The Coming Plague (54 page)

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Authors: Laurie Garrett

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And that is exactly what transpired: in May 1984 the FDA's task force told the agency that it simply couldn't reach agreement on use of the hepatitis test to screen out possible carriers of AIDS. Most of the world's blood and plasma supply, therefore, went unsterilized and untested for the first four years of the epidemic.
For drug injectors like Greggory Howard information about the new disease was scarce in 1983. No government agency, at any tier, distributed leaflets or educational materials to the country's most derided population. Drug users had no idea that some scientists wanted them to stop “donating” their blood and plasma. Howard hadn't heard of AIDS. All he, and tens of thousands of addicts like him, knew was that “something else,” some additional health hassle, was out there. And there were rumors of fellow junkies who got sick, went into the public hospitals, and disappeared.
The two federal agencies that were supposed to deal with the health of people like Greggory Howard seemed utterly disinterested in the AIDS problem in January 1983. Neither the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) nor the National Institute on Drug Abuse (NIDA) would request funds from Congress for AIDS research until mid-1983, and neither agency would undertake any research on the transmission of the disease through the use of syringes until late 1984.
The most conspicuous lack of interest, however, was at the National Institutes of Health in Bethesda. Though a handful of scientists inside the
NIH, particularly at the National Cancer Institute, were using their general research funds to tentatively explore the AIDS problem, the agency demonstrated no immediate enthusiasm for solving the AIDS mystery.
“AIDS is the leading cause of death of men between thirty and forty in San Francisco. And we need more money,” said Dr. Donald Abrams. Seated in his tiny office on Ward 86 of San Francisco General, where he and Volberding treated the city's swelling AIDS population, the young oncologist carefully chose his words. He pointed to stacks of files, filled with handwritten and manually typed pages.
“We've collected on our patients reams and reams of data. We don't have a computer to analyze the data, so what is the point of doing all the fancy [T-cell] testing if we don't have it put together and can't publish it?” Abrams asked. “This is a problem that is unique in the history of medicine. People keep telling us, ‘The money is coming.' From this city office, or that state or federal office. But it never materializes. And then the reality is that every day we've got more patients out there, waiting for answers in our clinic.”
Though only in his early thirties, after eighteen months of working with Volberding on the AIDS problem, Abrams looked exhausted. His voice was weary, his body leaden.
Imbued with something of an activist spirit, Andrew Moss was able to muster a bit more energy from his team, and himself. Now ensconced in shoe-box offices at one end of Ward 86, Moss's group was trying to make epidemiological sense of the epidemic. He felt that the only reasonable approach involved matching AIDS cases with demographically similar non-AIDS gay and straight San Francisco men, and following them over time to see what factors put them at risk for the disease.
But that would be expensive.
There were ten people working with Moss—not one of them was receiving a dime for AIDS research. Some, appalled by the epidemic's toll, were volunteers. Even Moss was, technically, a volunteer, as all his funding was earmarked for brain tumor and testicular cancer research.
“Guerrilla science,” Moss called it, only half jokingly. “You see a crisis and you just go do what you have to do, and figure out how to pay for it later.”
From the outset Curran had tried to raise interest in the GRID/AIDS problem inside the NIH. In the fall of 1981 he went to Bethesda to sketch an outline of what was then known about the disease, its victims, and the unanswered research questions. Robert Gallo heard Curran's pitch, as did several other key NIH researchers. And though many thought the situation grave for homosexuals, few were persuaded that the outbreak posed any intriguing basic research questions. Traditionally, NIH scientists left epidemic problem solving to the CDC.
It was not until a year later, when Curran returned dangling a new
tantalizing basic research problem, that the Bethesda scientists took up the challenge.
“We have evidence that a new infectious agent has entered the blood supply,” Curran told them. “And it produces severe immunodeficiency primarily via T-cell changes.”
Now that sounded like a terrific puzzle to Gallo, who immediately thought of the virus he had recently discovered, HTLV-I.
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He knew the virus caused immune system disruptions and cancer, though nothing like what occurred in people with AIDS. Gallo left Curran's talk thinking that the mysterious disease might be caused by some new variety of HTLV.
Later, Gallo spoke on the phone with Max Essex, at Harvard, who was familiar with the AIDS problem via Don Francis. Essex's lab had long since established that the feline leukemia virus altered T-cell activity in cats, and he had tentative evidence that HTLV-I similarly disrupted T cells.
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Essex worked with Curran and Francis, who sent blood samples to the Harvard laboratory for scrutiny. By June 1982 he had a serious effort underway at Harvard searching for the cause of AIDS.
Gallo also had an AIDS effort underway.
After some soul-searching about the possible contagious peril for his staff, Gallo decided that the epidemiology indicated that the mysterious agent was transmitted by blood, not through the air. In May 1982 he ordered lab personnel to start trying to grow a virus out of blood samples from people with AIDS.
A few months earlier another NIH team had begun searching for a link between Kaposi's sarcoma and “poppers.” Jim Goedert, Bill Blattner, and Dean Mann studied fifteen gay New York men, comparing their amyl nitrite uses and immune system status. The study found that five of seven men who didn't use poppers had evidence of immune system dysfunction, compared to five of eight users. They also found that CMV infection histories were identical in the two groups. They concluded that amyl nitrites probably didn't play a role in the disease, though the drugs could alter immune function.
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And at the National Institute of Allergy and Infectious Diseases, a division of the NIH, a team of scientists led by Drs. Anthony (Tony) Fauci, Henry Masur, and Cliff Lane were studying the nature of the immune system dysfunction in people with AIDS. The NIAID researchers discovered that, in addition to T-cell abnormalities, gay men with AIDS had severe problems in their B-cell systems: though they had lots of B cells of the highly activated antibody-producing type, other classes of B cells were deficient, even entirely absent. The NIAID team concluded that the B-cell system recognized it was challenged by a microbe, but, due to massive disruption of the T-cell system, was unable to respond with the control and precision customary when both arms of the immune system functioned properly.
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With much fanfare the NIH announced on April 25, 1983, that it was soon releasing $240,000 in research funds to four external laboratories. A week later the NIH announced six additional research grants to a variety of institutions. The money—in total less than $2 million—would fund studies of the immunology, treatment, genetics, pediatrics, and cancer of AIDS.
Volberding's group, for example, was awarded the first installment of a five-year $526,229 study of pre-AIDS symptoms and immunologic profiles. Two weeks after the NIH announcement, Volberding and eleven co-workers penned a letter to Margaret Heckler, the newly appointed Secretary of Health and Human Services (Schweiker having resigned on January 1, 1983). The letter thanked Heckler's department for the research funding, but noted that it was less than half the sum the San Francisco team had originally requested.
“This amount of funding is unrealistic if we are to make significant progress in finding the cause of this disease,” the group wrote. “In addition, we are unable to use equipment that is generally employed by other laboratory personnel because of the fear of the spread of the AIDS agent. Thus, unless funds are provided to purchase new equipment for this research, our work cannot continue.”
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By mid-1983 every aspect of the AIDS research situation had become a partisan matter in the United States. Republicans generally defended the pace of research and financial expenditures, while Democrats attacked the Reagan administration on all fronts. The situation polarized irreparably, as the war of words in Congress became increasingly emotional and hostile. The Democrat-dominated House of Representatives repeatedly demanded an emergency posture toward AIDS research. And the Republican-controlled Senate and White House sought to keep AIDS spending down. In congressional hearings throughout the summer and fall of 1983 the two parties traded insults and jockeyed for control of the AIDS agenda.
“The [Democrats] fail to define what would be ‘adequate' funding,” wrote a group of ten prominent Republican members of Congress.
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“In addition, temporary diversions of funds to help meet the AIDS problem should not be considered permanent … . Finally, the [Democrats'] recommendations that an independent panel be created to develop a comprehensive strategy for responding to AIDS should be rejected as unnecessary.”
Leading the counterattack for the Democrats was New York representative Ted Weiss, who denounced “inexcusable and unconscionable gaps in the Federal effort to resolve this crisis” and accused the Reagan administration of deliberately delaying or canceling research funds for what he termed “the Nation's Number One health priority.”
Medical research money per se was not usually a partisan matter in the United States. Republican Nixon started the War on Cancer, Democrats Johnson and Carter bolstered funding for cancer and heart disease research,
and in emergencies—Legionnaires' Disease, Swine Flu, Ebola fever—resources had been found quickly, regardless of which party controlled the Congress and White House.
But AIDS was unique. It touched every nerve that polarized Americans: sex, homosexuality, race (Haitians), Christian family values, drug addiction, and personal versus collective rights and security.
Of the 1,200 AIDS cases identified in the world by March 1983, all but a handful were in the United States and Haiti.
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The epidemic's political dimensions would not become obvious in other countries until the sizes of their respective outbreaks were sufficient to push the mysterious disease onto the public agenda.
At the CDC those responsible for finding the cause of AIDS—Gary Noble and Don Francis—still couldn't scrounge enough dollars and equipment to conduct decent laboratory experiments. The most obvious way to prove that an infectious agent was involved would be to inject human patients' blood samples into laboratory monkeys. If AIDS then appeared in the animals it would indicate that an infectious agent was in the patients' blood. However, the reverse was not true: if animals didn't get sick it could be due to an immunity the nonhuman species had to the humanly contagious microbe.
But the CDC had no primate research money. In August 1982, Francis and Noble injected four marmoset monkeys with patients' blood, and waited. And waited. Months went by, and the marmosets thrived. Francis tried reinjecting the animals with blood from a different patient. And then, again, waited.
Francis lobbied for other animals, particularly the rare and expensive chimpanzee, but the CDC didn't even have facilities in which to safely and humanely house large primates. In a joint agreement with Emory University's Yerkes Regional Primate Center outside Atlanta, the CDC's animal research program wouldn't begin until the spring of 1983, albeit moderately, with two chimpanzees and a dozen rhesus macaques. A year and a half later the agency scientists would still be waiting for some physical response in the animals to injections of contaminated human blood.
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The NIH had an enormous primate facility in San Antonio, Texas (South-west Foundation for Biomedical Research), and two chimpanzees there were injected with infected human blood in early 1983, producing rapid T-cell changes and lymphadenopathy.
In Paris, the Groupe de travail français sur le SIDA (French AIDS Task Force) had dismissed all environmental factors, such as “poppers,” almost from the outset because the history of the French patients so clearly followed an infectious trail. The first observed case was a flight attendant who got infected, it seemed, during one of his many trips to the United States, and passed the infection on to sexual partners in France. Indeed, frequent travel to the United States was such a striking hallmark of European AIDS
cases among gay men
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that the 1982 appearance of exceptions—of two French homosexuals with no American connections—was cause for note in a leading European medical journal.
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One of the most energetic of the French scientists was Jacques Liebowitch, a physician and immunologist who argued his cases with almost as much physicality as language. Gesticulating feverishly, pacing about, jumping in and out of his chairs, the handsome young Liebowitch had a habit of reaching an intellectual conclusion and then holding on to it tenaciously, seeking to convince others along the way, until data either proved him right or proved him wrong. For Liebowitch the most intriguing European AIDS cases were not among gay men—that was simply the American paradigm implanting itself on European soil, he said. Rather, he was moved by the occasional African and Haitian immunodeficient individuals that he and other European doctors had recently seen.
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