The film Treatment For All (produced by Colectivo Miradas as part of its larger project When Droplets Become Rain), which aired on teleSUR on Oct. 8, chronicles the first eight months of struggle led by the Association of People Affected by Hepatitis C (PLAFHC) in Spain.
Using militant direct action tactics, the PLAFHC forced an unwilling Spanish government to reckon with its constitutional mandate to provide healthcare as a human right, and to provide Hepatitis C patients access to lifesaving medicine.
Hepatitis C is a global public health crisis. According to the World Health Organization, 80 million people or more are estimated to be living with the disease. Every year, at least 700,000 people die from complications from the Hepatitis C virus (HCV) including cirrhosis, liver failure, and liver cancer. But this is not for lack of a cure; sofosbuvir —a drug marketed as Sovaldi and (in combination with ledipasvir) Harvoni by the pharmaceutical giant Gilead—has an over 90 percent success rate in eradicating HCV in just 8-12 weeks of treatment. Prior to the availability of sofosbuvir, HCV treatments involved up to a year of treatment with a painful interferon-based regimen that provided cure rates of 70 percent or less and was associated with severe side effects including anemia, depression, rash, nausea, diarrhea, and fatigue.
Sovaldi was developed in 2007 out of U.S. taxpayer-funded research and first tested in people to treat Hepatitis C in 2010. In 2011, Gilead bought the company that owned the patent, Pharmasset, for close to US$11 billion. This proved a worthwhile investment for the corporation, which profited US$12.4 billion on Sovaldi and Harvoni in 2014 alone. In Spain, which has a universal public healthcare system, Sovaldi was approved for inclusion in the national formulary in October, 2014, but the move was merely symbolic.
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Though numerous doctors prescribed the medication, Spain’s National Health Ministry refused to provide it to their patients, citing its exorbitant price tag: at the time US$84,000 for a 12-week Sovaldi treatment (Harvoni is even more expensive). However, over 99.99 percent of the treatment’s price is profit to Gilead, as demonstrated by a 2014 study published in Clinical Infectious Diseases placing the actual production cost of a 12-week course of sofosbuvir at between US$68 and US$136.
Gilead’s price-gouging led to world-wide protests against the company and against national governments that refused to negotiate for cheaper or generic versions of the drug. Advocates argue that the greed of pharmaceutical and insurance corporations is killing HCV patients, and that the only real solution lies in developing free and universal healthcare systems approaching health as a human right. Indeed, in its Oct. 2016 Global Report on Access to Hepatitis C Treatment, the World Health Organization affirms that the epidemic can only be effectively addressed through universal health coverage.
In Spain, healthcare has legally been considered a human right since the ratification of the country’s 1978 constitution following the dictator Franco’s death. It took over a decade more for a free, universal healthcare system to be put in place. Beginning in the early 1990s, however, the push for privatization of healthcare provision began. Following the 2008 economic crisis, austerity policies dramatically impacted the quality of service that healthcare workers were able to provide, harming worker safety and patient health.
As a recent study published in PloS Medicine points out, current HCV medication prices “threaten the sustainability of health systems in many countries and prevent large-scale provision of treatment.” In other words, if existing single payer and universal healthcare systems like Spain’s can’t or won’t force Gilead to lower its prices, then making HCV medications available to patients will bankrupt them. And as PLAFHC activists note in the case of Spain, there is a sinister collusion between Big Pharma and neoliberal governments intent on privatizing national healthcare systems to increase corporate profits.
Gilead’s attempt at mitigating PR damage over the international Sovaldi pricing scandal included a very partial discount plan and/or permitting generic production in select countries including India—where treatment now costs as little as US$500 per person. Other countries have negotiated directly with Gilead for discounts, but the cost of treatment is still in the tens of thousands of dollars per patient, in many cases surpassing average per capita annual income.
In recent years, pro-austerity Prime Minister Mariano Rajoy of the right-wing People’s Party has accelerated attacks on Spain’s public health system. In 2012, just as the Obama administration did three years earlier in the United States, Rajoy’s government spent between 60 and 100 billion Euros bailing out banks while making vast cuts to social services. Rajoy’s administration has been plagued with corruption, including the Tarjetas Black scandal, mentioned in passing in this film: in October 2014, it was discovered that Bankia, the bank that received the highest percentage of the 2012 public money bailout, gave special “black” credit cards with unlimited funds to all of its board members and some friends.
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Some recipients spent upwards of US$400,000 on massages, champagne, sex, hotels, and extravagant vacations. In total at least 83 people spent a total of over 15 million euros.
Meanwhile, in 2012, the same year as the bank bailout, the Rajoy administration announced major cutbacks to the Public Health System. Seven billion Euros were cut from the healthcare budget and numerous hospitals were closed. Many life-essential drugs were removed from the formulary. Immigrants without proper documentation were barred from accessing any healthcare services apart from emergency room care and birth services.
“La sanidad publica no se vende, se defiende” (“Public health is not for sale; it must be protected”)
Various groups, including the Marea Blanca (“White Tide”—in reference to the mass of white lab coats worn by protesting doctors), arose during the massive “15M” anti-austerity movement and in response to the 2012 health cutbacks to defend and improve Spain’s universal public health system. In January 2014, the Marea Blanca and its allies succeeded in blocking a plan to fully privatize six of the most important hospitals in Madrid. In November 2014, months after it became clear that the Rajoy administration would not provide Sovaldi to people with late-stage HCV-related illnesses, HCV patients and family members came together to form PLAFHC. On December 18th, 2014, inspired by recent anti-austerity healthcare victories, members of PLAFHC occupied the Doce de Octubre Hospital.
PLAFHC members camped out in the hospital’s lobby (with the full support of hospital staff) for 94 days, using it as a center of operation for the many actions that appear in this film. These include: a human chain outside the Ministry of Health (December 27, 2014); a march to the Prime Minister’s residence at Moncloa (January 10, 2015); a rally outside the EU Parliament building in Brussels (January 21, 2015); the filing at the Supreme Court of a criminal complaint against authorities for the murder of patients denied treatment (February 13, 2015); a motorcycle march (February 15, 2015); a press conference on the occasion of the delivery of over 200,000 signatures to the Spanish Congress demanding action (February 23, 2015); a march to the Spanish Parliament, joined by PLAFHC members from all regions of Spain (March 1, 2015); and the end of the hospital occupation marked by the March for Dignity (March 21, 2015).
As a result of the mobilizations depicted in this film, in April 2015 the Spanish government approved a plan promising to provide treatment for people with the most severe stages (F2-F4) of HCV. However, a month later (May 28, 2015) PLAFHC held a press conference denouncing the administration’s bad faith refusal to allocate the funding necessary to fulfill its commitment to provide Sovaldi to HCV patients with prescriptions for the drug.
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While the film ends here, the struggle did not. PLAFHC succeeded in forcing the Spanish government to negotiate lower prices with Gilead and provide funding to treat the most acute patients, as it had promised. In February 2017, pressure from PLAFHC obligated the Spanish government to agree to provide the appropriate sofosbuvir-based treatments to patients at any stage of HCV. Once again, however, the organization has denounced that the government has not provided adequate funding to cover the cost of universal treatment.
PLAFHC has also continued to demand access to generic versions of the drug, so as to not bankrupt the national healthcare system. It has carried out extensive work to ensure access to HCV treatment in prisons, where HCV rates are much higher than in the general population, and it has led the effort to build a coalition across the European Union of organizations dedicated to access to treatment as a human right. For their efforts, PLAFHC was awarded the EU Parliament's European Citizens’ Prize in September 2017.
Treatment for All provides an inspirational look at how Spanish patients and their allies came together as the PLAFHC to fight against Gilead and the Spanish government in order to ensure access to sofosbuvir-based treatments in Spain. Their struggle demonstrates that with direct-action tactics, broad-based mobilization and coalition-building, patient advocates can win against powerful corporations and neoliberal governments to achieve health as a human right. As the fight for single payer healthcare heats up in California and the United States, we would do well to learn from organizations like PLAFHC, which insist that our health is not for sale, and demonstrate that solidarity and militant struggle are necessary to ensure that everyone receives the care they need.
Adrienne Pine is Associate Professor of Anthropology at American University, where she also directs the Certificate Program in Health Inequity and Care, a collaboration between National Nurses United and AU.