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July 03, 2004

Polio Outbreak in Nigeria, Suppression of Dissent and the Origin of AIDS

I've always shaken my head in wonderment about the anti-vaccination hysteria we've seen from some quarters over the past few years. Thankfully, there haven't been wide spread epidemics resulting from this behavior. Until, now that is. This report from Nigeria confirms a large scale polio outbreak:

A suspected large-scale polio outbreak was reported Friday among children in a heavily Muslim northern Nigeria state that had boycotted immunization campaigns, and local authorities appealed for urgent action to stop the spread.

On Friday, local officials in the Kano state city of Rogo disclosed that they had recorded dozens of suspected polio cases in recent weeks. Rogo is 60 miles southeast of the state capital, also named Kano.

[. . . ]

Since Kano suspended polio immunization, there has been a resurgence of cases across 10 African countries previously polio-free, with strains traced to Nigeria.

Nigeria has reported 259 polio cases this year. The figure represents more than 60 percent of the 339 cases reported worldwide.

It accounted for nearly 50 percent of 784 cases reported in a total of 15 countries in 2003.

Six of those countries Afghanistan, Egypt, India, Niger, Nigeria and Pakistan are classified as polio-endemic by WHO.

Abiola has blogged on this in the past and what is clear is that much of the hysteria has to do with conspiracy theories that have no basis in fact. Simply superstitions. They bring to mind the Western fear of a causal link between the mercury-based preservative thimerosal, used in some vaccines, particularly the MMR vaccine and the development of autism in children. As this May 17, 2004 report from the Institute of Medicne of the National Academies makes clear, no evidence of such a relationship has been able to withstand scrutiny.

However, in the world of vaccination related illnesses there is still one unresolved mystery: did AIDS arise from poor quality control in the manufacture of polio vaccines in the late 1950s in present day Zaire.

This hypothesis first came to light in 1992 when Tom Curtis wrote a piece for Rolling Stone Magazine entitled The Origin of AIDS. It resulted in a debate between Curtis and Dr. Hilary Koprowski of Philadelphia's Wistar Institute at which a vial of the vaccine from the late 1950s was discovered and tested negative for Simian Immunodefiency Virus. Understandably Curtis's position was shattered and Koprowski won a libel suit against Rolling Stone.

Fast forward to 2000 and with the publication of Edward Hooper's The River: A Journey to the Source of HIV and AIDS the debate was reopened. Unlike Curtis's earlier work, Hooper was more methodical in his investigations and tracked down archival documents, film footage and has eye witness testimony to the activities centered on Camp Lindi, in the Belgian Congo, the center for Dr. Hilary Koprowski's work.

Dr. Jonas Salk perfected the first vaccine against polio and what followed was wide vaccination and the eradication of polio. In the following years however, a few hundred children died as a result of the Salk vaccine and this started a race for a new version. There were two competing teams, one led by Dr. Albert Sabin and one by Dr. Hilary Koprowski, and the Sabin vaccine eventually won out. Much of this history is covered in Hooper's book, and Atlantic Magazine published a detailed review of Hooper's book where it also investigated the controversy that erupted after its publication.

Some are referring to the Oral Polio Vaccine - AIDS Hypothesis as the grassy knoll of vaccine theories - plauasible bot wholly lacking in evidence and based on mere conjecture. This criticism would be more credible if the scientific community had more fully and openly examined and debated the hypothesis. Instead, both Nature and Science rejected submissions for publication from eminent scientists who offered support for the hypothesis and sought to silence the debate. This type of behavior, if anything, only adds to the belief that a conspiracy is taking place. [ Godless comments: I don't agree with this interpretation. Science and Nature only accept 10% or so of all submissions. If the work was solid it would have been published in a lower quality journal. ].

In a nutshell, the broad strokes of this hypothesis are that Dr. Hilary Koprowski vaccinated about 900,000 children in the Congo and surrounding areas and coincidentally that is where the earliest clusters of HIV/AIDS were discovered. Tantalizing correlations but lacking in details to explain causation. Polio vaccines are cultured on a substrate, even today with our mastery of recombinant DNA technology, of simian kidney cells. The simians used for the Sabin Vaccine are from a species that doesn't harbor Simian Immunodefiency Disease (SIDS). In correspondance between Dr. Sabin and Dr. Koprowski when the research race was still ongoing, Dr. Sabin, after examining a sample of Dr. Koprowski's vaccine, wrote that there were problems with the batch that was examined because they detected an unknown virus, which they labeled "Virus-X" to which Dr. Koprowski had no substantive reply. Shortly thereafter Dr.Sabin's vaccine was chosen to be the one to replace Salk's vaccine.

Koprowski's vaccine did find use is some areas of the world and was grown in labs in Europe and Africa. What distinguished the vaccine produced in Africa from those in parts of Europe was the choice of simian substrate. Chimpanzees were occasionally used in Africa but never in Europe. Chimpanzees are hosts for the SID virus. Of course this was unknown at that time. Dr. Koprowski disputes this allegation and has produced samples of the vaccine from that era which originated in Europe and claims that chimpanzees were never used. Hooper, however, has testimony from African nurses and technicians employed at Camp Lindi, and archival film footage of chimpanzees being disected for their kidneys and the testimony supports his claim that these kidneys were used locally as the substrate within which the vaccine was grown.

As the Atlantic Magazine article points out there have been claims and counterclaims on a host of issues surrounding Hooper's hypothesis. This battle is intensifying in these past months because of the release of the documentary Origin of AIDS which presents the archival film footage, the audiotaped testimony, and presents the dispute to a wider audience than those who read Science and Nature. Having seen this documentary I offer the opinion that it does present a compelling case for Hooper's hypothesis and elevates it above the grassy knoll category. Here is a review of the film. There are still unresolved issues which could certainly invalidate Hooper's hypothsis but in the background of this debate is a wider battle dealing with suppression of dissent,

If you're interested in following the debate, here is a source which documents Hooper's charges, the refutation of some of the charges, and the counter-refutations from Hooper and others. The siteowner is a social scientist who documents instances of suppression of dissent. The journals Science and Nature, acting as gatekeepers and opinion shapers should be taking a value neutral position. Instead they are miring themselves in a controversy of their own making by following the Scientific American suppression of dissent tactics employed against Bjorn Lomborg (here is his rebuttal to their article) and Eric Drexler (here is his rebuttal to their article) where either dissent is not publlished or legal threats are made. The editorializing on scientific issues by these journals is jeopardizing their impartiality.

Finally, if the Nigerians, and others, have concerns about vaccinations, they should base those concerns on substantive scientific data, not anti-Muslim plots that purport to make girls infertile. The AIDS/polio connection that Hooper hypothesizes is an intruiging historical and scientific puzzle but should in no way be used as a basis for concern about the safety of today's vaccines, nor about past vaccinations in the majority of the world.

Godless comments:

I am unsympathetic to this theory for several reasons. First, there have been several other theories about AIDS (such as Duesberg's, the CIA plot to kill black people, etc. ) that have been debunked. This has made scientists cautious about politically charged conspiracy theories about the origin of AIDS.

Second, the idea that Science and Nature are "suppressing" this information is unlikely. Either the work is worthy of publishing or it is not - and there are MANY more journals in the world than Science and Nature. If these guys had solid but controversial evidence, I'm sure that PNAS or the New England Journal or JMB or whoever would take the paper. Scientific journals *must* be opinionated and harsh, as there is a lot of junk out there and journals serve as valuable filters for a scientist's limited time.

Thirdly, even if it is true that the emergence of AIDS is an accidental consequence of experimentation with the polio vaccine - so what? Sometimes accidents happen, and we just couldn't have known that the virus would jump to humans. The idea that we should only pursue medical procedures that are already known to be safe would discourage all medical innovation. Brain surgery, pig heart transplants, open heart surgery, and vaccination...developing these invaluable tools *did* result in accidental deaths. Should we abandon the promise of gene therapy because of a tragic death?

Finally, I would take the criticisms of the people in this article with a major grain of salt if they accompany their attack on Koprowski with a call for massive subsidy of AIDS drugs to Africa. The thing is that Koprowski was fighting a killer disease and could not have known the consequences of his actions *even if* things took place the way Hooper alleges. Second guessing the man who was the first person to successfully vaccinate someone against polio is Monday morning quarterbacking which neglects the urgency of the polio situation.

By contrast, modern day proponents of massive AIDS drug subsidies are - or should be - informed about the danger of partial compliance with a drug regimen:

Unfortunately the very success of the drug treatment of tuberculosis has been the catalyst for the emergence of a new wave of drug resistance. Patients have been allowed to take their medication at home completely unsupervised. The experience of the early single use of streptomycin taught us that taking one drug on its own for tuberculosis would lead to drug resistance. There is a danger that if the patient is sent home with three separate drugs, he or she might take a single drug at a time. In the patient with extensive lung disease taking a single drug for just a few days may allow drug resistance to emerge. If a patient happens to be resistant to one drug and takes a combination of two drugs including the one to which he is resistant, drug resistance to the second drug will emerge. Similarly if the patient is resistant to two drugs, and takes these two drugs and a third only, then resistance to the third will emerge and so on. In this way a combination of poor compliance and poor medical supervision may result in multi-drug resistance.

In other words: those criticizing Koprowski for lack of foresight are guilty of the exact same thing, with less of an excuse. By denying that those likely to contract AIDS are unlikely to have the conscientiousness necessary to comply with a drug regimen, they are in part responsible for the rise of new drug resistant strains of AIDS :

Anything short of full compliance with one's assigned antiretroviral regimen can lead to incomplete suppression of viral replication -- and to the development of drug-resistant viral strains (R). The result of poor compliance is shown in this column, in which the original mix of strong and weak virus (seen in Column 1) is being replaced by a new type of super-strong, drug-resistant virus.

Which are already popping up in Africa:

The unregulated supply of Aids drugs in the non-industrialised world threatens to accelerate the development of drug-resistant HIV strains.

Misuse of Aids drugs is common in Africa
That is the conclusion of a study from the London School of Hygiene and Tropical Medicine, just published in the British Medical Journal.

The study urges governments and international agencies to deal with the problem now.

Drawing on evidence from Africa and Asia, the study shows that uncontrolled prescribing of anti-retroviral drugs is widespread and rising. ..

The study's author, Dr Ruairi Brugha, says that often patients do not take their drugs as they should.

"These drugs are not being used according to the correct regimens. For instance, monotherapy - just giving one anti-retroviral drug - is definitely bad practice. And we see evidence of that both from Zimbabwe and Uganda, and I'm sure it's happening in other countries too."

Dr Brugha also found that in some places patients are changing medication frequently, taking the wrong dose, or stopping treatment in periods when they cannot afford it.

This is exactly the set of conditions in which a virus quickly becomes drug-resistant.

And unlike Koprowski - who I doubt is "guilty" - they don't even have the defense that they couldn't have foreseen the consequences.

TangoMan Responds

Godless raises some concerns that I think are tangential to my post, and while important on their own, they are premised on a thesis that I don't make.

I don't view the Origin of AIDS question as expressed by Hooper as being political, rather it is more of a scientific detective work. No one, to the best of my knowledge, and this includes Curtis, Hooper, and the documentary filmmakers, have ever expressed the opinion that Koprowski should have known about AIDS, about Simian Immunodeficiency Disease, or that by using chimp kidney cells as the substrate at Camp Lindi, they may have created the mechanism to foster the jump between species. These issues were simply unknowable. If the hypothesis is sustained, then we can finally understand the puzzle of hows AIDS jumped species and write it off to unintended and unknowable consequences of good work done for humanity.

Secondly, again to the best of my knowledge, no one associated with this hypothesis is calling for AIDS policy towards Africa to be changed. The points Godless makes are important but I don't think they stem from the substance of my post.

Thirdly, Hooper's hypothesis has been called the killer hypothesis by those involved with vaccination issues. Almost all involved prefer the bushmeat hypothesis but are at pains to explain the recent appearance of AIDS against a history of bushmeat going back for centuries. The implications of AIDS having been developed and initially propogated via vaccination would create a climate of fear in present-day vaccination receptivity and would present a daunting task for rebuilding the public's confidence towards vaccination.

Lastly, I don't dispute the issues that Godless raises just his inference that I was making the points that he uses in order to frame his rebuttal .

Posted by TangoMan at 06:58 AM