-Caveat Lector-
New York Times
November 30, 1999
THE DOCTOR'S WORLD
New Book Challenges Theories of AIDS Origins
By LAWRENCE K. ALTMAN, M.D.
Is AIDS a disaster inadvertently brought on by humans that arose from early
testing of a polio vaccine in Africa in the 1950's?
In ``The River,'' Edward Hooper finds disturbing links between an
experimental oral polio vaccine _ being given here in L eopoldville (now
Kinshasa, Congo) in 1959 _ and the beginnings of the AIDS virus. The virus,
he says, could have originated in chimpanzee tissues that he suggests were
used to make the vaccine.
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This provocative theory seemed far-fetched when it first came to public
attention in an article in Rolling Stone in 1992. Most AIDS experts
dismissed it after a scientific committee reviewed the theory and deemed the
probability very low.
But that panel based its conclusion in part on a published finding that was
later shown to be in error. And now a remarkable new book by a British
journalist offers tantalizing clues to revive and expand the polio vaccine
theory.
In "The River" (Little, Brown, $35), Edward Hooper suggests that an
experimental oral polio vaccine might have been made with chimpanzee tissue
contaminated with an ancestor of the virus that was to cause AIDS. Although
he has no medical expertise, Hooper, 48, has done a prodigious amount of
research since 1990. In 1,070 pages, including extensive footnotes, he
builds a case based entirely on circumstantial evidence that he accumulated
in hundreds of interviews and exhaustive library research.
He finds close coincidence in both time and place between the earliest cases
of AIDS and the testing of an oral vaccine developed at the Wistar Institute
in Philadelphia and, later, in two laboratories in Belgium. From 1957 to
1960, the vaccine was given to a million people in what are now Rwanda,
Burundi and Congo.
If the experimental vaccine was contaminated, nothing could have been done
about it because tests for the ancestor virus did not exist then. And it
would have been a one-time event because standard polio vaccines were not
made from chimpanzee tissues. Of 28 cases of AIDS acquired in specified
towns in Africa through 1980, 23 were from the same towns where the
experimental vaccine was given or within 175 miles of them. The area is the
epicenter of the African epidemic, which is the worst in the world.
And there is precedent for a simian virus's lurking in polio vaccine:
millions of Americans were inadvertently infected with such a virus, SV-40,
in the 1950's and early 1960's. (Fortunately, it was not harmful.) But in
1967, several laboratory workers in Germany died from the newly discovered
Marburg virus after it had been imported in African green monkeys. The virus
is harmless for the monkeys but lethal for humans.
The similarities Hooper describes could be coincidence. "The River" does not
prove his extraordinary theory, nor does it claim to. But it builds a
sufficiently detailed case to require serious examination of his theory.
Attempts to find answers require extensive research, and in the book and in
subsequent interviews Hooper has offered a long list of suggestions,
including laboratory testing of the small amounts of vaccine that still
exist after having been stored for more than 40 years. Because the vaccine
may have degraded over the decades, performing all the proposed research
might still not determine whether it accidentally touched off the AIDS
epidemic. And even if a simian virus turned up in the stored samples, it
would not prove that it started the epidemic.
Still, even if the vaccine thesis is disproved, Hooper's research has
embarrassed scientists. He has found that leading researchers kept sloppy
records and that prestigious peer-reviewed medical journals published
reports that omitted crucial details.
Despite a diligent search, Hooper could turn up no records of what primate
tissues were used to prepare the first experimental polio vaccines, which
were tested mostly in Africa but also in the United States and Europe.
Though the government requires more record keeping today, scientists say
there is ample room for improvement.
With the exception of a negative review in the journal Nature, experts
writing in scientific journals have praised Hooper's diligence and
scholarship and the plausibility of the thesis, even if they are skeptical
of it. In the journal Science, Dr. Robin A. Weiss, a leading virologist in
London, wrote that Hooper had written the most exhaustive history of polio
vaccine trials and early AIDS cases.
The Wistar Institute, the first independent medical research center in the
United States, appointed the 1992 panel to examine the theory that its
vaccine might have touched off the AIDS epidemic. Now it says it is trying
to find independent experts to do what they were unwilling to do seven years
ago, when the panel recommended testing the remaining stocks of the
experimental polio vaccine. One aim is to detect evidence of simian cousins
of H.I.V.-1, the virus responsible for the overwhelming majority of AIDS
cases in the world. A second is to determine the primate species from which
the vaccine was prepared.
Ever since American doctors first recognized AIDS in 1981, the origin of the
viral disease has been a mystery. Scientists have dismissed many theories,
including those that held that the Central Intelligence Agency or K.G.B.
concocted it, because they lacked evidence or did not fit the facts.
What is known is that the earliest documented H.I.V.-1 infection is from
1959 in a man in Kinshasa in what was then the Belgian Congo, was later
Zaire and is now Congo.
Scientists generally agree that H.I.V.-1 derives from a simian virus in
chimpanzees. But the unanswered question is how the virus jumped to humans.
The usual view is that passage must have occurred in blood-to-blood contact,
like a bite or cut during the slaughter of chimpanzees.
But humans have killed chimpanzees for centuries. So why did transmission
not occur until the late 1950's? The conventional explanation cites the vast
social changes that occurred after World War II: mass migration,
urbanization and sexual freedom.
Monkey cells were routinely used to make polio vaccines then and now. But
Hooper theorizes that chimpanzees were also used to prepare the experimental
polio vaccine. As circumstantial evidence, he points to a large colony of
chimpanzees at the Lindi River in central Congo, where the primates were
caught for research. (The river of the book's title is a metaphor for the
search for the source of AIDS.) Only a small percentage of chimpanzees are
believed to carry the H.I.V.-1 ancestor virus. But if chimpanzee tissues
sent to a laboratory in Philadelphia or Belgium were infected, they might
have found their way into one or more batches of experimental polio vaccine,
particularly the strain known as CHAT, prepared at the Wistar Institute.
In such an event, H.I.V.'s simian ancestor might have grown in the batches
of polio vaccine used in experimental trials only. When the vaccine was
squirted into human mouths, the simian virus could have passed through a
sore or ulcer and entered the bloodstream, subsequently to evolve into
H.I.V.-1. From there it would have been transmitted through sexual or
blood-to-blood contact.
Any contamination would have been accidental, because specific tests could
not have been performed before 1985, when a simian counterpart of H.I.V. was
first isolated.
Whether chimpanzee tissue was used should be easily confirmed or refuted by
checking laboratory records and scientific journals. But Hooper said he
could not find out precisely how the vaccine was made, and neither could the
committee that the Wistar Institute appointed in 1992 to examine the theory.
The committee was justifiably skeptical of the theory, in part because
British scientists had reported that a seaman from Manchester died of AIDS
in 1959 and probably was infected for about 10 years, thus placing the
origin of H.I.V.-1 before the development of polio vaccines. Also, the
experimental Wistar vaccine had been given in Poland and Sweden, and AIDS
was not reported there in the critical years.
Despite the committee's skepticism, it recommended that two independent
laboratories test the remaining vaccine. In seeking such cooperation, Wistar
officials found only one lab, at the federal Centers for Disease Control and
Prevention, willing to do the work, so it was dropped because it would have
been impossible to obtain confirmation, Dr. Clayton Buck, Wistar's deputy
director, said in an interview.
The testing has taken on new urgency because further research has shown that
the Manchester man did not die of AIDS: that the H.I.V. thought to have been
isolated from his body was actually from someone else infected more
recently.
Nevertheless, the misdiagnosis of AIDS in the seaman does not alter any of
the committee's other conclusions. Even if chimpanzee tissue was used, the
vaccine theory remains a long shot, the head of the committee, Dr. Claudio
Basilico of New York University, said in an interview.
Still, the committee was so concerned about the theoretical dangers from
primate tissues that it urged vaccine manufacturers to make "a serious
effort" to stop using them.
Dr. Basilico says his committee may be reactivated to oversee the
preparation of the stored vaccine for testing. And the Wistar Institute has
pledged to find two or three independent laboratories to do the tests.
"It ought to be done because it can be done," Dr. Basilico said, though he
added that the testing might not provide a conclusive answer, in part
because of the difficulty of disproving a theory.
In preparing the material for the independent laboratories, the Wistar
Institute will include samples other than polio vaccine for purposes of
scientific controls. The committee will code all the material to keep the
testing laboratory from knowing which is which, Dr. Basilico said.
The Wistar polio vaccine was also given to a small number of Swedes. When
some of the remaining vaccine was tested in 1995 as a result of Hooper's
work, Swedish scientists found no evidence of simian viruses in it. But the
findings do not refute the theory, because different vaccine batches may
have been used in Africa and Sweden. Nor did the Swedish scientists try to
determine the source of the primate species for the vaccine. Dr. Hans
Wigzell, the director of the Karolinska Institute in Stockholm, said in an
interview that he was skeptical of the vaccine theory but assumed the
Swedish government would be willing to do more laboratory testing to try to
find out.
Hooper's recommendations go beyond such testing.
One proposal is to conduct a formal investigation into the missing
information and how the vaccine was made. If the precise technique could be
determined, then scientists could investigate whether a contaminating simian
virus was capable of surviving the vaccine-making process.
A second recommendation is to conduct a vast search of blood and tissues for
evidence of H.I.V. in blood or tissue taken before the polio vaccine era;
detecting the virus would strongly challenge the vaccine thesis.
A third proposal is to find out whether another early case of H.I.V., in a
baby born in 1973 to a teenager in New Jersey, could have been linked to the
testing of the experimental vaccine at a women's prison in Clinton, N.J.
With 16 million people dead and 33 million more infected, AIDS is among the
worst epidemics in history. A seriously researched theory about something so
devastating deserves a full scientific investigation even if the theory is
unlikely and chances of proving or disproving it are slim. Since the credo
of science is to seek the truth, science should assure the public of its
integrity.
Vaccines are unquestionably one of medicine's great triumphs, and they have
nearly eradicated polio from the world. But if experimental batches of polio
vaccine were inadvertently contaminated with an ancestor of the AIDS virus
when immunizations were made by much cruder techniques than those used
today, then scientists and government officials would have to accept
responsibility for a historic blunder.
Yet many scientists say privately that publicizing Hooper's theory would
risk tarnishing public confidence in the safety of vaccines. Scientific
groups that could have sponsored scientific meetings to discuss the vaccine
theory, or taken an interest in testing the vaccine, have not done so.
Hooper said an official of the World Health Organization told him that the
origin of AIDS was "certainly of no interest today."
But that attitude is surely shortsighted. As Dr. Peter Piot, the head of the
United Nations AIDS program, said in a recent interview, "If it were
possible to determine where AIDS came from, that would be important for
science and the world to know."
The New York Times
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