturally in the last couple of days we’ve talked a lot about possible motives, but really none stand out...’

‘I’ve been reading the various conspiracy theories which are posted at The World Online, but I’d be grateful if you could share your own ideas.’

‘Oh yes, it’s been fascinating to see how many interpretations can be applied to the bare facts of the sabotage. I admit I’ve spent hours reading those posts. It really is addictive – and a little bizarre. It’s almost like we’ve become part of a giant video game!’

‘Any of those theories stand out for you?’

‘Well, yes and no. They all seem to be plausible, to some degree. My own view is that the sabotage of the UN warehouse in Sweden shows the perpetrators are not only targeting us – the Indian pharmaceutical industry – but rather the entire supply chain for antiretrovirals. I agree with the person who wrote that we were simply the most vulnerable link in the supply chain. We gave the saboteurs the best bang for their buck.’

Baldwin returned Gupta’s wry smile. ‘And the attempted sabotage in Reykjavik?’

‘That simply confirms the saboteurs aren’t targeting generic producers alone, or limiting themselves to first- line ARVs...’

‘Yes, I’ve heard that second-line drugs have been affected as well. Don’t they use the same active ingredients which you made here?’

Gupta looked impressed. ‘Quite right! Two of the three active ingredients in both first- and second-line combination drugs are NRTIs – only the third molecule is different. But global consumption of second-line drugs is very much smaller than first-line, so we expect the originator companies will be able to restore second-line production without much difficulty.’

‘But they won’t be able to make enough to replace first-line treatment with second-line?’

‘Not in the same time-frame, no. But if we are going to use second-line drugs, we have more time to play with.’

Gupta noticed the uncertainty on Baldwin’s face, so he explained. ‘I’m sure you know that drug-resistance develops very quickly if ARV treatment is interrupted?’ The American nodded. ‘Well, if treatment IS interrupted – deliberately or otherwise – most patients can go a couple of months before their health declines significantly. As long as they progress to the next generation of drugs when their treatment resumes, they should be fine.’

‘Okay, I get it. If we want to maintain first-line therapy, we have to restock hospitals before they run out in, what, two months?’

‘Yes, about that.’

‘But if we decide to switch everyone to second-line drugs, we only need to send them in... four months?’

‘Correct. Perhaps even more – we don’t really know for sure. But it will definitely give the pharmaceutical industry more time to get itself sorted out.’

‘Is that enough time for you?’

Gupta hesitated slightly before answering. ‘Theoretically, perhaps. But in practical terms, the Chinese will have increased their production of NRTIs by then, so it’s a moot point.’

‘So what will you do here?’

‘We’re not sure yet, colonel. Of course we’ll resume production of all the other molecules which we made before the bomb went off, but as for antiretrovirals – we’re waiting to see what happens next.’

‘What happens next?’

‘Yes. Perhaps you’ve been wondering why anyone would bother to sabotage laboratories and warehouses around the world, when all it achieves is a brief hiatus in the pharmaceutical industry, and in a few hospitals around the world, with no clear winners or losers?’

‘Yes. In fact I was going to ask for your thoughts on that.’

‘Certainly – here they are. I don’t think the saboteurs are finished yet. Our view is that they have something else planned. What we do here...’ Gupta pointed out the window ‘...will depend on what they do next.’

Baldwin turned to look where the Indian industrialist had pointed, and found himself staring at the damaged shell of a large modern building, surrounded by scaffolding and swarming with construction workers. A sign next to the entrance read ‘Welcome to Maurya Pharmaceuticals, Chandigarh.’

Chaturvedi led Gupta and Baldwin on a short tour of the badly damaged laboratory. ‘Unfortunately the bomb destroyed all of our chemical reactors, and they are not easy to replace. At least, not in a hurry. Restoring the building is relatively easy.’

‘What about your product – your API? Did the blast destroy materials you’d made already?’

Chaturvedi shook his head. ‘No, our dispatch area was empty. We shipped everything before we closed down for the holidays.’

‘What do you make of the fact that the bombings took place when all the plants – and the warehouse in Stockholm – were closed down?’

Gupta answered. ‘Do you mean – did they want to spare lives, or was it easier to place the bombs when there was nobody around? I think it might be the latter. After all, killing a lot of critical staff would certainly have made it much harder for us to recover. It takes far longer to train people than it does to build reactors.’

Chaturvedi picked up the thread again. ‘But it also means the bombers still have leverage. They could return to attack our people...’

Baldwin let out a low whistle. ‘Damn, that’s worrying. But in that case, wouldn’t you expect them to issue some kind of ultimatum? Stop producing NRTIs, or we’ll kill your people!’

Gupta nodded. ‘It is worrying. And it’s another reason why we’re not publicly committing ourselves to anything. At least, not yet.’

‘So what are your immediate plans?’

‘We’ve ordered new equipment to replace what we’ve lost here, of course. In the meanwhile we’re continuing to produce some active ingredient in the research laboratory attached to our headquarters near Shimla, which is not far from here. But our capacity there is quite limited.’

‘It’s a small facility?’

‘No, it’s actually quite big. About the same floor area as this one. But it’s equipped for research, rather than production, and we recently refurbished it to focus on biopharmaceuticals – essentially living compounds, rather than chemical molecules.’

‘Like those at Vikmed?’

‘Yes, exactly. In fact I offered to help them – to get their injectable to large-scale production quickly, so it can be used in Africa. But their CEO wasn’t impressed.’

‘You said you refurbished your laboratory in Shimla. How was it set up before that?’

‘Well... more conventionally...’ Gupta was obviously not certain how to answer the question.

‘What if you were to find you still had equipment – reactors, like those which were destroyed here in Chandigarh – kept in storage, from before the refurbishing took place?’

‘I... I’m not sure what you’re getting at, colonel.’

Suddenly Dr Chatuvedi’s grandfather face broke into a broad smile, and he murmured a couple of words in Hindi. Gupta turned on him in surprise, but then his face changed and he looked back at Baldwin and bellowed one of his trademark laughs.

‘Ah hah! This should be interesting! Well, Dr Chaturvedi’s wife has prepared some lunch for us and then, if you wish, we could take the helicopter to Shimla and poke around in our store-rooms. You never know what we may... come up with!’

Baldwin was smiling too. ‘Looking forward to it!’

New York 11:00 Thursday 6 January T+ 4 days 16 hours

‘You may recall, ma’am, that you authorized me to share any information we had on the sabotage of our warehouse in Stockholm with the US intelligence community?’ Francis Dumont was explaining the background to the meeting she’d requested with secretary general Maryam Kapur, UNAIDS executive director Ibrahim Mazzer and his head of drug procurement, Nicola Kershaw.

‘Yes I remember, Ms Dumont.’

‘Well, our point of contact is colonel Baldwin, from the office of the director of national intelligence. He’s monitoring the various investigations to see whether there are any security implications for the US and, I guess, for anyone else. He’s been to Reykjavik and Stockholm, and he’s currently in India...’

‘I didn’t realize the ODNI conducted their own investigations?’

‘Oh, no ma’am. I believe he’s simply observing, on behalf of the director.’ Kapur raised an eyebrow. ‘Please go on.’

‘Colonel Baldwin called me last night to brief me on his progress so far. The bottom line is that he doesn’t believe we are going to identify the perpetrators anytime soon. Evidently none of the investigating bodies even have a good theory as to who might be responsible – or at least a better theory than those which are being thrown around in the public domain.’

‘So Ms Dumont – what can we do for the ODNI? Or what can they do for us?’

‘Well ma’am, colonel Baldwin says that until we know who was behind the bombings, we’ll have no idea what they might do next. And he believes the only way to find out who they are, before they strike again, is to force them to reveal themselves. He’s come up with a plan with Dr Gupta – they want UNAIDS to announce that Maurya are converting their research laboratory in Shimla to produce active ingredients for ARVs, and that it will begin production very soon.’

Maryam Kapur glanced at Mazzer and Kershaw. Mazzer took this as his cue to speak. ‘Are you saying this is simply a fabrication – a bluff?’

‘Yes. They figure the bombers, whoever they are, will do whatever they can to stop Maurya. But they’ll have to react, rather than choosing the time and place, and there’s a much better chance they’ll make a mistake.’

‘But Ms Dumont,’ Mazzer was looking incredulous. ‘This would be extremely dangerous...’

‘I know, doctor! But Baldwin tells me that the Maurya research lab is in a remote area in the Himalayas, and they are convinced they can catch anyone who tries to sabotage them. He says the Indian government is willing to commit strategic resources to catching these people...’

‘No, my dear, you misunderstand me. I’m not talking about danger to Maurya, but danger to millions of people who depend on ARVs...’

‘Oh, I’m sorry, I... don’t follow.’

Mazzer’s incredulity was slowly turning into anger. ‘Let me spell it out for you then, Ms Dumont. Once word gets out that the ARV crisis is over – or even that it’s less serious than we thought – how do you think all those who are presently engaged in resolving it will react?’

Dumont recognized a rhetorical question when she heard one, so she merely shook her head.

‘I’ll tell you! They will slow down, or opt out of the rescue plan altogether. Go back to what they were doing before this... pharmageddon. A lot of pharmaceutical companies are giving up profitable work in order to help us avert a humanitarian disaster.’

‘But... what if we told them what’s really going on?’ As she uttered the words, Francis Dumont wished she could take them back, or alternatively that the floor would open and swallow her up before her face turned bright pink.

Mazzer’s own face grew dark. ‘How can we? For all we know, the saboteurs could be one of these companies! Or word of this could leak out to the perpetrators. The whole idea is horribly misconceived – I cannot believe an intelligent man like Dr Gupta would go along with it.’

‘Ibrahim, maybe we don’t have the full story here.’ Nikki Kershaw put her hand on her boss’ arm. ‘Let’s say for argument sake that we... let it slip that Maurya are about to resume production. Not full scale, not enough to warrant a reduction to our orders with the Chinese, or to abandon any other aspect of our recovery strategy, but enough to significantly increase our confidence that disaster can be averted.’

Mazzer was not looking convinced, but Kershaw kept going. ‘We could even say we’re planning to increase the UN stockpile of ARVs from one to three months, so we’re less vulnerable in future. It’s something we’ve been talking about anyway, and it would explain why we’d keep the pressure on the other API manufacturers.’

The secretary general held up a hand. ‘I’m sorry, but I want to go back a step. It sounds like this colonel Baldwin is doing a great deal more than observing foreign investigations. Surely we need to know why this initiative is coming from the director of national intelligence and not the CIA? Unless...’ She stared at the other three in turn. ‘Unless they think the CIA may have been involved! Is that a possibility?’

Francis Dumont saw an opportunity to redeem herself. ‘Ma’am, there are many theories floating around on public forums, like the one at The World Online. One is that the US government did it – through one of their agencies – to bring an end to what they’re calling the funding black hole. American taxpayers providing chronic medication to an ever-increasing number of Africans, forever. But the US president has categorically denied it, and is asking congress to actually increase funding to help restore the status quo.’

The secretary general looked thoughtful, and her chief security officer kept going. ‘Dr Mazzer is right, of course. If we go along with this plan, we can’t tell anyone. Whatever we decide, it must not go outside of this room.’

Kapur nodded, as if she’d come to a conclusion. ‘I have several thoughts on this matter. The first is that, until we know who is responsible for these attacks, we are all vulnerable. We need answers, and we need them quickly. If conventional investigations are leading nowhere, unconventional measures may be needed.’

She focused on Mazzer. ‘I share your concerns, Ibrahim, but I haven’t heard a better idea, and we must be careful not to reject anything until we’ve looked at it carefully. Of course, if we decline to... participate, there’s nothing stopping the ODNI and Maurya going ahead without us. At least if we are involved, we can retain a modicum of control.’

Mazzer was nodding, his earlier outburst forgotten, and Kapur continued.

‘What about sending Dr Kershaw to meet with Gupta and Baldwin to help refine their plan – to give it the best chance of success, with the least risks – and then to report back to us? Just as long as they agree they will shut down this project instantly if it threatens our recovery program in any way.’

Johannesburg 21:00 Thursday 6 January T + 4 days 18 hours

‘You’re going where?’

‘To Shimla. To meet your boss.’

‘Hey, that’s great, Nik. Make sure he gives you one of his souvenir shawls – and ask for a ride in his chopper. Tell him I told you all about it.’

Nikki was on video, so I saw her wicked leer. ‘I’d love to get hold of his chopper! But I wasn’t planning to tell him that we’re friends – unless you already have?’

‘Oh, no, I suppose you’re right.’ If Shan learned that Nikki and I were mates he’d know she was my deep throat in the UN. ‘But he’s very well informed – you may find he knows already.’

‘I’ll let you know, Gip. But listen, I have to leave for JFK to catch my flight...’

‘Okay but... will we be able to chat later – when Bettina gets here?’ I’d already told Nikki that Bettina was coming over to the hotel again to update us on her meeting with her boss, minister Colin Makeba, but I’d said nothing about his involvement in NguniMed, or their secret stash of active ingredients for ARVs. If I had, it might get back to Bettina – better that she tell Nikki herself, which was very likely after a couple of glasses of wine.

‘Oh sure. I’ll have an hour to kill in the departure lounge. I tried to call Betts earlier but I couldn’t get through. I wanted to let her know that we got her inventory of ARVs – just under the wire! I’m dying to hear what’s going on in their hospitals. Will you call me when she arrives?’

After we rang off I sat for a while thinking about Shimla, and wondering whether Nikki would be given the same red-carpet treatment I got. My muse was cut short when Bettina came crashing in with an overnight bag, looking very pleased with herself.

It turned out her minister had no idea how much active ingredient they had at NguniMed, even though he was a major – albeit secret – shareholder in the company. Bettina told me he ‘wasn’t much of a reader’ and relied on verbal briefings on most issues, so he’d not read the routine reports sent to him and simply assumed they were flush with stock because ‘it’s a very well run business.’

After worrying about it all morning, Bettina said raising the issue with Makeba had turned out to be easy – he’d been in a celebratory mood as she briefed him on the restoration of medical services around the country, and no less jovial as she handed him an inventory of ARVs, prior to the looting, which he authorized for immediate release to UNAIDS.

When Bettina told her boss she’d ordered fresh stocks of ARVs from NguniMed, for hospitals that were due for replenishment, he had merely nodded his endorsement of her decision. Then, when she added how relieved she was that the factory had generous reserves of API, he shrugged and said he’d simply assumed this was the case, and asked Bettina to get up-to-date figures from Nguni on their reserves, ‘for planning purposes’.

To crown it all, it seemed Makeba’s instruction not to export antiretrovirals to neighboring countries had been based on yet another misconception – he hadn’t realized that looted ARVs were being returned to hospitals in those countries too, so naturally he thought that sending them fresh stocks would simply add to the already well-stocked garages of the rich and powerful. Today he waved away her concerns about an embargo as simply a misunderstanding.

I asked Bettina whether the minister grasped the irony of his position – he’d proposed an embargo of ARVs to neighboring states for precisely the same reason that the UN had threatened South Africa with the same sanction. Her deadpan response was that the minister was ‘quite unspoiled by stupidity.’

By now we were laughing so loudly that an embarrassed manager arrived at the door to ask us to tone it down, because the people in the next room were trying to sleep!

‘We need champagne!’ I bellowed at the man, who returned ten minutes later with a bottle of Piper- Heidsieck. We called Nikki so she could hear the cork being popped and be jealous, but she smugly reminded us that they had pretty good champagne in the first-class lounge at JFK and on the Emirates flight, so our ambush fell flat – even though our bubbly didn’t.

Johannesburg 15:00 Friday 7 January T+ 5 days 12 hours

Once again I said goodbye to Bettina as she left for her office. I hadn’t argued when she asked to sleep over, even though there seemed to be no risk for her or her family – it was great to have company. If Bettina was kept awake by my snoring, she bore it stoically.

Giving a sisterly hug to Bettina made me miss Emily terribly, so as soon as I was alone I skyped her and spent a happy hour filling in the gaps in what she’d read online. If Em was jealous of my life, or of the people in it, she gave absolutely no indication – and I held nothing back in telling her all about them.

I found myself promising her that I’d book my return flight to Istanbul, and then actually doing it while she giggled incoherently out of my laptop. The quickest connection was Swissair to Zurich, then back to Istanbul, departing Jo’burg at seven that night. Yay!

The day flew by as I tied up all the loose ends to this story and spent an hour in a hairdresser in the giant Sandton City shopping mall, to which the Michelangelo Hotel is attached. By 3pm I was about to ask the concierge to arrange a car to the airport when my phone rang.

‘Gipsy?’

‘Bettina? What’s wrong?’

‘Oh Gipsy! You’re not going to believe...’

‘What? Tell me, girl!’

‘Those ARVs – from NguniMed? The new batch I ordered for our hospitals?’

The concrete mixer in my belly was back, and churning up to maximum speed. ‘Yeah, I remember. What about them?’

‘There’s something wrong with them, some kind of toxicity. Contamination. Patients who take them are reacting... vomiting...’

‘Jesus, Bettina! How many people are affected? And how do you know it’s those ARVs? I thought you only ordered them yesterday?’

‘Yes, but some hospitals were so desperate for them that they sent vehicles to collect them from the factory, and started dispensing them immediately. Patients always take the first dose in the doctor’s rooms, but this time they reacted within half an hour. Nausea and diarrhea. We’re admitting and re-hydrating them but it’ll be hours – days – before we can analyze the medications and know what’s causing this...’

‘Oh Christ, Bettina. But it’s only one batch of ARVs, right?’

Bettina didn’t reply immediately. My heart skidded to a halt. ‘Bettina?’

Finally she spoke, and I could hear she was in tears. ‘...it makes no difference.’

I wanted to be strong for her, but gentle. Strong and gentle. ‘Bettina, girl. What makes no difference?’

Again the pause. What wasn’t she telling me?

‘It’s started again.’

‘What? What’s started? Bettina?’

‘The police. The looting. They must have heard the latest drugs were bad, or that there will be no more. It’s going on right now.’

I’d shut down my laptop, but it was open now and logging on through the hotel’s wireless broadband. I needed to alert our stringers – we couldn’t afford to miss this – but something inside me was praying that Bettina was delusional. Or exaggerating. Or I was dreaming.

‘Gipsy?’ Her voice was very small.

‘Yeah girl?’

‘Can you... not say anything? I mean on your website? Can you keep this quiet?’

‘Oh god, Bettina. I don’t know how to... you know how we work. Most of our news comes from stringers – they post it directly. I... can’t control it. That’s the whole point of TWO. Nobody can stop the news getting out. We’ve got hundreds of stringers all over South Africa. It’s probably already there – on our site. I’m just checking ...’

And it was. The system was working. The genie was out of the bottle. If there was anyone in this country who didn’t know already that ARVs were being cleared out of government hospitals – again – they soon would. As I told Bettina what I was reading, I heard her ragged breathing. She sounded beyond despair.

‘Bettina – if I can write something that will help, I’ll do it. We sorted it out once before, girl.’

‘Oh, Gipsy. I don’t see how we can... really. The minister called. He told me I mustn’t issue any statements to the press without clearing it with him first.’

‘Bettina, let’s work through this together. I bet we can think of something.’

We tried. I cancelled my flight. We roped in Nikki, who was waiting for her connection to Delhi in Dubai. We gave it our best shot.

By the next day – Saturday – the dispensing of antiretrovirals in public health centers throughout South Africa had stopped. By Monday the pressure was back on private hospitals and pharmacies to turn over their remaining stocks of ARVs to their local police.

One piece of good news was that, this time, most private pharmacists had squirreled away their precious stocks of ARVs. But this meant they couldn’t be openly dispensed, which in turn gave a huge boost to the black market.

Another ray of hope was the fact that South Africa’s neighboring countries had not yet received any of the contaminated drugs and, for the most part, their newly restored treatment programs kept going. UNAIDS locked it down by promising an immediate shipment of new ARVs to take the pressure off them.

In South Africa the renewed looting was met with a blast of condemnation from the media, international community and the medical establishment, but silence from the minister, director general, and – bizarrely – from most AIDS patients, who seemed oblivious to the fact that, with every day that passed, tens of thousands more people were being left without the drugs that kept them alive.

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