Fire in the Blood: Sundance Review

A provocative wakeup call that presents vital evidence in the ongoing global healthcare debate.

Director Dylan Mohan Gray probes the gross injustices of AIDS treatment in Africa, chronicling the battle of a dedicated group of people to break down pharmaceutical industry resistance.

PARK CITY – Anyone minimally aware of the evolution of HIV treatment in the past two decades will know that much of the developing world, and Africa in particular, was callously excluded from the anti-retroviral breakthrough of the mid-1990s, when AIDS was suddenly no longer an automatic death sentence. But the admirable balance between impassioned argument and clear-sighted reporting in Dylan Mohan Gray’s chronicle of the why and how makes Fire in the Blood indispensable viewing. This is a shocking account of international trade terrorism sanctioned by Western governments.

Perhaps the smartest thing about this very smart documentary from India, however, is that neither Gray nor his many well-credentialed talking heads make this predominantly a political issue. Instead, the subject is presented from the start in non-partisan terms as “a crisis of humanity.”

One of last year’s Sundance breakout entries, David France’s Oscar-nominated How to Survive a Plague was an emotional history of the rocky path to effective combination therapy, documenting the hard-fought battle against the unresponsive U.S. government, health organizations and the pharmaceutical industry that led to the protease inhibitor revolution.

Picking up more or less where that film left off, Fire in the Blood is in a sense a global sequel, showing how AIDS activist groups and government bodies turned their backs on the plight of Africa, a continent that by 2000 had more than two-thirds of the world’s cases of HIV infection.

Given the prohibitive pricing of branded drugs and the trade restrictions that kept cheaper generic alternatives out of reach, Africa had minimal access to lifesaving medications for years after they became available. According to one statistic cited by George W. Bush in his 2003 State of the Union address, out of 30 million Africans with HIV, only 50,000 were receiving treatment.

The explanation for how that genocide of indifference was allowed to continue for so long and now risks a recurrence after some years of reprieve is simple. It boils down to blatant manipulation by the pharmaceutical giants. The most profitable industry on the planet strictly interprets the word "patent" to mean "monopoly."

Just as France’s film identified heroes within the movement, so too does Gray focus on a handful of individuals who made a difference. Among them are James P. Love, an American intellectual property activist; Dr. Peter Mugyenyi, head of the largest HIV treatment and research center in Uganda; Zackie Achmat, a South African AIDS activist; and Yusuf Hamied, the Indian scientist behind the socially conscious pharmaceutical manufacturer Cipla.

The greed of Big Pharma that these men go up against is perhaps unremarkable. As pointed out by former Pfizer VP Peter Rost, who has distanced himself ideologically from the industry’s business methods, those companies are naturally focused on the bottom line of profit and shareholder satisfaction. Gray’s film details the laughable percentage of pharmaceutical revenues funneled back into medical research, which remains primarily government-funded. But the formidable resistance posed by the industry to low-cost solutions at the expense of 10 million lives in Africa is nonetheless astonishing.

What’s even more mind-blowing is the evidence, carefully mapped out, of how little lifesaving AIDS drugs actually cost to produce.

Gray’s central narrative outlines the plan spearheaded by Hamied to slash the cost of generic antiretrovirals for poor countries, and provide their governments with the know-how and technology to manufacture their own drugs. When that offer found no takers at the European Commission in Brussels, Hamied and his colleagues then returned with a second proposal that eliminated all overheads, charging only for the ingredients. That step made sense purely on a humanitarian level, not an economic one.

The wall of willful ignorance put up against this strategy by the World Health Organization, UNAIDS and by U.S. and European governments in the stranglehold of the pharmaceutical lobby is expertly outlined. But mounting political and public pressure ultimately broke the blockade.

The film is extremely moving as it illustrates the overwhelmingly positive impact of affordable ARVs in African countries. But that uplifting chapter ends abruptly. While Big Pharma conceded the battle, the industry won the war by enlisting the World Trade Organization as its global bully to protect future profits.

Gray sifts through this recent history with methodical clarity, positioning his findings within the big picture of a healthcare industry that is holding the world hostage. Insightful commentary to support the film’s justified alarmism comes from, among others, Nobel prize winning economist Joseph Stiglitz, Bill Clinton, New York Times health reporter Donald McNeil, and Washington veteran William F. Haddad, a longtime advocate of generic drug trade. Going forward, the implications are made evident, not just for the Third World but also for America, where an increasing number of citizens lack access to prescription medications.

Crisply shot and edited, with effective use of Ashutosh Phatak’s graceful music, this is a powerful documentary that demands to be seen by as wide an audience as possible.

Venue: Sundance Film Festival (World Cinema Documentary Competition)
Production companies: Sparkwater India, Dartmouth Films
Director-screenwriter-producer: Dylan Mohan Gray
Executive producer: Christopher Hird
Director of photography: Jay Jay Odedra
Music: Ashutosh Phatak
Editors: Dylan Mohan Gray, Chris Seward, Pascal Akesson, Hugh Williams
Sales: Films Transit International
No rating, 84 minutes