The River: A Journey Back to the Source of HIV and AIDS by Edward Hooper 1070pp, Penguin, £25
When I lived in Uganda during the late 1980s, journalist Ed Hooper was already a well-known figure. He had spent time in jail under Milton Obote's regime, been a United Nations official, a school-teacher and worked as a store-keeper in a diamond-mine. Later he reported on the post-Amin wars and, crucially, the first signs of the HIV epidemic as they began to appear. Now we at least have an idea of the figures, rough beasts though they may be: over 35 million infected with HIV; 15 million already dead through Aids. Back then, things were sketchier still - and the craziness, paranoia and prejudice only beginning.
Hooper was a maverick and risk-taker in those days: a tough, street-wise figure whose habit of whipping scoops from under their noses irritated the small community of East African foreign correspondents. He was more at home in the low dives and bars of Kampala, Nairobi and other cities than the press club - the same sorts of place as the Mombasa bar which, in the thirties, awakened memories in Evelyn Waugh of the old port of Marseilles. All races, and all vices, were catered for.
It was a miracle, given his friendliness with the bar-girls, that Hooper didn't contract Aids and his first book, Slim (1990), is an account of his personal odyssey through the East African epidemic (the term refers to the name given to the wasting disease in African slang).
Now, nine years in the writing, comes The River , a journey to the "source" of Aids. Hooper's massive, 1,000-page piece of medical detective work contends that the HIV epidemic is the work of human hands, in particular the vaccination in the late 1950s of more than a million Africans with an experimental polio virus.
Aids research is a field riven with disagreements, but one thing the scientists do seem universally to acknowledge is that the main type of human HIV is a variant of a simian equivalent found in chimpanzees. How, asks Hooper, did it get passed on?
The most common answer is to point to the tradition of "bush meat" - the hunting and eating of chim panzees and other primates for food. It is a tradition which, somewhat horrifyingly, continues to this day, with packets of frozen meat even now being sent as delicacies by plane to rich Congolese exiles in Brussels and Paris. But bush meat has been eaten since the dawn of homo sapiens . Why hadn't Aids appeared earlier?
It is Hooper's contention that it was a single venture in polio vaccine research which led to the epidemic, the Lindi chimp colony outside Stanleyville (now Kisangani) in the Belgian Congo. It was here, in 1957, that Philadelphia doctor Hilary Koprowski established his research centre, where primate kidneys of some description were treated with the polio virus. By 1959, the chilled vaccine, known for inexplicable reasons as CHAT, had been fed to nearly a million people (most of them children) in the Congo, Uganda, Rwanda and Burundi.
At the time, polio was almost as feared a disease as Aids is today. The search for a polio vaccine was spurred on by the death of Franklin D Roosevelt, its most high-profile sufferer, and by the fact that many of its victims were children. The vaccine was a scientific prize of the highest order. There was one crucial hurdle: weakening or "attenuating" the virus so that it would take in humans without giving them polio. This was best done by passing it through a series of live animals and tissue cultures ("substrates") before it was administered to the human subject.
It was always known that cross-infections from elements in the tissue cultures other than the primary virus was possible. Yet Koprowski is on record as saying in the 1950s: "Whatever it takes to attenuate the virus, we will do it." Is Aids the end result of that risk-ignoring bravado? Is this the source of "the river"? Even if it is, we must weigh that against the facts that vaccines have saved hundreds of millions of lives and that most vaccines are perfectly safe.
Hooper's thesis is backed up by 10 years of travel, nearly a thousand interviews and the examination of 4,000 articles and archival documents. All that work comes to rest on four central points, circumstantial but compelling:
1) the astonishing geographical correlation between the 1959 mass polio immunisations in Africa and the first recorded outbreaks of HIV
2) that chimpanzee kidneys were used at Lindi camp; they were the perfect, first-choice medium
3) that contamination from simian viruses in these kidneys eventually led to human infection with HIV
4) that no one has been able to find a confirmed case of HIV before 1957, when the Congo vaccination programme began (the earliest confirmed case being one in a stored tissue sample from the Congo itself at that time).
Hilary Koprowski is still alive, and rejects these allegations, saying that he does not remember which simian kidney types were used in the substrates but they were definitely not chimp: the kidneys, he says, were from Asian monkey types which can't carry an HIV-like precursor virus.
There are three main arguments against Hooper's thesis:
1) the polio vaccine was used elsewhere, such as Eastern Europe, and a similar epidemic did not ensue
2) the evidence that the particular monkeys used to make substrates at Lindi had the simian precursor virus has not been scientifically proven
3) the Lindi vaccine was given in small doses orally, a difficult route for viral transmission - especially when weighed against the heavier likelihood of infection from blood and mucus membranes through the eating of bush meat.
Hooper has counter-arguments to all of these. One key piece of evidence - that kidney chimps were routinely excised for tissue cultures at Lindi - he didn't find until June of this year, with his book already at the printers.
Again this new evidence, which involves detailed, stomach-churning descriptions of what happened to these poor animals, is anecdotal. Could it be, Hooper wonders, that the mysterious acronym CHAT stands for Chimpanzee Attenuated? Or Chimpanzee Adapted and Tested? On the face of it, and given the personal testimony he has garnered from African helpers at the camp, it does seem likely.
It still doesn't prove his hypothesis. But in a context where scientists themselves are unable to provide the answers, this layman's crusade - and he does have some distinguished scientific supporters - is not only fascinating but important too. Most of the information in this book has never been gathered in the same place before. Some of it is entirely new.
There are ways in which uncov ering the source of Aids can help virologists find a viable vaccine against it. More importantly, The River warns against the growing likelihood that animal organs will be used for human transplants - at a time when we still don't know viral risks. Taken together with other instances of technical over-reaching - from atomic energy to BSE, from GM foods to gene mutation - Hooper's scrutiny of the polio vaccine issues another powerful challenge to the scientific establishment.
Indeed, if you cut through its thousands of footnotes and cross-references, this book represents nothing less than a version of the Faust myth for our age. There have been scaremongers for every revolution. Some have been right, others wrong. But on the eve of a biotechnological future, scientists and all of us would do well to read The River . For it is not often that one can say that the tensions in a book are those at the heart of civilisation and its so-called progress.
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