Heart of Darkness Revisited

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'Every one of all known HIV-1 cases in Africa before 1981 came from places within 160km of those CHAT vaccination sites.' Could the AIDS pandemic have been sparked off by polio researchers in Belgium's former African colonies? ANDREW DONALDSON reports on a new book that claims to have found the source of HIV.

[Commentary on The River: A Journey Back to the Source of HIV and AIDS]

South Africa Sunday Times, 14 November 1999

FEBRUARY 1959 and the wind of change is blowing through Africa. Two doctors, an American and a Belgian, find themselves in Leopoldville soon after the first pro-independence riots in the capital of the then Belgian Congo.

However, the political unrest is of little concern to the doctors, Arno Motulsky and Jean Vandepitte, who are busy with microbiological research into malaria. With the help of local doctors, they collect blood samples from medical staff, hospital patients and police recruits in Leopoldville.

A quarter of a century later, these blood samples, together with others gathered from various areas in sub-Saharan Africa, arrive in the US, where an academic at Atlanta's Emory University, Professor André Nahmias, tests them for the presence of antibodies to the virus that causes AIDS.

Over several months in 1985, the samples are subjected to exhaustive tests, first at Emory and then at Harvard, before results are confirmed at two independent laboratories. One sample - L70, from a batch of 99 specimens taken in Leopoldville in 1959 - emerges positive in all tests: taken from an unknown African male who lived in a city soon renamed Kinshasa, it is the oldest specimen of the human immunodeficiency virus, or HIV, in existence.

It's not known what happened to that African male, but in the two decades since his blood was taken - and before 1981, or Year Zero for AIDS, the year the US officially recognises the epidemic - a number of other Africans and European visitors to Africa will be infected with HIV-1, the first strain of the virus to be identified.

These are cases who wound up in clinics and hospitals - mainly in the Congo, but also in Rwanda and Burundi - with what we now recognise as principal AIDS-type symptoms: aggressive Kaposi's sarcoma, toxoplasmosis, diarrhoea, tuberculosis and other ailments. Doctors were baffled at the time, but blood samples were taken - and years later, after tests, were found to be HIV-1 positive.

What's disturbing about these cases is that 87 percent of them - that is, of all known samples of HIV-1 from Africa from 1980 or earlier - come from those towns where an oral polio vaccine, known as CHAT, was fed to Africans between 1957 and 1960. Put another way, every one of all known HIV-1 cases in Africa before 1981 came from places within 160km of those CHAT vaccination sites.

AIDS and the polio vaccine - is there a link? Author Edward Hooper suggests there is, and, in his staggering work The River: A Journey Back to the Source of HIV and AIDS, he offers a powerful and exhaustively researched argument.

But this hypothesis is not new. At least three different researchers around the world, working independently of one another, offered up slightly differing versions of the theory in the late '80s.

One of them was Professor Jennifer Alexander, head of the Department of Microbiology at the University of the Witwatersrand. Together with Professor Gerasmos Lecatsas, chief virologist at Medunsa, Alexander published letters proposing the polio vaccine hypothesis - first in the SA Medical Journal in 1989 and then, in 1992, in the British medical journal Lancet. Both letters provoked savage criticism in medical circles.

It was a meeting with Alexander, in a Belgian restaurant in 1992, that prompted Hooper, on his return to England, to resign as a teacher and devote his life to working on the theory that the vaccine led to AIDS.

"For the first time," he writes of that meeting with Alexander, "I was convinced that as far as CHAT went, there was a genuine case to answer."

Underpinning his inquiry was the following question: If, as it now seems certain, HIV can be traced back to retroviruses found in certain species of African apes and monkeys, like the simian immunodeficiency viruses, or SIVs (which are the closest known relatives of the HIVs), how did these simian viruses suddenly - and not gradually , as those who believe in a natural movement across the species barrier would suggest - transfer to humans in the late 20th century?

The short answer, Hooper believes, is that doctors, unwittingly and acting with the noblest intentions, put them there.

His search for the source of AIDS took him backwards from the gay bathhouses of New York to the Caribbean island of Haiti, which had a reputation as a holiday destination for European and American sex tourists in the '70s, and then to the Republic of Congo (it was only renamed to Zaire in 1972), which, after the mass exodus of Belgian settlers in 1959 and 1960, was forced to "import" Haitian technocrats to help run the country.

In the Congo, Hooper focused his attention on Lindi, a camp on the River Congo some 14km from Stanleyville (now Kisangani) where captured apes and monkeys were caged and then sacrificed for their kidneys, which were minced for substrate, or tissue culture used to perfect vaccines.

The vaccine in this case, CHAT, was developed in the '50s by Dr Hilary Koprowski, a pioneer American virologist and, as a developer of a set of oral polio vaccines, the first person to feed the vaccine to humans in 1950.

Koprowski arrived at Lindi in 1957 to oversee vaccine research there, but little else is known about his work at the camp, other than that some of the animals he and his colleagues worked with were evidently sick.

"We do not know exactly what happened at Lindi," Hooper writes, "but there is a huge and unexplained gap in the records of the experiments conducted there, and considerable secrecy surrounds the work carried out on the chimps - secrecy that continues to this day.

"What we do know is that two species of chimpanzee were housed in the camp, often in the same cages. We know that hundreds of the chimps that entered Lindi are unaccounted for, and that some of the chimps had symptoms of immunosuppression, suggesting they may have been infected with SIV . . . Furthermore, it is clear that a pool of [CHAT] vaccine made in chimp kidney tissue culture could have been produced [in poor conditions] in Stanleyville itself."

Between February 1957 and June 1960, an estimated 330 000 Africans were vaccinated with CHAT in the former Belgian Congo and, between February 1958 and March 1960, a further 660 000 in the Rwanda-Burundi regions - almost a million CHAT vaccinees in Belgium's former colonies. All this before a single white Belgian in Africa was vaccinated.

In a massive, apparently unsupervised operation, Africans from the Ruzizi Valley in Rwanda and Burundi took part in CHAT's first mass trials between February and April 1958. "Nobody supervised," a defensive Koprowski told Hooper. "They feed the children. They feed the infants. They supervised the whole thing and fed 256 000 in six weeks . . . the call to mass vaccination was made by . . . drums, drums, drums, drums.

"And it was a heroic undertaking, 256 000 in six weeks. They were on their feet for a long time. And every day a new wave, a new wave, standing. They finished always with darkness."

Hooper makes it clear that Koprowski and others involved in the race to eradicate polio were "great pioneers of tissue culture development" and worthy of "enormous credit". But it was a race nonetheless - one in which national pride and personal honour were at stake, possibly to the detriment of acceptable scientific practices.

In Koprowski's defence, however, is the fact that - as far as is known - no sample of CHAT virus or vaccine has ever been tested and found to contain SIV or HIV. Hooper, however, suggests that tests could be carried out on CHAT polio viruses held in various international research institutes to this end.

As for the AIDS epidemic, it continues - and so does medical science's struggle against it. "The biotechnological advances of the last 25 years hold out tantalising promises of human advancement and happiness," Hooper notes, "but they also confront us, potentially, with the greatest dangers that our species has ever faced.

"Are we mature enough to proceed cautiously, and sensibly, amid that understandable clamour from the optimistic, the egotistic, the foolhardy, and the desperate, amid those pressing demands to take bold steps before it is too late?

"Or are we about to make the same mistakes all over again?"

The parallels between AIDS and polio are obvious. In 1959, as now, there was a fearsome disease of global concern and enormous pressure for a cure. Then, as now, scientists were not only fuelled by noble intentions, but also fired by more selfish motives of prestige and potentially huge profits.

Meanwhile, 40 years later and because of the internal strife there, polio vaccination initiatives in the Democratic Republic of Congo have been disrupted. As a result, it is chillingly ironic that the region is once again a stronghold for the disease.

*The River: A Journey Back to the Source of HIV and AIDS by Edward Hooper is published by Penguin