How to Survive a Pandemic, investigative journalist and director David France’s documentary on the road to developing, producing and inequitably distributing several Covid-19 vaccines, begins on the day vaccines went from murky future to clear horizon. The film opens in December 2020, in the remarkably bespoke basement of the US Food and Drug Administration’s Dr Peter Marks. The room is decked in Mardi Gras beads and a teddy bear; Marks’s clunky work laptop is surrounded by cans of oats. On camera and on the phone with Gen Gustave Perna, the chief operating officer of the federal Covid-19 response for vaccine and therapeutics, Marks celebrates the FDA’s emergency use authorization of the Pfizer-BioNTech vaccine. “Sorry you had to deal with all that political crap,” says Perna. “Vaccines will be moving tomorrow.”
The moment is an undeniable achievement of modern science despite significant political headwinds in the US and, as France’s film deftly argues, an opportunity to empower public health largely squandered by national self-interest. By 2022, there are now several documentaries tackling some slice of the pandemic: Alex Gibney’s Totally Under Control, on the Trump administration’s costly botching of the early pandemic response in the US; Nanfu Wang’s similarly damning In the Same Breath, on the US and China’s mishandling of the virus; Matthew Heineman’s grueling The First Wave, on the devastating initial pandemic in New York. France’s film has its fair share of devastation and tragic Covid iconography – ambulances, ventilators, footage of mass burials. But is trained in particular on the sprint, from the moment the virus was sequenced, to develop a public health bulwark of vaccines: when they would be available, who would make them, how they would be distributed, how much the political chaos of the Trump administration would corrode the scientific process.
“This totally opaque, massive scientific undertaking was invisible to everybody,” France told the Guardian. “Given how much money was being thrown into it through taxpayers’ money, and given how essential their work was, and how much we needed them to succeed, we eventually started thinking we should turn our obsession into a documentation project to make sure that this got recorded for posterity.”
France and a team of contributors, which eventually spread to five continents, started shooting in April 2020, just weeks into the pandemic in the US. The nearly two-hour film embeds first and foremost with Jon Cohen, a senior correspondent for Science magazine who has also published widely elsewhere and, like France, was an early chronicler of the Aids crisis. Both Cohen and France, whose 2012 film How To Survive a Plague offers what many consider to be the definitive account of activism in response to the HIV/Aids crisis, were familiar with numerous public health experts from their prior work.
“I knew that they would understand my proposal to them, which is that given the historic nature of this – a scientific undertaking unlike any in our lifetime, the entire globe waiting for them and putting our hopes on their shoulders – [to] let me in, let me behind the curtain,” France said. “And luckily, they agreed.” This includes White House adviser Anthony Fauci, who appears in the film over a glass of beer with Cohen on a back patio, after work hours.
The project required a “magisterial amount of producing” crew on five continents, sometimes shooting at the same time. “We had this motto: do no harm,” France explained. “We were really careful about our requests for people’s time.” For those they did request, including developers of the Moderna, Oxford-AstraZeneca and Johnson & Johnson vaccines, “people really understood the need to document,” France said. The crew worked out exclusive arrangements “where we said, ‘Look, I know you’re getting hit by a bunch of proposals, we want to do the definitive story as faithful to the science as possible.’”
Overshadowing the whole process were the expectations of Operation Warp Speed, the Trump White House effort to turbocharge development of a vaccine, and the specter of the 2020 presidential election. Or, as Cohen put it in May 2020, as the global death toll surged past 250,000 lives: “We’re just scared that science will be steamrolled” by the political agenda.
That anxiety permeates the film, particularly by public health officials toggling between candor and contrition around the political atmosphere that threatened to derail or alter the process. “I told everybody that we weren’t doing the politics story; we were doing the science story, but that the politics would of course be in the background,” France explained of striking a balance between acknowledgment of the political reality – a childish White House hellbent on staying in office – and a dispassionate view of the science.
The film captures the weight of that noise, “to know whether science would be able to hold to its own rails given these hurricane winds.” The team found that the answer was yes, which was “an important revelation because there’s so much skepticism about the speed with which these vaccines were developed and rolled out,” France explained.
Still, as France said, “a vaccine is only good if it becomes a vaccination” – and the second half of the film is concerned with the gnarled, incomplete rollout on a national and global scale, and resistance borne from genuine, grounded skepticism or cynical identity politics. The coordinated anti-vax movement enters the frame more as oblique side show – footage of anti-vax protests from around the world, or of Brazil’s blatantly anti-science president Jair Bolsonaro, or of Cohen stumbling upon a Trump rally (one man wears a “Fuck Fauci” hat) in his California neighborhood. Though France’s team considered speaking to several anti-vax leaders, the film ultimately skirts what France called “such a Gordian knot as a philosophy that it makes your brain hurt to listen to it”.
“The only way to take that on is to really take that on,” he explained. “Otherwise there’s no way to understand it.”
Instead, the film-makers embedded with the Rev Paul Abernathy of Pittsburgh, Pennsylvania, a black man whose organization, the Neighborhood Resilience Project, went door to door to check in on black residents and encourage vaccinations among a community skeptical from years of medical racism and institutional neglect. Abernathy embodied the energy of the 2020 Black Lives Matter protests, which France saw as “being the first sign of hope that literally something might come out of the ashes of Covid that would be not only acceptable but better”.
If the film’s first half is a shocking success story – multiple vaccines with efficacy rates over 90% – its final section is a tragedy: the deeply inequitable distribution of vaccines, in which rich, powerful nations maintain a surplus while low-income nations struggle to reach double digit vaccination rates and protect the most vulnerable. To date, only 14.5% of people in low-income countries have received at least one dose; How to Survive a Pandemic closes with the shocking statistic that if existing vaccines had been distributed equitably – as in, if every at risk person (elderly, healthcare workers) in the globe been vaccinated up to 20% of each country’s population – one million more lives would’ve been saved globally. (The global Covid death toll as of this writing is 6.13m.) “We had the vaccine quantity to do that,” said France. “The stock existed to do that.”
“There were so many advances that came out of HIV/Aids,” said France, from the vaccine platforms to the global infrastructure of clinical trials. “But where we haven’t reformed is in this global sense of how you approach a viral pathogen that comes from nowhere and prowls the globe.”
“No nation has relinquished that control, and it’s in their self-interest to do it,” he said, as countries from the US to India have not met pledged contributions to Covax, the World Health Organization initiative for global vaccine access. “Will we learn from it? Will we be in a better place when the next one comes? And the next one is around the corner, it’s not another 100 years – what are we going to do then?”
How to Survive a Pandemic is now available on HBO in the US with a UK date to be announced