A Turning Point That Left Millions Behind

For credibility, the so-called sherpas preparing for meetings at the top levels of their companies agreed that any industry plan would need to be embraced by international authorities. They focused on two: Annan and Brundtland, each of whom had something to prove on the issue. Annan's call to arms had come the previous month. It might be worth suggesting, someone said, that Brundtland make an equally public request.

Four days later, Bruntland, the WHO director general, gave her second annual speech to the policymaking executive board. Much of it centered on AIDS. "Squarely put, the drugs are in the north and the disease is in the south," Brundtland said. "I wish to invite the pharmaceutical industry to join us in taking a fresh and constructive look at how we can considerably increase access to relevant drugs."

A teleconference on Feb. 8 brought high-ranking officers of the six companies into the talks for the first time. Among them were Weg of Bristol-Myers; Glaxo Executive Director James Cochrane; Per Wold-Olsen, Merck president for Europe, Middle East and Africa; Pfizer Senior Vice President Ian C. Read; Boehringer corporate marketing director Riku Rautsola; and Roche's global pharmaceutical chief, William M. Burns.

To a man, they were frustrated.

"We've got to get off the subject of prices!" Burns exploded, speaking from his headquarters in Basel, Switzerland. "Prices are not the issue."

At the first mention of prices, lawyers chimed in from speakerphones. They cautioned the executives to steer clear of price-setting, for fear of antitrust violations. But that was not where this conversation was going.

Some of the participants, including Cochrane, wanted to take on the industry's critics--above all Bernard Pecoul of the French medical aid group Doctors Without Borders, and James Love of the Consumer Project on Technology in Washington. According to participants, Jeffrey L. Sturchio of Merck and Glaxo's Ben Plumley, public affairs specialists, said that would be a losing battle. The only way to turn perceptions around, Sturchio said, was "to make something affirmative happen," including substantial price cuts.

That view was not unanimous. Pfizer's Read registered strong dissent, and Pfizer withdrew.

"He said, 'We're not interested,' " said Wold-Olsen. A third participant in the call, speaking on condition of anonymity, said Read "could not accept the concept that affordability was an issue. . . . Pfizer felt it was simply not true. The philosophy here is that the U.S. price of the medicine represents good value, and any discussion of preferential pricing undermines that value in core markets."

Read did not return telephone calls to his office and his home seeking comment. Andrew McCormick, Pfizer's vice president for media relations, declined to detail Read's role in the intercompany talks.

The company principals, now reduced to five, met face to face for the first time on March 2 at the Radisson Heathrow Hotel near London, not far from Glaxo's Middlesex headquarters. In the third-floor Edwardian Suite, laid out as a mock boardroom, they reviewed the confidential "merged drafts" of their initiative.

As planned, the preamble cited Kofi Annan. It said the companies were "taking up his call to action" and would "significantly expand our response to the HIV/AIDS pandemic."