Observer, Sunday 9 July 2000
World scientists gather in Durban today to discuss the epidemic sweeping the continent. But still we don’t know how it began. Edward Hooper returns to Uganda where 14 years ago he first charted the scale of the calamity. His fears have been confirmed, he argues: we unwittingly sparked the horror with a contaminated polio vaccine
The catch of fish was good this morning, and because the coffee season is beginning, swollen sacks of beans lie scattered in the dirt like great brown maggots. A few yards away, beside the boats drawn up along the shores of Lake Victoria, the marabou storks skip and glide from one fish head to another.
Kasensero looks as dirty and dissolute as it ever did, as the sun burns down on its tumbledown shacks of wood and corrugated iron. Now is the season for making money and the village is full of young fishermen and smugglers, and young women with dyed hair. There is a constant hubbub of shouting and laughter, flirting and argument, intertwined with the lingala music that booms from the tiny bars and cafes. Although it is not yet noon, many are already drunk.
One mile away, in the relative calm of the landing site at the mouth of the Kagera river, the man in charge tells us that Kasensero never changes – that the young still make money, have sex, and forget to use condoms.
This, for me, is a journey back in time. For this small smuggling village is the place that I and a fellow-journalist first visited in 1986, after tales of the cataclysm along Uganda’s southern border began filtering up to Kampala.
The people told us, almost casually, how ‘Slim disease’ had arrived in their midst four or five years earlier, and how more than 100 of Kasensero’s itinerant population of 500 had died since then. Then they called a meeting beneath the big tree, and asked us what to do about it. Acutely aware of our amateur status, we did our best. Use condoms, we said. If you have an injection, make sure the needle is first boiled. By good fortune, the advice was sound, and nowadays it is echoed by posters on display in the village – posters that are all too often ignored. The only thing that has changed in 14 years is the name. These days, everyone calls it Aids.
Happily, the stubborn, hedonistic fatalism of Kasensero is not typical of Uganda as a whole, where the norm nowadays is to ‘love carefully’, to use condoms. Elsewhere in Africa, however, there are still many such venues, and wherever they exist, they fuel infection rates in surrounding areas. So it is that over two-thirds of the estimated 53 million people who have become infected with human immunodeficiency virus type one (HIV-1) since the start of the pandemic have been from Africa.
Back in 1986, we spent four days travelling around Kasensero and its neighbouring villages, until we realised that we were witnessing something momentous and strange. Aids had been seen before in specific groups such as gays, drug users and haemophiliacs, and in hospital beds across central Africa, but what we were witnessing was the first community-wide Aids epidemic in the world. Men, women and children were all affected, and we rushed back to Europe and America to tell the story.
In 1995 my friend, the late great evolutionary biologist Bill Hamilton, visited to get an update on the situation and brought back sad news about the men who had escorted us through the villages in 1986 – the tall, dignified district chairman, Joseph Ssebyoto-Lutaya, and the ever-smiling medical assistant, Jimmy Ssemambo. Both had died of Aids.
Now, 14 years after that initial visit, I call at Joseph’s house, in the village of Kyebe, near Kasensero, to offer my respects. His wife, it turns out, died a few months after him, but their 10 children all survive, and thankfully all look healthy. The younger ones are still cared for by their grandparents, who live in the house next door to Joseph’s, beside the concrete graves among the banana trees. These children are lucky. So many houses around here now lie deserted, abandoned – their former occupants either dead, or scattered to the winds.
I am here in Uganda with a Channel 4 news team, to help them prepare a front-line report ahead of the thirteenth International Conference on Aids, which opens in Durban today. There has been a belated acceleration of interest in Aids and Africa over the past few months. Partly this has been because of the conference, but partly because of other events including the ill-judged comments of South Africa’s president, Thabo Mbeki, questioning whether HIV actually causes Aids, which have provided unmerited oxygen for the moribund hypothesis of Professor Peter Duesberg. And at long last, international donors such as the US and Britain have made significant contributions.
In addition, my book The River seems to have ignited a major scientific debate about how Aids started in Africa. This pleases me, for the book was an obsession and a labour of love. It took more than nine years to research and write and included more than 600 interviews with scientists. What I was stunned to discover was that a perfectly sound and scientific explanation for the origin of Aids had been casually – and irresponsibly – dismissed by the scientific establishment. Now, as a result of the controversy, a two-day conference on ‘The Origins of HIV and Aids’ will be held at the Royal Society in London in September.
My central hypothesis was that the Aids pandemic was sparked by an experimental oral polio vaccine (OPV) called CHAT, which was fed to more than a million infants, children and adults in the former Belgian colonies of central Africa between 1957 and 1960. It is now accepted that the immediate ancestor of HIV-1 is the simian immunodeficiency virus (SIV) of the common chimpanzee. In the late Fifties, polio vaccines were grown in cells from monkey kidneys, but evidence suggests that some batches of the CHAT vaccine fed in Africa were, uniquely, produced in chimp cells.
By contrast, the hypothesis to which most Aids researchers still subscribe is that the virus was originally acquired by a hunter or market-woman, perhaps with cut hands, who butchered a chimp for bushmeat. When asked ‘Why now?’ (for chimps have been hunted and eaten since time immemorial), the reply of ‘cut hunter’ proponents is that it was probably decolonisation, leading to urbanisation and new sexual interactions, that allowed the newly acquired chimp virus to break free from its rural hearth, to proliferate in an urban environment, and then to spread across Africa.
On the face of it, the cut-hunter theory seems plausible. On the other hand, the CHAT hypothesis fits the known facts considerably better. For example, it is now known that the CHAT researchers had a chimpanzee camp at Lindi, just outside Stanleyville (now Kisangani) in the then Belgian Congo, and that between 1956 and 1958, some 400 chimpanzees were held there, of which nearly 300 were first used to test the polio vaccine, and then sacrificed. According to a growing number of witnesses, both kidneys and blood were extracted shortly before sacrifice, and were then dispatched in flasks to Philadelphia and to Belgium, the two places where the CHAT vaccine used in Africa was made.
Then there are the astounding correlations between CHAT vaccination sites and early Aids. Fully 64 per cent of the first Aids cases seen in Africa (up to and including 1980) come from the same towns and villages (all in the former Belgian colonies of Congo, Rwanda and Burundi) where CHAT was fed in the Fifties. Furthermore, every single one of the 46 earliest HIV-positive blood samples from Africa comes from within 140 miles of a CHAT vaccination site.
Reviews of The River have generally acknowledged that the CHAT theory is plausible, albeit unproven. However, earlier this year, researchers led by Bette Korber placed the last common ancestor of all the HIV-1 variants seen today (which she called ‘the Eve virus’) in 1931, plus or minus 10 to 20 years. Since this was before the CHAT trials began, Korber pronounced the polio vaccine theory ‘highly unlikely’.
Many US journalists assumed that this theoretical data settled the issue, which it most certainly did not. Korber’s mentor and former boss, Gerry Myers, will oppose her position at the Royal Society conference pointing out that Korber’s dating says nothing about when chimpanzee SIVs transferred to humans and that the new data supports the CHAT theory better than the cut-hunter position.
This and other counter-arguments to CHAT will all be addressed at the London meeting. It is worth noting, however, that none of the opposing scientists has thus far come up with data or arguments to refute the theory.
The conference was initially proposed by Hamilton, who was a leading scientific supporter of the CHAT theory for many years. In January, he travelled to Kisangani (by then in the midst of civil war) to collect shit samples from chimpanzees to see whether any were SIV-infected. Tragically, he contracted malaria and, shortly after his return to England, died.
Since then, there has been a concerted attempt by some of those who made the vaccine, or who support the cut-hunter theory, to scupper the conference. First, several ‘cut-hunters’ who had previously agreed to speak, withdrew. They later relented, but only after the meeting was postponed from May to September, and they had been allotted extra speakers.
Meanwhile, a series of extraordinary public and private attacks have been mounted against Hamilton, myself and others who believe that the CHAT theory deserves a fair hearing, accusing all involved with organising the London meeting of being enemies of science.
In fact, there are sound reasons for having the debate that so many wish to stifle. One is that knowledge of how a disease began often leads to a better understanding of how to cure, prevent or alleviate it. Another is that the CHAT story has important implications for future medical and scientific practice, at a time when we may be about to embark on other well-meaning, and potentially even more dangerous, biomedical interventions. These include xenotransplantation (placing animal organs in humans, together with whichever undiscovered viruses may be lurking within), and trials of live Aids vaccines (which have the potential to recombine with existing HIV variants, to devastating effect).
In June 1981, a German missionary doctor, Margerete Bundschuh, saw five women from the Ugandan border regions with unusual bacterial infections of the groin and anus, together with a man whose penis was ‘half rotted off’. Much later, she wrote to me to explain her sense that these conditions were complicated by serious immune-deficiency: ‘We had the impressions – sex infection, three to six months of slow deterioration, then acute disease and death. At that time, there was no long stage of undetectable Aids.’ Bundschuh worked at Mugana hospital, in northern Tanzania, on the smugglers’ road leading to Lake Victoria and Kasensero, which would witness its first cases a few months later.
In Tanzania, the new condition was christened ‘Juliana’ by local people; in Uganda, ‘Slim’. This detail alone – that non-specialists realised a new disease had arrived – destroys the claims by Peter Duesberg that the Aids epidemic in Africa is merely a collection of ancient diseases, to which Western doctors have ascribed a new name.
So how did HIV-1 arrive along the Uganda/Tanzania borders? This coffee-growing region receives many Hutu migrant workers from Burundi and Rwanda, so it is possible that one of these was the carrier. However, there is an alternative explanation.
In the early Sixties, hundreds of thousands of Tutsi refugees fled ethnic violence in Rwanda. In 1962, 3,000 of them were transferred to this region, and encouraged to settle. They came from Butare and Nyanza, two of the four ‘territories’ where CHAT vaccine was administered in Rwanda. Shortly afterwards, a two-year-old child from one of the settlement villages died of aggressive Kaposi’s sarcoma – a possible early case of Aids.
This same region later experienced a series of upheavals. In 1978, Idi Amin’s army invaded the Kagera salient of northern Tanzania, and Julius Nyerere summoned 45,000 troops to oppose him. For three months they trained intensively for the counter-invasion.
Seven thousand men from the 207th brigade camped out on an open, grassy plain beside the village of Bugandika. Local men told us that there were many instances of rape, and that: ‘Soldiers came and went from village houses. There were many divorces. Girls and mothers came here from far away for meat and beer.’ Bugandika lies just nine miles from Mugana hospital, at the foot of the smugglers’ road.
It seems likely that someone who spent time at that camp, a soldier or a female visitor, was already infected with HIV and that – just as with the gay bath-houses in America at around the same time – a seed was planted in a fertile environment. From Bugandika, the 207th took a route north which was different to those of other Tanzanian brigades. It crossed into Uganda at Joseph Ssebyoto-Lutaya’s village, Kyebe, and then moved north through Kyotera and Masaka to Kampala, which it occupied until the Tanzanian withdrawal in 1981. By 1987, a quarter of the women in Masaka and Kampala were HIV-positive, while Kyebe and Kyotera were famous as epicentres of Aids.
In 1987 Uganda initiated the first Aids Control Programme in Africa, and began a campaign of health education that continues to this day, with posters, TV ads, lessons in schools and villages, and the popular radio show Straight Talk. The rewards are there to be seen. A few days ago, President Yoweri Museveni announced that national (adult) HIV-prevalence had fallen from 30 per cent in 1992 to under 10 per cent today.
Last weekend, Bill Hamilton’s memorial service took place at New College, Oxford. I booked an early flight home from Uganda, and made it with minutes to spare. Bill’s family, friends and a large contingent of the great and the good were there. Mike Worobey, one of his two young Canadian companions on the fateful Congo expedition, spoke movingly of his ‘last bite’, delivered by one of several safari ants. Richard Dawkins, who organised the service, quoted liberally from the many obituaries, before adding John Maynard Smith’s magnanimous conclusion that Hamilton was ‘the only bloody genius we had’.
It was remarkable to see so many eminent professors with tears in their eyes. This was a tribute not just to the brilliance of the man, but to his humanity. Dawkins spoke also of Hamilton’s championing of the ‘unfashionable – even reviled’ polio vaccine theory. He added later that ‘Bill was usually right’.
Whatever the truth of how Aids began, Africans, tragically, are taking the brunt. Of the 19 million who have died globally, probably 15 million have been African. Half of all 15-year-olds in Zimbabwe, Botswana and South Africa can expect to die of Aids. This is an unprecedented cataclysm – and it needs an unprecedented response.
This morning, as the Durban Aids conference opens, this is what African doctors and scientists are saying Africa needs – and needs urgently:
- more needles, syringes, gloves, gowns and protective gear, so that the virus is not transmitted unnecessarily to health personnel, or to other patients.
- more drugs, to alleviate the symptoms of Aids.
- more antiseptic solutions and IV drips; more linen, bedding and beds.
- more HIV test kits.
- more money for the training and support of doctors, nurses and counsellors.
- more condoms.
- more and better focused health education, especially for the young. Repeat twice over.
These are the simple things that work, that save lives. In comparison, anti-retroviral treatments can be afforded by very few, and most African countries lack health systems that can deliver and monitor the drugs.
In addition, more support is needed for social interventions which might massively reduce onward transmission. Some of these could be quite painful, but could be effected, given the political will. Let the Catholic Church match its compassion with pragmatism, and tell its congregations that condoms may be used to protect lives. Let Africa’s politicians and ethnic leaders tell their peoples that male circumcision can reduce the risk of contracting HIV during sex. And let a concerted effort be made to elevate the position of women in African society.
If the oral polio vaccine theory should come to be proved, it is my belief that an overwhelmingly dreadful and difficult lesson will eventually be learnt. Vaccines save millions of lives. But new vaccines – including Aids vaccines – need to be tested appropriately and rigorously before they are released. New medical and genetic interventions likewise must be tested to exhaustion, even if that means more money is spent, and even if the potential benefits are delayed.
But, if CHAT/Aids were proved correct, I believe it would help nobody for the original researchers, or even the institutions or governments that supported them, to be deemed legally culpable. At its core, the CHAT vaccine story involved an attempt to help people, not to kill them. In science, as in other walks of life, the road to hell is paved with good intentions. In this case, it was also paved with paternalism and a tendency to exploit groups that did not control their own destinies. Like other polio vaccines, CHAT was tested first on the handicapped, then on prisoners. Finally, one million Africans were ‘volunteered’ for vaccination by their colonial masters.
Nowadays, this process is being presented by some of the vaccine-makers as a heroic attempt to curb polio epidemics in Africa. This is largely incorrect. In the Fifties, polio was a Western scourge – 95 per cent of Africans were naturally immune to the virus by the age of five. Essentially, the great majority of African CHAT vaccinees were used as guinea-pigs to safety-test a Western vaccine.
In Kampala, Uganda, the first Aids vaccine trials are now taking place on 40 volunteers. Virologists say that to be effective, an Aids vaccine needs to be tested in an area of high HIV-prevalence, and that Africa affords a more logical setting for trials than the US or Europe. The trials have received full approval and co-operation from the Ugandan government.
And yet the vaccine has been prepared against HIV-1 subtype B, the so-called Euro-American strain, and one which is hardly, if at all, found in Africa. Ugandan researchers say they want to see if a vaccine against one subtype can protect against others, and add that the vaccine-makers have promised a vaccine against subtypes A and D (which are prevalent in Uganda) within two or three years. However, there is already evidence from chimpanzee trials which suggests a vaccine prepared against one subtype does not protect against others. So are the mistakes of the past happening again?
If Aids was a Western medical error, then there surely has to be a change in Western approaches to helping Africa and Asia cope with their spiralling epidemics. At the very least, this would involve Western governments (especially those of the US and Belgium) accepting responsibility for the devastation caused by past paternalism, past mistakes.
Earlier this year, the US committed $254m to fighting Aids overseas, and declared the global situation ‘a threat to national security’. There was no mention of the threat to African security and, though welcome, the donation smacked of pre-emptive action ahead of Durban. The World Bank reckons Africa needs more like $2 billion; others place it higher.
Law suits and reparations are not the way forward. What might help Africa, however, is a different scale of financial commitment, a different set of ethical standards. Cancelling Third World debt might be a start. And drug companies would earn enormous approval ratings were they to abandon the profit motive for a moment, and slash prices for Third World drugs and medical supplies
Massive human support is needed too. Perhaps the setting up of a new agency, a revamped VSO and Peace Corps for the new millennium, run by Europeans, Americans, Africans and Asians which would allow caring, ethical, well-balanced and brave young people to channel those gap years to better purpose.
The Hamilton Project? Perhaps in years to come, we will routinely watch our recent graduates, our unemployed but not yet feckless youth, going off to ‘do a Bill’.
© Edward Hooper 2000.
The revised paperback edition of Edward Hooper’s ‘The River – A Journey Back to the Source of HIV and Aids’ is published by Allen Lane/Penguin at £10.99.