Documentary makers can get as close to the war zones of disease as doctors and researchers — perhaps even closer. Julie Clayton and Declan Butler talk to Kevin Hull about his experiences.
Like many people on the receiving end of bad news, Kevin Hull rode waves of emotions as he discovered the malaria crisis. “When you start finding out about malaria you first get intrigued, then confused,” he says, “then you get outraged and depressed — and then angry.”
Hull is an award-winning film-maker with more than 20 documentaries and television series under his belt, including The War Machine — a TV series about the secretive weapons-development arm of Britain's Ministry of Defence. In 2002, he turned his camera on the war against malaria.
Taking a break from final editing in the cutting room of the production company Films of Record in west London, Hull admits that he first became interested after being hoodwinked by headlines announcing that a malaria vaccine was now on the way. But he says that the film's initial focus on the search for a vaccine soon shifted to address a larger question: why is malaria control failing?
The quest for answers took Hull to Gambia, Kenya, Tanzania, Florida, Britain, France and Switzerland. With the same insistent style as the maker of Fahrenheit 9/11, malaria's Michael Moore grilled those fighting the disease, from remote villages in Africa, to top research labs and the corridors of power in health ministries, UN agencies and the World Health Organization.
The resulting film, Fever Road, pulls together three issues that are usually dealt with separately: the personal experience of African villagers; the scientists' efforts to defeat the disease; and the political and economic issues shaping the international community's response to it. With its powerful narrative, Hull hopes that his film will make decision-makers sit up and listen. “I don't normally make films that are about increasing public awareness of a problem,” says Hull. “But sometimes you just feel very strongly about something.”
The 90-minute documentary is scheduled to hit screens later this autumn, starting with BBC Four television in Britain, and Public Broadcasting Service in the United States. Videos and DVDs will then be distributed as part of an international awareness campaign.
Hull's initial plan of tracking vaccine development led him to Oxford, where trials at the Centre for Clinical Vaccinology and Tropical Medicine were getting good results (S. J. McConkey et al. Nature Med.9, 729–735; 2003). The ‘prime-boost’ vaccine created by Adrian Hill and his team looked like a promising candidate. Classical vaccines that provoke antibody production cannot get at parasites hiding inside cells, but Hill's vaccine is designed to trigger killer T immune cells that can destroy infected liver cells.
Hull's crew met up with the researchers again during field trials of adults in Gambia at the end of the year. There they found that the vaccine gave little protection against natural infection. “It's not straightforward,” says Hull.
The long road towards a vaccine inspired Hull to use pictures of villagers walking along dusty roads as the central metaphor of his film. “Everyone is trudging up and down these roads for hours and hours trying to get to hospitals that don't have any drugs,” says Hull. “Adrian in a way is on the same road, trying to get to a vaccine.”
A roller-coaster ride
The ups and downs of malaria-vaccine development are frankly portrayed in the film, and Hill applauds Hull's efforts. “If he gets across to audiences that vaccine development is a long sequence of steps rather than a moment of brilliant discovery that cracks it, then that will have been useful,” Hill says.
Emerging from the labs, Hull tracked down the people at the sharp end of dealing with the disease. In Kenya, he secured behind-the-scenes access to researchers and officials struggling within an undeveloped health structure, and spent a month filming local doctors trying to quash a malaria outbreak in a remote part of the country.
What made Hull angry was watching doctors who had nothing to prescribe but drugs — often purchased by international agencies — that have been rendered useless by parasite resistance. “How can you justify giving drugs that don't work to people who are dying? It's really upsetting,” he says.
“I was outraged about the injustice of the situation and the complexity of the problem, in terms of linking the science, economics and politics,” says Hull. “Malaria is a disease that we can do things about, at every level of prevention and cure. But deaths have doubled over the past ten years, and projections suggest that the same will happen over the next 20, because of a massive level of neglect. This is a terrible problem that should be dealt with.” Hopefully, he adds, his film will take the first few steps towards doing just that.