The Makings of a Medical Disaster
(Interview re The River: A Journey Back to the Source of HIV and AIDS)
The race to find a polio vaccine in the 1950s now appears to have caused the modern AIDs epidemic. Edward Hooper, who has traced the virus back to mass vaccinations of African children, explains his devastating findings to Penelope Dening
Irish Times, 31 August 1999
Edward Hooper has written an extraordinary book: extraordinary because of the story he has to tell, extraordinary because he succeeds in making an investigation into the origins of HIV and AIDS as readable and compelling as a thriller, extraordinary that at 1,000 pages, The River doesn't feel a page too long.
We meet at his publishers in London, all very-last-minute as lawyers have only just given the go-ahead to publish. The River is a legal minefield, and to avoid litigation each and every assertion is shored up with the detail of his meticulous research - hence its length, the final 200 pages are simply footnotes. Also, he explains, his careful sourcing to the different medical journals and other literature which provide the stepping stones to his theory should make it far more difficult for the scientific community to dismiss it - which so far they have. "I very much hope that this time around they will actually have to mount some kind of investigation into it."
Edward Hooper is a maverick, exactly the sort of inspired amateur that a closed elite such as the world of biochemical research appears to find intensely irritating. He is not even a scientist. Born in London's East End, at university he read American literature with no idea what he wanted to do in life. Then, having fallen in love with east Africa as a back-packing student, he did anything in order to stay there, from teaching to storekeeping in a diamond mine.
He lived for three years in Uganda, where he fell foul of Milton Obote's notorious regime and was thrown into jail for a month before being deported in 1983. He then returned to London where he set himself up as a freelance journalist, returning to Africa as a stringer for the BBC, first in the Sudan, and then back to Uganda. He was one of the first to report on the terrible disease that was sweeping southern Uganda in early 1986.
"It moved me in a way that seeing people dying of starvation in the Sudan or the impact of the civil war in Uganda didn't. It was a very powerful experience; you could tell that what was happening here was going to be a portent of what would happen in large areas of Africa and, as it has turned out, the whole world. At that stage AIDS was very much viewed as a disease of gay men and intravenous drug users, people on the margins of society, but here was a report from the front that said the entire population was at risk."
HIV is now universally acknowledged as the human variant of SIV - the monkey equivalent. The current establishment view is that the virus spread through the killing - and eating - of chimpanzees (though if that was the case, argues Hooper, why did it not happen earlier in Africa's history?). The horror of Hooper's hypothesis is that AIDS was not just a blip in nature's usual balancing act, but was due at best to human carelessness and at worst to a disregard for safety by medical scientists.
The whole story has a horrific symmetry. In the 1950s polio was as feared as AIDS is today, with up to 15,000 cases a year in the US during the summer months, a quarter of which led to death. Its victims were largely children, and when the virus attacked the spinal chord it led to paralysis (the most high-profile example is probably US president Franklin D. Roosevelt) and spurred by his emotive death at the end of the second World War, the US was at the forefront of the race to find a vaccine.
Like all vaccines, the most effective and longest lasting is a live vaccine made safe by being weakened - "attenuated" - by being passed through a succession of live animals and tissue culture, the most effective in the case of polio being monkey kidney. This technique ran the risk - well known to virologists by that time - that any infection present in this "substrate" could be delivered with the vaccine to the recipient. It needed only one kidney from a monkey infected with SIV to contaminate thousands of doses.
Chimpanzees are the only species of monkey susceptible to polio and therefore the only animal on whom the vaccine's efficacy and safety could be tested. Crucially, however, chimps are not affected by the SIV virus whose existence in their kidneys would therefore go unrecognised.
In 1957, Hilary Koprowski, then leader in the field of polio vaccine research, set up a chimpanzee colony outside Stanleyville (now Kisangani) in the Belgian Congo. Conditions in Lindi camp were pretty dreadful and many of the chimps died. The number involved was huge - the numbering system would indicate over 400, far more than would be needed solely for vaccine testing and Hooper contends that "one of the major reasons for the camp was to use chimp kidneys as a substrate for the vaccine".
Koprowski, who is still alive, refutes this claim and has so far resisted any attempts to test samples of the vaccine that still exist in the vaults of the Wistar Institute in Philadelphia, either for traces of SIV or even for the DNA identity of its host. He claims not to remember what kidney substrate was used but nonetheless denies it was chimp.
Koprowski first tested his oral polio vaccine (OPV) back in Philadelphia on 20 severely handicapped children, and then on normal children born to female prisoners. What he really needed was a much larger trial. As he already had links in the Belgian Congo with the Lindi chimp colony, why not there? The decision was hardly altruistic; the mass trial was not to give immunity to a vulnerable population - 88 per cent of the community had natural immunity - but to test its safety, both in the short term and to discover whether the vaccine could reactivate itself in the longer term. (It could and did: 600 people died two years after the trial in Leopoldville, now Kinshasa.)
In 1959 nearly a million people - mainly children - in an area that now falls within Uganda, Rwanda, Burundi and the Congo were "fed" the vaccine. The programme was stopped largely due to the outbreak of civil war. Hooper had no preconceived ideas about the origins of AIDS when he began his odyssey in 1990, but one of his first actions had been to make a map of where the disease had first appeared. When the theory about polio emerged in 1992 he began to piece together a map of the 1959 mass immunisations, all records having disappeared. The geographical correlation between the two is damning.
The River makes unsettling reading: the treatment of the chimps, the approach to safety, the non-existent monitoring of trials, the use of "volunteers" who couldn't say no, the overriding commercial concerns. The issue of where and how AIDS began is argued by many who Hooper interviewed to be irrelevant - but this ignores the point that the issues raised by what happened are more relevant now than they have ever been.
So why does the medical establishment refuse even to investigate the polio vaccine theory, given Hooper's meticulously argued case? "If I am correct - and I am 97 per cent certain that this is the explanation for what happened in the major AIDS pandemic - then it threatens the whole basis whereby medicine operates."
Hooper says he has no wish to scaremonger. "Vaccines have saved so many hundreds of millions of lives and generally most of the vaccines we have today are perfectly safe. This was an experimental vaccine which we believe had some problems connected with its manufacturer."
"We will do whatever it takes to save lives," Hooper quotes towards the end of The River from a xeno-transplant specialist - eerily close to what Koprowski is on record as saying in the early 1950s: "Whatever it takes to attenuate the virus, we will do it." And they did. With Koprowski and his fellow competitors in the race for a polio vaccine, the methodology was, Hooper says, "pot luck, running 10 cultures at the same time, trying to come up with a bombshell vaccine that worked."
Hooper has no time for the argument that the presence of SIV in the OPV fed to hundreds of thousands of people in the Congo was just bad luck and that therefore no blame should be attached to Koprowski or the laboratories in Philadelphia and Belgium manufacturing the vaccine. Already by 1953, he says, Koprowski's boss (with whom he later fell out) wrote an article in the Lancet on human viral vaccines and the danger of contamination from other viruses present in monkey kidneys, yet Koprowski continued using monkey tissue secretly. In 1954 and 1956 other viruses had reared their heads.
"What was abundantly clear," says Hooper, "was that this particular substrate had the potential of nasty viral surprises and, instead of responding by saying, "Hang on, this may be the most effective tissue culture, but it's actually a bit dangerous, we might be doing something that's really going to cause a lot of problems', they just rushed ahead. "And of course if you carry on, you carry on until one of the viruses does cause human disease. In this instance it looks as if there was a 20-year time lag between the feedings and the visible epidemic of AIDS in central Africa," he says. This is the length of time it would take for the vaccines to achieve sexual maturity added to the incubation period. With xeno-transplantation, Hooper says, it might take three generations to find out.
The story has now come full circle. The search for an AIDS vaccine is just as desperate as the search for a polio vaccine early this century. Fifty million people are currently HIV-positive; 15 million have already died of full-blown AIDS, and the humanitarian and commercial pressures are huge. Unless the lessons of the polio/AIDS disaster are learnt, Hooper argues, there is a real danger it could happen again.
The River - A Journey Back to the Source of HIV and AIDS by Edward Hooper, is published by Allen Lane, £25 in UK