What appealed to you about this particular story and the wider subject?
Initially it was really just shock and disgust that so many millions of lives could be so callously and I would say brutally set aside, with very little attention paid to the fact and no one called to account. Then it seemed absolutely incredible to me that there was no book or film on the subject, aside from some contemporary news pieces. Later, once I started delving more deeply into it, I was immensely moved and inspired by the people who played key roles in breaking the blockade of AIDS drugs into Africa, and it struck me that the example of their passion, bravery and determination could potentially ignite a spark in all kinds of people inclined to work for change, in whatever area, but who might doubt their power to actually make a difference. And finally, when it became clear to me that the story was being lost, swept under the rug and forgotten, that there was a very real threat no lessons would be taken from this unimaginable atrocity and that the drug industry and major Western governments were actively working to shut down future production of low-cost generic medicine in the global south, something which will almost certainly lead to horrific, unnecessary loss of life in rich countries as well as poor, it seemed to me that there was no option but to try and do something to get this story out there.
When did you start learning about this story and begin think about making a film about it?
The genesis of the project goes back to the spring of 2004, when I was working on a film in Sri Lanka and happened to read an article in The Economist about Yusuf Hamied, an Indian generic drugmaker who was battling to get lower-cost AIDS drugs into developing countries. I was both fascinated by the story and surprised I hadn’t heard more about it, and quite soon thereafter by a quirk of fate it turned out that my friend, who later became my partner, is actually related to Dr. Hamied, so I was able to go meet him in Bombay some months later, and eventually through him met several other people who would later become key contributors to the film.
How long did it take you to complete it and what were the biggest challenges, both in accessing information and getting to speak to people you needed to interview, including Bill Clinton?
The original firm decision to do the film was taken in June 2007 and I have been working on it ever since then. Without a doubt the biggest challenge was taking a fairly complex story and subject with a lot of important strands, and trying to distil it down into something that could be both comprehensible and compelling for general audiences. When I did my initial research I had drawn up a list of people I really wanted to do on-camera interviews with for the film, and ultimately I got all of them. Unsurprisingly, the most difficult person on the list to get time with was Bill Clinton. It took a year and a half to schedule the interview, and even on the day it looked like it might actually get cancelled, but finally it came through, which of course I was extremely happy about since he plays such an important part in this story.
What drove you to make a film about AIDS and pharmaceutical companies?
I didn’t have any interest in making a film about either. There are plenty of films on AIDS already, and I would also say that pharmaceutical companies are not necessarily interesting as a subject either. This film is really a case study about human rights, globalization, trade, big business and the extent to which governments work on behalf of immensely profitable corporations against the better interests of huge swaths of humankind. The real villain of this story for me is not an industry addicted to astronomical profits, irrespective of the consequences, but the governments which do their deadly bidding, all the while firmly perched on a high moral horse and claiming to care about human rights.
Why aren’t there more contributors from Big Pharma in the film?
I made a decision very early on in the process to include among the interviewees only people who played a direct role in the story. I certainly wasn’t interested in including paid mouthpieces or lobbyists, which is what the pharma industry always offers people like me doing stories about it. There were a number of players from ‘Big Pharma’ whom I would have liked to bring in, but they weren’t interested in participating. I have spoken to many of them off the record, and often they cite confidentiality agreements which prohibit them for speaking about their time in whichever company, although almost all of them are now no longer part of the industry. Just as an aside, I have found it exceptionally interesting how the current and recent leadership of major drug companies has tended to absolve itself of responsibility in the crimes portrayed in the film by pointing to the fact that there is now a “new generation” of executives, which has “learned many lessons”, that “that was a different time”, etc. Contrition is rarely expressed.
In earlier versions of the film I included a number of Big Pharma executives from that era in archive material, but in the end I had to break my rule and bring in an honest but alas not-directly-involved ‘pharma voice’ in the person of Peter Rost. He was a high-level executive at three major pharmaceutical companies during a decades-long career, a genuine “true believer” in what the drug industry stands for and has achieved, until eventually as Vice-President of Pfizer becoming deeply disillusioned with its business practices and turning whistleblower. I often say that of all the people in this film, Dr. Rost is almost certainly the one most hated by Big Pharma, since he was the ultimate insider and his insights are impossible for them to brush aside with a dismissive wave of the hand.
What would you like the public to understand by watching this film?
The levels of popular understanding about how basic research into life-saving drugs, almost all of which is publicly-funded, comes to be controlled by a handful of giant corporations, which then use government-granted monopoly power to price the resulting medicine far out of reach to all but the most privileged and affluent sliver of the world’s population, are exceptionally low. I certainly think this film has the potential to be a very important conversation-starter. At the moment there is essentially no conversation, despite the fact that up to a third of all deaths worldwide in any given year are directly attributable to this systemic problem.
Ultimately I hope Fire in the Blood can open a lot of people’s eyes to the fundamental inhumanity and unsustainability of the current set-up, and the urgent need to begin effecting positive change in terms of how life-saving medicines are researched, developed and delivered to the global public.
What would you say about the people like Zackie Achmat portrayed in the film, who took such great risks in order to make sure others could access drugs?
They are real heroes to me, and I hope their work gets considerably more recognition because of Fire in the Blood. I have always felt that if people like Zackie, Peter Mugyenyi or Yusuf Hamied were German or Swiss instead of African or Indian, everyone in the world would know their names.
You were trained as a historian. How did this background influence the making of this film?
I would say my interest in and study of history influence everything in my life, and of course everything in my working life. This includes obvious things like research methods, but also trying to frame a narrative in such a way as to place things into a firm historical context, and underscoring aspects of the material which are likely to be significant in future, to avoid getting pulled into discussions about current affairs. The study of history should ideally also instill ethical principles of fairness, not taking facts or statements out of context, not omitting pertinent information which doesn’t necessarily serve one’s hypotheses, understanding that people in past years did not have all the information at their disposal that we do today, and so on.
What kind of policy change would you like to see come out of this film?
First of all I would definitely agree that it would be wonderful to see this film ultimately lead to critical changes in policy, because as I have said the current system of developing and commercializing medicine is totally inappropriate for addressing the needs of global public health. That having been said, specific policy objectives will naturally vary from jurisdiction to jurisdiction, depending on what the key barriers to access are in a given place, and where useful opportunities for change appear.
In general, however, there are several principles which in my view could go a long way toward protecting the public interest, ensuring and expanding access to lifesaving medicine:
• Patent-holders should not be allowed to have monopolies on essential medicines (the ‘Canadian model’, whereby no monopoly was allowed, but a royalty of 4- or 5% was paid to patent-holding companies when generic versions of their products were made and sold, worked beautifully for 70 years)
• Publicly-funded research should be freely accessible and serve the public good
• There should be a mechanism for challenge the validity of patents on medicine before they are granted (the ‘Indian model’, also known as ‘pre-grant opposition’, has proven very useful in discouraging bogus and frivolous patent claims, which are an especially significant problem in the realm of pharmaceuticals)
• The US and other Western governments must make an explicit commitment not to exert economic pressure on, or threaten sanctions against, developing countries for exercising their international rights to make essential medicine available to their citizens
• Any pharmaceutical company applying for a patent must publicly disclose associated research costs
• Doctors and pharmacists should be required to disclose any remuneration or non-monetary incentives they receive from pharmaceutical companies in a publicly-accessible database
• Pharmaceutical companies and researchers should be legally required to disclose all research results, and there should be significant criminal penalties for not doing so
Of these, the first two are obviously the most important.
Intellectual property and access to medicine might seem at first to be topics which would make for a pretty dry film... have you found it can be tough to pique people’s curiosity?
It can be difficult at times, mainly because the issues don’t necessarily lend themselves to being encapsulated in a few words. In my experience, it is important to underline that this film tells a story, rather than being about an issue, but also to make it clear that the story is one which is extremely relevant and important to all of us. Of course they get all that when they see the film, but as you say the challenge is often in piquing that initial curiosity. A strong trailer helps, and we have had an excellent response to ours, probably because it really highlights the “crime story” nature of the film. I was at the Toronto Film Festival a few years back, meeting a lot of important, busy people in quick succession, with precious little time to make my case, which is why I began to introduce the film as being about “the Crime of the Century”. Once I said that, people invariably wanted to hear more about it, and more importantly listened to what I had to say from that point onward with a view to learning about a unique crime, rather than an ‘issue’.
Isn’t it stretching things to refer to this story as the crime of the century?
No... and, if so, then only in the sense that there’s still a fair bit of the 21st century left... although it’s worth pointing out that the Lindbergh kidnapping, the case commonly associated with the phrase, also took place relatively early in the 20th century. Fire in the Blood tells the story of a crime which killed more people than just about any other in history (though there will always be debates as to how something like the Great Leap Forward should be categorized), yet in contrast with various other well-known mass atrocities and genocides, relatively few people are on the one hand aware of its dimensions or on the other hand realize that this was in no way the unavoidable calamity it has generally been made out to be... so I do feel very strongly that the moniker of “Crime of the Century” is totally apt in this case, and that it also puts the magnitude of what happened into appropriate context.
- This Q&A has been adapted from questions Dylan has been asked by interviewers -
“Whenever anyone asks me what Fire in the Blood is all about, I always say it’s about the Crime of the Century. I felt totally compelled to make this film because the historian in me first could not believe, and then could not accept that there was not a single film or even book in circulation which told this endlessly fascinating and important story...”
Several years ago I got to know a couple of the key figures in the film, and soon thereafter began to learn about the “sick business” of medicine. The more I read, saw and heard, the more I became convinced that this film had to be made, and made before the story it tells was completely obscured and lost.
As in the film, it was the unimaginable carnage of AIDS, first and foremost in Sub-Saharan Africa, which infused urgency into the fundamental question of access to medicine. For several years after the breakthrough of combination antiretroviral (ARV) therapy had turned HIV/AIDS from a death sentence to a highly manageable chronic condition in rich countries, millions in the global south were condemned to die horrible, agonizing deaths by the world’s very most profitable companies – patent-holding pharma conglomerates – and, more accurately, the Western governments doing their bidding.
Along with the profound sense of disgust which is the only rational response to cynicism and inhumanity of this magnitude – all of it, as it turns out, justified with the most flimsy of commercial rationales – came the immense admiration and respect with which I grew to regard the few brave individuals who refused to accept what virtually everybody at the time considered to be an unfortunate-but-inevitable state of affairs, whose relentless, stubborn determination ultimately ensured that millions of lives would be saved in Africa and across the global south through the introduction of affordable generic AIDS drugs.
In the end it is that which really spoke to me about this story: that from something unspeakably dark and inhuman a spark could be struck, that even one or two small, unknown, unconnected individuals could take on the most massive, powerful and unyielding of adversaries, and actually manage to change the world.