Movies

The Director of the Definitive AIDS Documentary Came to a Sobering Conclusion About COVID

The maker of How to Survive a Plague on his new HBO documentary, How to Survive a Pandemic.

Three nurses in white bodysuits stand in front of an open truck trunk in a white corridor.
HBO

This isn’t David France’s first pandemic. In 2012, he turned years of firsthand reporting on AIDS activism in the 1980s into the Oscar-nominated documentary How to Survive a Plague. A decade later, he’s back with a sequel of sorts, the COVID documentary How to Survive a Pandemic, which debuts on HBO March 29. France saw the parallels between the two pandemics early on and contacted camera crews around the world to get a sense of the growing catastrophe when it was impossible for him to travel.

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The earliest COVID documentaries focused on the crisis itself, but France begins his with the announcement of the successful vaccine trials—a moment of triumph that we already know portends a different kind of crisis altogether. The movie’s first half focuses on the race to develop the vaccine, featuring many scientists who cut their teeth on HIV research. (Anthony Fauci looms large in both movies, but now France knows him well enough to conduct their interview over a glass of wine.) Midway through, an ominous “Part II” caption appears on screen, the transition to when the issue is not whether the vaccine exists but whom it’s available to, and the people who won’t take it even though they can. The movie briefly acknowledges both vaccine hesitancy and more militant anti-vax sentiment in the United States, but its real focus in the second half is on the rest of the world, especially countries outside Europe and North America, where vaccines have been prohibitively priced or simply impossible to obtain. It’s a sobering reminder, even as the U.S. rushes to get back to pre-pandemic normal, how far we’ve let others fall behind and how impossible it is to separate our fates from theirs. Our conversation has been edited and condensed for clarity.

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Sam Adams: The title of How to Survive a Pandemic obviously sets up a comparison with How to Survive a Plague, your documentary about the AIDS crisis. When did you start seeing parallels between the two?

David France: Well, I immediately thought of it as being the next pandemic. So many of the people I know are still so injured from the previous one, and I recognize that my people, the survivors of the AIDS pandemic, were having special difficulties in coping with lockdown and this whole idea that once again we’re facing the prospect of death. One of the things that launched this project was knowing that so many of the scientists working on COVID were also from that previous pandemic, and I knew many of those researchers from my journalism around HIV/AIDS. So I thought of it as a kind of a bringing back together of the band in a way that might reflect the knowledge learned over the last 40 years and might be connected in ways that would be interesting to discover.

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The first thing I did after finishing Pandemic was go back and rewatch Plague, which starts by informing us that it’s year six of the AIDS crisis and there are still no drugs to treat the disease. That’s a huge difference from what happened with COVID.

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Absolutely. It took street activism and the impact of the community to get researchers busy in the HIV/AIDS world and to really change the way research is done in Big Pharma and elsewhere. And the people on the ground when COVID came had learned those lessons. I mean, they knew the need for urgency very personally, but they also had the experience of knowing how to take out, as Dr. Peter Marks says in the film, the “dead space” in research and in science without compromising the science itself.

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I doubt I started seeing the similarities as soon as you did, but it definitely occurred to me in mid-2020, when New York City was becoming the epicenter of COVID in the U.S, that history was repeating itself in a very unfortunate way. As with AIDS, you had a disease the rest of the country could write off as product of New York’s and other big, blue cities’ lifestyles, and by the time it started affecting other places more forcefully, it was too late to stop it.

Exactly. You’re right to point out that in both instances, both pandemics claimed New York as the epicenter at the beginning. People looked to New York to see how they were managing it. And it was not managed any better in New York than you might have imagined, given that we had been through it before. The Department of Health was not on top of things the way they should have been. Politically, there were confusions. It was impossible to find a test in New York, as it was everywhere. But New Yorkers adapted, much as we did to the condom code once that became a public health strategy. New Yorkers adapted very quickly to the nonpharmaceutical interventions that were necessary to keep the spread of the disease down. I was very proud of my New Yorkers for the responsibility that they took, that we took, not only for ourselves but for our fellow citizens. In a way, that could be part of this kind of cellular knowledge we gained during the AIDS plague.

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How to Survive a Pandemic covers a global story on a global scale, but you were making it at a time when travel was difficult and sometimes impossible. How did you deal with that challenge?

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Well, we didn’t know how to do it at first. We knew that we couldn’t travel even through the U.S., because we were being responsible so that we weren’t carrying the virus across state lines from one city to another. Our first shoots were through the windows of people’s offices. Ultimately, working directly with scientists, we were able to find the PPE requirements that would be necessary to meet these protective barriers. And then we hired very, very local crews, hyperlocal crews, and devised a method with them that would allow us to be present in the room with them electronically so we could see what the camera was seeing. We did do a little bit of traveling post-vaccine, pre-delta. Went to India. And then post-delta, pre-omicron, we went to Geneva. So we did get a little bit of on-the-ground work with some of our sources, but for the most part, we just never met them.

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You said in an interview about How to Survive a Plague that the best work about historical calamities often comes 15 years after the fact. But Pandemic goes all the way until the end of 2021, so you don’t have the advantage of the long lens of history. It’s more like journalism.

Well, it’s journalism that is trying to stress reflection. We were producing this film with the idea that it will stand in for the historical record for some time. And reflection is what one gains after that 15-year interval, or whatever the interval. You can really look back and measure the events with clarity about their import. From my experience working on the AIDS plague, I felt I was pushing myself into kind of a future consciousness in an effort to look back and see what we saw. That’s why even from the start we knew that the film was not going to be about the vaccine itself. It was going to be about what global impact that would have in its first year of availability.

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You plant that seed early on, when you have the head of the World Health Organization warning that “the worst is yet to come if we don’t rush to ensure unity.” It underlines that the disparity in global vaccination rates was not only something we could have seen coming but that people, in fact, did. Even so, did you have hopes that might not be the case?

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I certainly hoped it would not be the case. I had not continued my reporting of global health access movements since the 2000s. And I hoped that they had solved some of those problems. Tedros [Adhanom Ghebreyesus, the WHO’s director-general] is a veteran of the AIDS world. Much of his early published work in scientific journals was about AIDS medications and access. Seth Berkley, who is the COVAX director, he comes from the AIDS world. He had headed up the International AIDS Vaccine Initiative. So I felt like we had the right people in the right place, but what we didn’t have were the mechanisms for them to do what was necessary to assure equity. The World Health Organization is a membership organization. They can’t do anything if any of the members object. So to get consensus about something that would impact various countries on a national level is impossible. So something really has to be adjusted there, and I think that’s the lesson. Because this is going to happen again, and it’s going to happen not in a hundred years, but much quicker.

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We’ve talked a lot about the similarities between the AIDS pandemic and the COVID pandemic. As you were watching this unfold, what struck you as the differences?

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Well, my very first instinct when we learned that this was going to be a big problem was to go find the activists, the people who would be pushing the system and helping keep the ship afloat. It turned out that those people were the scientists, and that surprised me. I guess it shouldn’t have, because I think that they have learned so much from their work in AIDS about the power of activism and the flexibility of the system that they could change the system, they could impact it in productive ways. But I also expected citizen activism of the kind we saw from ACT UP and other groups from the AIDS pandemic, and we just didn’t see that. We just didn’t see that in any real way. I mean, we filmed, God knows, with a bunch of health care workers who were going out on strike because of the lack of PPE, we filmed with people who were trying to purchase PPE on the open market and bring it into various hospitals on private jets, we were finding all these small examples of individual initiative, but none of it was coming right into the center the way the scientists were, or the way the citizen scientists of the ’80s and ’90s had. It was surprising that that didn’t materialize.

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In the movie, you have Jon Cohen, a journalist who has been covering public health for decades, expressing concern that the rush to have a vaccine available before the 2020 election is going to “steamroll” the science, and the suggestion from many scientists that the Trump administration wants to get it on the market much faster than is safe. And yet we did develop a massively effective vaccine with unprecedented speed. Some of that is due to advances in technology, but did we also just get lucky?

Well, the way it happened so quickly is that, unlike vaccine trials in the past, there already existed a vast trial network, a global trial network, that had been built up by the AIDS clinical trials groups around the globe to test all of those HIV vaccines that have been through that system over the last 35 years, none of them successfully. So everybody was there on the ground and they all knew one another. There was this kind of global brain trust. We go to South Africa in the film and we meet Dr. Glenda Gray. She’s part of this central gang of scientists and researchers around the globe who had already established a way to test a vaccine. That’s why it seems to you and to me like it just happened like that. They could enroll a million people in those vaccine trials in a flash, in a heartbeat, which they did do globally. So that was lucky. What we learned was that much of the work that was done for an HIV vaccine, which didn’t produce an HIV vaccine, produced so much that set up this research undertaking to succeed very quickly, including mRNA and the vector platforms, the adenoviral platforms. Those have all been developed by AIDS researchers and have been through human trials. We knew that they had potential because of the way that they experimented on Ebola and other areas. But they had never gone into a large human trial before. When the [genetic] description of the virus came out, all of the scientists spent that weekend, basically, designing the vaccine that they were going to put into human trials. So they were ready in February, before the rest of us were even sent home, with their candidates to try.

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Another thing we were “lucky” about, which is unfortunate, is that the virus was so uncontrolled around the globe through the nonpharmaceutical interventions, the viral load was so heavy, that we could count on getting a signal from them all very quickly.

And now some of the breakthroughs in mRNA from the development of the COVID vaccine may be helping develop a vaccine for HIV.

People are excited. After 35 years of failure in the HIV vaccine world, I expected everybody to be a lot more dispirited than they seemed to be going into COVID. But coming out of COVID with this huge scientific achievement across the board has really energized people and given them the sense of confidence that they can go back and try it again.

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That’s especially true for Tony Fauci. A man in his 80s—he says, if you ask him, that he thinks he’s got another 10 years left at the helm, and what he really wants to do is solve HIV. He’s turned back to HIV already, and that’s where so many of the rest of the people that you meet in the film have returned, because they want to use what they’ve learned now to see what they can do about this intractable 40-, 50-year-old problem.

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You’ve talked about the lessons we learned from the AIDS crisis that helped us fight COVID more effectively. What are the lessons we haven’t learned?

I think the big failure is in public health. And it’s not that our public health professionals failed us—it’s that we have undermined public health wherever possible, even over these last 30 years, knowing that this thing was going to come. Maybe this is human nature to not invest in the future, and public health is really our investment in the future of human civilization. If we don’t listen to those experts and do what they tell us, there’s no way we can clean up once these pathogens take over.

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Right now we’re essentially being told that the COVID pandemic is over and are dismantling our defenses even as the BA.2 variant is becoming dominant around the world. What should we be doing instead?

We should be vaccinating those most at risk in low- and middle-income countries. By the end of the film, which takes us through the end of 2021, only 8 percent of people in low-income countries are inoculated, and that hasn’t gotten much better in the months since. What creates variants? People in poorer countries with more compromised immunities and without access to the vaccine are the Petri dish that the new variants grow in. We can’t vaccinate a wall around the West. It’s just not possible.

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It’s not difficult to grasp, but it seems difficult to actualize the idea that in order to make things better here, we need to be doing more elsewhere.

Right. They figured it out, with the help of their knowledge of epidemiology and public health, that we get 20 percent of the globe vaccinated to begin with, starting with the elderly and the most at risk and health care workers, then we can keep lifting up and adding more segments of the population in a way that would preclude the arrival of these new variants and the possibility that even the brilliance of the vaccines that we have now might be undermined entirely by something that comes out of left field. It’s not really left field, I guess that’s what it is. We know it’s happening. We know where it’s happening. We know how to stop it, and we’re not doing it.

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Watching How to Survive a Plague and looking at all the backbreaking work activists did to get companies to develop drugs to treat AIDS, it’s almost inconceivable that we’d be in a situation where we have the drugs we need to treat a deadly pandemic and we’re either not getting them to the people who need them, or the people who should be taking them just refuse to do it.

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We need a world health organization, right?

Right.

We really need a kind of a deep state around the question of protecting us against these crises. That’s what it would take, some kind of empowered global body. That’s the kind of power that no country is going to be willing to give up.

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From where you’re sitting, is there hope for the future?

I felt like we were out of the storm before delta came. I felt we were out of the storm after delta. So I’m not willing to celebrate yet until we vaccinate the world. It’s essential that we get vaccines to Asia and Africa and Latin America, and do it right away. We’re just hearing from the major pharmaceutical companies, the building of plants in decentralized parts of the globe might roll vaccines out sometime in 2023, which means we’re in this danger zone for another year, year and a half, two years.

Two more years is who knows how many more variants.

Right. And then the political bumps that AstraZeneca and Johnson & Johnson took sidelined them when really they shouldn’t have been sidelined. J&J has just been vindicated in week after week of peer review publications, but J&J closed down their plant in the U.S. They’re manufacturing only in South Africa now, and we need it to be manufactured on every continent. It’s single shot. It’s very stable. And yet, where is the political will of the globe to come and make that happen and to open up the possibility for J&J to bring that vaccine out to the world?

I usually like to end an interview on a positive note, but I’m stuck with this one.

Well, maybe the positive note is that I hope not to make a third installment.

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