Man of the World: The Further Endeavors of Bill Clinton (27 page)

In a country where the veil is mandatory, and where women are neither allowed to drive cars nor to venture outside the home without a male relative, this was a shocking incident. If the visiting Americans regarded the presence of women as a minor gesture to modernity, the local religious authorities saw it as a revolutionary offense. The nation’s chief religious authority, Grand Mufti Sheikh Abdul Aziz al-Sheikh, swiftly issued a condemnation:

“We followed what happened at the Jeddah Economic Forum, which should be denounced . . . namely, the mixing of men and women and the latter’s appearance without wearing the Islamic hijab ordered by God. This is prohibited.”

Warning of “dire consequences,” the Mufti continued, “what is even more painful is that such outrageous behavior should have happened in Saudi Arabia, the land of the two holy shrines, whose rulers consistently abided by Islamic law without fear of criticism.” He was also deeply disturbed by the publication of photographs of women, which he said was prohibited by Sharia law. Still worse was the implication in Arabic media that the conference represented “the beginning of the liberation of Saudi women—as if they were being constrained by Islamic law,” he lamented.

The crown prince may have gotten a heavier dose of progress than he expected. When he received the American entourage at his palace in Riyadh, Clinton deliberately mentioned that his guests included Christians and Jews as well as Muslims, which the Saudi leader took in stride. But when Brooke Shearer started to ask him some pointed questions about the oppression of women in Saudi society, Abdullah answered
sharply, reminding her how long American women had waited for the right to vote. Band then jumped up to curtail the exchange and a few moments later, the prince bid his visitors a gracious farewell and left, saying it was time for his evening devotions.

As the Boeing 767 roared into the sky toward Switzerland the next day, Doug Band lounged on a couch in the cabin, talking with the Google trio—Eric Schmidt, Sergey Brin, and Larry Page. He wasn’t looking forward to Davos, which he had attended as a presidential aide to Clinton in the 1990s. While public exchanges of ideas could be important, such elite gatherings were too often, in his view, a waste of time. It was an opinion the young aide had communicated to his boss more than once.

Yet they were on their way again to the world’s most exclusive confab, and Band couldn’t help wondering aloud why. And why weren’t all the important people who would be at Davos—and for that matter, all the people on this aircraft—doing more to address the world’s most pressing problems, instead of just jabbering and networking and drinking little cups of espresso?

If there was anyone in the world who could convene a powerful group like the Davos crowd—and perhaps inspire them to
do something
—that person was Bill Clinton, mused Band. “We could do this differently, with a substantive agenda and a real purpose,” he said as the Google guys listened.

“Do it!” blurted Page, the stubborn, idiosyncratic, and extraordinarily creative engineer, who often talked about his hope that Google would help solve the world’s woes. “Do it,” he said again, as the others nodded. “And we’ll give you money to get started.”

It was late morning when the Clinton entourage finally made its way up winding mountain roads and into the chilly, snow-covered town. Visible atop many of the taller buildings and discreetly stationed along major streets were armed commandos in gray-green camouflage gear, automatic weapons slung over their shoulders.

No fewer than two thousand Swiss Army troops were present to bolster the town’s regular complement of several hundred police officers. With dozens of heads of states arriving, followed by hundreds of other prominent government, corporate, and nonprofit leaders, secu
rity was a deep concern, even in this isolated and inaccessible place. On the Davos schedule along with Clinton were such conspicuous targets as Iranian president Mohammad Khatami and Dick Cheney, vice president of the United States.

As was often his habit, Clinton had remained awake during the six-hour night flight. He was slated to speak at the opening luncheon in the town’s Congress Centre, a sprawling modernistic pile that could accommodate well over 1,500 in its largest room. As
Newsweek
later reported, his appearance drew the largest crowd of the week to hear a sweeping, hour-long overview of the current state of affairs on planet earth, with a focus on “globalization,” the buzzword agitating the few protesters who had found their way into Davos.

“Globalization works for half of us,” he noted pointedly as he began. “The other half lives on less than $2 a day.”

He went on in his usual diplomatic style: “I respect the anti-globalization people and I think a lot of their criticisms are valid. But they want to take us back to a time that never was. . . . Human history is the journey of going from isolation to interdependence to integration. A divided world is unsustainable and dangerous. Anti-globalists want to go from interdependence to isolation, and it’s not possible. We are caught in the middle, and must systematize the process to make real economic difference for all.”

To “smooth the rough edges of globalization,” he said, would require much more from his powerful audience than emergency solutions and gestures toward social responsibility.

“The world is not organized systematically to deal with the fact that we are globally interdependent, whether it’s AIDS or [violent] conflicts or economics,” Clinton lamented. “You change the reality of human history by systematic action.”

He asked his influential listeners to think about how they could help to develop more rational, orderly, effective ways to address the difficulties of a globalizing world. “When you hear about a good thing,” he suggested, “think about how we can systematize it to scale.”

Except to the most wonkish listener, “systematize it to scale” hardly sounded like a plausible solution to climate change, mass unemployment, or a raging pandemic. Yet that clunky phrase had real meaning for Clinton, reflecting his hope that the breakthrough his foundation
had achieved in reducing the price of AIDS medications might indicate fresh approaches to other major problems. His call to action also reflected the frustration expressed by Band and others about the surfeit of chatter at conclaves like Davos.

But Band already was exploring the ways and means to do something very different. While Clinton took questions from the audience, the young aide stepped out of the hall to speak to an older, elegantly attired man with olive skin and graying hair. His name was Richard Attias, and aside from founder Klaus Schwab there was nobody who knew more about the inner mechanics of the World Economic Forum.

A Moroccan-born Jew whose family had immigrated to France, Attias earned a degree in civil engineering and worked for IBM before he founded an event-planning company. In 1995 he met Schwab, who hired him to help “reinvent” the Davos gathering while overseeing its planning and logistics—a job he would handle behind the scenes for well over a decade, keeping track of literally every aspect of the annual meeting, even the distribution of hotel rooms and the selection of menu items.

“How does this work?” Band asked, with a wave of his hand. “And how much does it cost?” He would remain in touch with Attias. And weeks later in New York, Band would start to develop an idea that he eventually called the Clinton Global Initiative.

When Clinton urged his Davos audience to encourage strategies that might benefit humanity, he was speaking from a renewed position of authority. Shortly before the former president boarded the plane that brought his entourage to Saudi Arabia and then Switzerland, he and Ira Magaziner had notched another critical advance in their effort to reduce the cost of HIV/AIDS treatment. It was a step that brought the world a little closer to the prospect of universal care—and “systematic” change.

On January 14, Clinton’s aides summoned the press to the Harlem office, where the former president announced a new agreement between the Clinton HIV/AIDS Initiative and five of the world’s largest medical equipment manufacturers to drastically reduce the price of laboratory testing for the disease in poor countries. Standing beside
him as he spoke were executives of the five companies, notably including Edward J. Ludwig, chairman, president, and CEO of Becton Dickinson, along with executives from Bayer Diagnostics, Beckman Coulter, Inc., Roche Diagnostics, and the French diagnostics giant bioMérieux.

As the first step toward a course of treatment, and then to monitor blood levels of the AIDS virus, routine blood tests are essential to providing effective treatment. For new patients, the CD4 test measures the number of CD4 lymphocytes in the bloodstream, indicating the condition of the immune system and helping doctors determine when to start treatment with antiretroviral drugs.

For patients in treatment, the viral load test measures the amount of viral particles in a milliliter of blood, determining whether a particular drug regimen is effective. To administer them regularly was a prohibitive expense in poorer countries, and an obstacle to treatment almost as daunting as the cost of medicines.

Under the agreement negotiated with the medical companies, the cost of the CD4 test would be cut by more than half, Ludwig told the assembled journalists. The other executives present declined to be specific, but the foundation’s press release stated that the reductions would cut costs by “up to 80 percent” below prices currently charged in developing countries.

Combined with the reductions achieved by the generic drug manufacturers, this meant that the cost of treating a single AIDS patient for a year in those countries would drop from around $800 a year to less than $250, a reduction of 70 percent. Initially, the lower-cost tests would be available in the sixteen nations where CHAI already was working to provide low-cost generic medicines and improved management of care—and eventually the new price regime would be expanded to other countries in Africa, Asia, the Caribbean, and Latin America.

Listening quietly in the fourteenth-floor office as the cameras whirred were Magaziner and the blue-ribbon team that had advised him, without compensation, during months of shuttle negotiations with the manufacturers—attorneys Steve Petras of Baker & Hostetler and Richard Zall of Mintz, Levin; and Harvard AIDS experts Trevor Peter and Dr. William Rodriguez.

“These companies are world leaders in their fields, and they deserve credit for their willingness and desire to make AIDS tests more afford
able and more available to millions of people in the developing world,” intoned Clinton. “They have stepped up to the plate and demonstrated tremendous compassion and corporate citizenship.”

While the medical companies had earned Clinton’s praise, the truth about the diagnostics deal was slightly more complicated than his remarks suggested. For months, in parallel with the negotiations Magaziner and his team were conducting with the generic drugmakers, they had simultaneously engaged in talks with the test manufacturers. And for months, those talks had moved very slowly, or not at all. When Clinton had announced the generic drug deal in November 2003, the pace quickened overnight.

Neither Ludwig nor his competitors relished the possibility of competition with companies in India—a threat that no longer seemed idle—and their attitude suddenly changed. The agreement was completed in a matter of weeks, despite the December holidays.

Around the same time, the pharmaceutical firms Boehringer Ingelheim and GlaxoSmithKline announced that they would license production of their AIDS drugs by four generic firms in India and South Africa for sale throughout sub-Saharan Africa—in return for a mere 5 percent royalty. A combination of threatened fines and the deal Clinton announced two months earlier seemed to have concentrated the minds of Jean-Pierre Garnier, the once dismissive GSK boss, and his counterparts at Boehringer Ingelheim.

The ramifications of CHAI’s intervention appeared to be spreading well beyond the countries that initially joined with Clinton and into the broader market.

“We are systematically changing the economics of AIDS treatment in places where, before now, very few people have been able to receive life-saving care,” said Clinton at the Harlem press conference. “By pushing down the price of HIV/AIDS medicine and laboratory tests, we are ramping up the ability of developing countries to treat millions of people, and to do so with the kind of quality of care that people with AIDS in the developed world usually receive.”

Even as Clinton hailed the diagnostics and generic drug deals, he had no illusions about the reaction that attempts to bring systemic change
provoke from powerful interests—in this instance, the branded pharmaceutical industry, which was fighting the adoption of generic drug formulations for AIDS treatment. He and Magaziner knew that Bush administration officials had warned CHAI’s partners in Africa that PEPFAR’s billions in aid and research funding would be withheld from any agency or country participating in the generic drug purchasing scheme.

On a visit to Paris early in 2004 at the behest of former treasury secretary and Citicorp executive Robert Rubin, who had invited him to address an event sponsored by the bank, Clinton encountered the opposition in person.

Over dinner at an opulent Parisian restaurant with Rubin’s other guests, he sat near Hank McKinnell, president of the New York–based pharmaceutical giant Pfizer, Inc. Clinton knew that Pfizer was heavily involved in research, development, and production of HIV/AIDS medications, and was donating as many as sixty thousand doses a year. He also knew McKinnell’s reputation as an aggressive advocate of legal and political action to protect his industry’s intellectual property rights against foreign governments and generic manufacturers.

“Somebody at our table asked me about what we were doing,” Clinton recalled later. He began to talk about CHAI’s progress in bringing AIDS treatment to countries hit hardest by the pandemic, through the bulk purchase of generic drugs.

Almost immediately, McKinnell voiced his objections. “You know,” said the Pfizer executive, “the generics are just not any good. They’re only 60 percent as effective as my drugs.” But Clinton had heard dozens of firsthand reports from communities across the Caribbean and Africa where people who had been dying were surviving, thanks to a generic drug regimen. And he had read several early studies of the impact of generics in AIDS-stricken communities.