Exposing an unpunished crime

FIRE IN the Blood is a documentary that exposes in meticulous detail how the international pharmaceutical industry, in collusion with Western governments, blocked access to medication for millions of people dying from AIDS on the African continent and in the Global South.

It's a story of one of the greatest unpunished crimes of the 20th century, but also an amazing tale of a grassroots movement that fought and won massive price reductions in the cost of AIDS drugs. It is also a story that took over two decades to reach a mass audience through this documentary.

The film is standard documentary filmmaking, with gorgeous digital footage interspersed with talking heads, but because the issue and the people who appear are so compelling, it's never boring.

The central issue that Fire in the Blood addresses was shrouded in secrecy before the advent of AIDS: patents on medicine. The drug companies are among the most profitable of all corporations because patent monopolies bar other companies from manufacturing critical medicines, often for decades.

The discovery of a new class of drugs, protease inhibitors, in the late 1980s and 1990s changed AIDS from being a death sentence to a chronic disease that could be managed. Patients who take a combination of these drugs--known as highly active anti-retrovirus therapy, or HAART--would live, and those who didn't would die. It was that simple.

The cost of a year of HAART in the 1990s was over $15,000 a year, well out of reach for people in developing nations where the AIDS epidemic hit hardest.

IN THE film, doctors in South Africa and Uganda recount how entire families and villages were wiped out. It's estimated that there were 8,000 deaths per day from AIDS in sub-Saharan Africa during the 1990s, and more than 10 million unnecessary deaths overall from lack of access to medication. Doctors were put in impossible ethical situations by having to decide which patients would get medication from restricted supplies--in effect, playing god.

If there is a true hero in Fire in the Blood, it is Dr. Peter Mugyenyi. Year after year in his clinic in the Ugandan capital of Kampala, he could do nothing to stop the deaths of his pediatric patients. It outraged him that medicines existed to end this needless death.

Mugyenyi appealed to the pharmaceutical industry on humanitarian grounds, but to no avail. AIDS drug manufacturers used their political power to ensure their patents were protected, and that cheap generics couldn't be imported. Mugyenyi also had to confront the racist argument that it would be a waste to give poor Africans access to expensive drugs because they wouldn't be able to adhere to a strict medication regimen.

So he took direct action. Mugyenyi ordered generic drugs from India in defiance of Uganda's patent laws. He challenged the authorities to arrest him and refused to leave the airport until the drugs were allowed into the country and guarantees were given that drugs could be imported in the future. He won his battle.

The Treatment Action Campaign (TAC) in South Africa played a crucial role in mobilizing thousands of HIV-positive people to fight for access to medication.

The protests, which many viewers probably have never seen, get a fair amount of screen time and are exhilarating to watch. At the International AIDS conference in Durban in 2000, TAC organized a series of protests attacking the pharmaceutical industry. Their slogan was "Patents Kill Patients." In an interview, Zackie Achmat, a leader of TAC, states, "All those people who had the power to stop it, including drug company executives, but didn't, are responsible for all those deaths. The rich world didn't care until the poor mobilized."

All over the world people began to question how drug companies operated. How could it be that millions were dying of AIDS when medicines were available to treat the disease? What kind of an economic system protects the rights of patent holders, but denies human beings the right to life-saving medication?

The story of TAC is part of the "people's history" of the movement to make HIV medications a human right. The struggle against the greed of the drug companies saved lives all over the world.

Generic drugs finally reached AIDS patients in Africa because of CIPLA, the Indian generic drug company. Yusef Hamied, the chairman of CIPLA, lowered the price of AIDS drugs to less than $1 a day.

Hamied is a fascinating and contradictory character. He's a capitalist with a conscious, who said he believed Gandhian business principles. Hamied was instrumental in India passing the Patent Act of 1970, which eliminated product patents on medicine in India.

DURING FIRE in the Blood, other interviewees fill in little-known details about the drug industry's war to block HIV medications from reaching the dying.

Peter Rost, the former vice president of Pfizer-turned-whistle-blower, explains that drug makers aren't concerned about poor people because they're not a market--they don't have the money to pay for the industry's products. James Love, an expert on international intellectual property laws, explains how patents work and why they need to be reformed. His activism was crucial in getting politicians and governments to rethink the human cost of enforcing patent laws.

There is one major problem with Fire in the Blood: Bill Clinton. He should never have been allowed in this film as a sympathetic character, rather than a partner with the drug company villains. His administration brought trade sanctions against South Africa over a 1997 South African law endorsed by President Nelson Mandela to allow the country to manufacture or import inexpensive versions of high-priced U.S.-patented AIDS drugs.

Clinton and Vice President Al Gore, working with the Office of the U.S. Trade Representative and drug makers, attempted to block the law in South African courts. Gore, then the chair of the U.S.-South Africa Binational Commission, put pressure on Mandela and his government to repeal the law.

Clinton was on the side of the pharmaceutical industry, not AIDS patients. The film doesn't reveal any of this--instead, Clinton is rehabilitated as a humanitarian and savior of poor Black Africans. You'll need a vomit bag handy for when Clinton declares, "We can never let this happen again"--Clinton let it keep happening in the first place when he had the power to stop it.

At a New York screening of the film, I was able to ask the director, Dylan Mohan Grey, why Clinton was in the documentary. Grey admitted that the number one criticism of the film among test audiences was Bill Clinton. But Grey felt his inclusion was necessary because of the subsequent role his organization, the Clinton Health Access Initiative, has played in pushing down the price of generic AIDS drugs in Africa.

Despite this very real weakness, Fire in the Blood is a revelation. It is a film full of tragedy, but also of triumph.