“If it is true that one death is a tragedy, and a million deaths a statistic, then this is a story about statistics.” So begins Fire in the Blood, a compelling documentary by Dylan Mohan Gray. There is, however, nothing remotely prosaic about this story. The film is a powerful exposé of the geopolitics of access to essential HIV medicines in the developing world. It is a David versus Goliath tale of how an unlikely coalition of people worldwide joined forces to fight against the patent monopolies of the world's biggest pharmaceutical conglomerates and secure the right to distribute low-cost antiretroviral drugs to those who need it most.
Mohan Gray gives an unapologetically raw view of the extent to which pharmaceutical companies blocked the sale of generic HIV treatment; in the film he makes the point that between 1996 and 2003, more than 10 million people are estimated to have died from HIV/AIDS in developing countries while life-saving antiretroviral drugs were transforming the lives of those in high-income nations. Patent laws in force at the time made it illegal to make, sell, or import low-cost generic drugs, while the annual price tag of up to about US$15 000 per patient put patented antiretrovirals far out of the reach of patients in poor countries.
The film's narrative begins in 1996 and follows the efforts of key players to bring about change. Peter Mugyenyi, Director and co-founder of Uganda's HIV/AIDS Joint Clinical Research Centre, fought to import generic drugs, only to see them seized on arrival and himself placed under arrest. “I knew where the drugs were, and as a doctor it was my job to save my patients’ lives”, he states. “Let me put it this way—there is no developed country that would have tolerated the loss of millions of their citizens while life-saving drugs were available.” We see Veteran South African HIV campaigner Zackie Achmat, co-founder of the Treatment Action Campaign, telling protestors that “the only reason we are dying is because we are poor”. While intellectual property activist James Love recalls his disbelief on discovering that no government organisation could provide information about the cost of producing a generic triple-therapy antiretroviral cocktail: “They didn't want to know”, he says.
The answer to this question finally came from Yusuf Hamied, head of Indian pharmaceutical company Cipla. Changes to India's Patents Act in 1970 had enabled the manufacture of generic medication, and in 2001 Cipla was able to offer antiretrovirals for the cost-price of $350 per patient per year. But initial optimism was stifled as changes to international trade laws allowed drug companies to fight back. Fire in the Blood shows how at the time Africa accounted for only 1% of global revenue, and yet the multinationals were unwilling to cede any of their patenthold in the region. Mohan Gray takes on the argument that generic drugs rob pharmaceutical companies of money for research and development by highlighting that new drug discovery accounts for a only small proportion of the industry's spending.
Lending gravitas to Mohan Gray's film are insightful contributions from, among others, Bill Clinton, Desmond Tutu, founder of the Generic Trade Association William Haddad, economist Joseph Stiglitz, and former vice president of marketing for Pfizer Peter Rost. Although Rost has distanced himself from the industry, he provides valuable insights into the mindset of pharmaceutical companies to maximise revenue, even at the expense of patients. Interspersed within the film's larger historical and political narrative are personal accounts from people who are alive today only because of access to HIV medication. Their stories, which include those of a high court judge in South Africa, a body-builder in Manipur, and a journalist in Uganda, are immensely moving, and show first-hand that HIV no longer needs to be a death sentence.
Fire in the Blood more than evokes the emotions its name suggests. As Mohan Gray so convincingly shows, although we still have a long way to go in ensuring access to life-saving medicines worldwide, real progress can be made if people are prepared fight for it.
Fire in the Blood
Directed, produced, and written by Dylan Mohan Gray. A Sparkwater India Production/Dartmouth Films, 2012. On general release in the UK http://fireintheblood.com