Capitalizing on the Flu

Washington, D.C.—President Bush’s vague plan for coping with a serious outbreak of bird flu is based largely on fear and greed. There is no secret about this. He seeks to get people’s attention by scaring the citizenry with visions of millions of people dying from a pandemic so bad it leads to martial law, mass quarantines, restrictions on travel, and so on. He wants to encourage private business to meet the crisis by producing more of existing drugs such as Tamiflu to combat a flu plague and entice the drug companies to work harder and faster to make a vaccine by ensuring its profitability.

The answer to a bird flu pandemic is not a passive first-world population riveted to the TV, watching one person after another drop dead across the world as sickened birds fly closer and closer and finally land in our midst.

The answer lies in effective communication at all levels among different nations, through their medical establishments, scientists, and spotters, so that as soon as sick or dead birds are found, the birds in surrounding areas can be culled. This is a job for the World Health Organization, which is part of the United Nations, the organization Bush and his ambassador, John Bolton, are determined at all costs to wreck.

While developed countries race to lay in supplies of antiviral drugs, there is little interest in the animals themselves and in animal-human interaction where flu can begin and spread. The WHO and Food and Agriculture Organization have only 40 veterinarians between them. “Reducing human exposure requires education about handling poultry and a fundamental change in cultural attitudes towards human- animal interactions and husbandry in many parts of the world,” writes The Lancet, the British medical journal. “In some African countries, people sleep in the same places as poultry. In southeast Asia, ‘wet markets,’ where live poultry are traded and slaughtered on the spot, pose a risk of human transmission. And in Central Asia and Eastern Europe, hunting of wild birds may have played a major part in the spread of avian influenza.”

Changing the interplay of animals and humans may meet considerable resistance among small poultry farmers in poor countries, who face the loss of whole flocks in a mass culling. If farmers are offered too little to cull their birds, they won’t do it. And if too much money is proffered, “the money will be an incentive to deliberately infect their flocks,” Milan Brahmbhatt, the World Bank’s lead economist for East Asia and the Pacific, told The Lancet.

The overall effect of a pandemic in Asia will be to drive small poultry farmers out of business and open the way for U.S.-style industrial chicken farming, with ownership concentrated in the hands of a few. Among the major exporters are China and Thailand (Southeast Asia now accounts for about a quarter of the world poultry business). Most of their chickens go to Japan. Many countries are banning imports from these two nations, and that is running up the price of chickens worldwide and promising to up exports from such places as the U.S., Brazil, and the EU.

Robber Barons

A serious effort to stave off a pandemic also means stopping the pharmaceutical companies from scaring people to make more money. It is by now well-known that the drug companies provide huge sums of cash to politicians—$133 million to federal candidates since 1998, according to the Center for Public Integrity, with upwards of $1.5 million going to Bush, the top recipient. The industry operates an elaborate lobby in Washington that in 2004 spent $123 million and employed an army of 1,291 lobbyists, more than half of whom were former federal officials. The industry’s sales machine aims to bypass doctors with TV and other advertising aimed directly at the patient, appealing to his or her judgment over that of a physician.

In the case of making and marketing drugs to combat flu, the results are disastrous. The industry claims it can’t make flu vaccines because there is no money in it. When asked about last year’s flu vaccine shortage by CBS’s Bob Schieffer, Bush said the industry was fearful of damage suits concocted by ambulance-chasing lawyers. He explained the shortage this way: “Bob, we relied upon a company out of England to provide about half of the flu vaccines for the United States citizen, and it turned out that the vaccine they were producing was contaminated. And so we took the right action and didn’t allow contaminated medicine into our country.” This was not true. The American inspectors had approved flu vaccine shipments from a U.S. producer’s British company. It was British inspectors who blocked shipment of the questionable vaccine from the American firm.

With no vaccine in sight, the U.S. government, along with others, is belatedly stocking up on Tamiflu, a drug that supposedly offers some defense against bird flu. But last week Japanese newspapers told how children who were administered Tamiflu went mad and tried to kill themselves by jumping out of windows. In a cautionary statement the FDA noted 12 deaths among children, and said there are reports of psychiatric disturbances, including hallucinations, along with heart and lung disorders. Roche, the manufacturer, is quoted by the BBC as stating that the rate of deaths and psychiatric problems is no higher among those taking its medication than among those with flu. The company is increasing Tamiflu production to 300 million doses a year to meet demand.

Rumsfeld’s drug connections

There are other reasons people are leery of Tamiflu. Given the rip-offs in Iraq and after the hurricanes, people are understandably interested in knowing just who is going to get rich off the plague. Secretary of Defense Donald Rumsfeld, himself former CEO of drug company Searle, currently owns stock in the one company that owns Tamiflu patents—to the tune of at least $18 million. Rumsfeld says he understands why people might question his holdings, but selling them would raise even more questions. So he is hanging on to what he’s got.

A flu pandemic could mean a reduction in travel. A recent Citicorp report says likely economic losers would include airlines (such as British Airways, Lufthansa, and Air France), insurers like AXA, and luxury-goods conglomerates such as Richemont.

The report adds: “Winners could include drug makers such as Gilead Sciences, Roche, GlaxoSmithKline, and Sanofi-Aventis. Other possible winners are hospital chains such as Rhoen Klinikum, cleaning-products makers such as Henkel, Ecolab, and Clorox, as well as home entertainment companies such as Blockbuster and Nintendo.”

In order for the pharmaceutical companies to profit from making flu vaccine in the administration’s $7.1 billion pandemic flu plan, Bush now is proposing to ban liability suits against them except in cases of willful misconduct. As for those injured by a flu vaccine, possible lawsuits remain an open question.

With a worldwide market estimated at more than $1 billion, there’s big money in a flu plague. Kimberly-Clark’s Chinese subsidiary is already ramping up manufacture of new lines of medical masks, wipes, and hand-washing liquids, according to Business Week, with consulting firms Kroll and Booz Allen Hamilton selling flu preparedness advice to companies and governments. “Crisis is an opportunity as long as you see it first,” Pitney Bowes’s Christian Crews tells the magazine.

If all Bush wants to accomplish is to see the drug industry make more money, any fight against the flu will be uphill.

Additional reporting: Isabel Huacuja and Ali Syed


Occupational Hazards

Work—most people hate it, but can’t live without it. Laurent Cantet makes films about it. The 40-year-old French director explores the way livelihood shapes identity; his latest feature, Time Out, is a psychological drama about Vincent (Aurelien Recoing), a recently unemployed executive who constructs elaborate fantasies about a glamorous new job. “A religion of work surrounds us,” Cantet says. “We’re all devoured by this idea that being out of work is somehow shameful. Vincent lies not only because he’s ashamed of being idle, but also because he wants to stay that way.”

Thin and intense, Cantet radiates the nervous energy of a militant activist, though in fact he’s always been a cultural worker whose imagination is fueled by politics. After attending IDHEC, the state-run film school, he made a prizewinning short called Everyone to the Demonstration! (1993). Far from polemics, his films are complex investigations of family dynamics. His first feature, Human Resources (1999), built patiently to a brutal confrontation between a working-class man and his only son, who is hired by management in his father’s factory to come up with a plan for restructuring employee hours. In Time Out, Vincent, whose father is a grand bourgeois, has inherited a place in the world of bureaucrats and administrators. “Vincent didn’t struggle for his place in society,” Cantet notes. “It was given to him because of his milieu. And so he had the continual feeling of being a usurper.”

The film was loosely inspired by the true story of Jean-Claude Romand, a man who pretended for 18 years to be a medical researcher for the World Health Organization in Geneva, when in fact he had no medical degree or legitimate profession. In 1993, when his secret was uncovered, he murdered his wife, children, and parents. (Romand’s case is the focus of French author Emmanuel Carrere’s recently translated book, The Adversary.) For Cantet, it’s the starting point for a meditation on double identity. At one point, Vincent visits an office of the United Nations in Geneva, where his family believes he’s working. “I tried to show him as a ghost,” Cantet explains, “moving through an unreal world of distant sounds and glass partitions.” This abstract architecture, he says, is the physical embodiment of the immaterial labor taking place within it.

“Globalization gives us the impression that everything is happening so far away,” he says, “that we’re almost negligible in the midst of a huge, powerful machine. It makes it harder and harder for people to feel that they have a stake in society.” Cantet thinks he’s found an answer to the problem of alienated labor in the work of French economists who have proposed a guaranteed salary for everyone. “Society generates a lot of money. Why should income necessarily be linked to labor?” he asks. “Just by recycling the money spent on social services, everyone could be paid for living. My film is also a plea for that idea.”

In Time Out, the nonprofessional actor Serge Livrozet plays an amiable crook, who tries to help Vincent out of his dilemma. In real life, Livrozet was a safecracker; after spending time in jail during the ’70s, he met Michel Foucault, wrote books, and became a militant anarchist. Cantet was inspired by a line from his biography. “At 14, Livrozet wrote, ‘When I began to work, they told me I’d be a plumber,’ ” Cantet recalls. ” ‘And I understood that day that I was condemned to forced labor for life.’ ”

Related article:

Dennis Lim’s review of Time Out


Lethal Lasers, Alien Fossils

Even with concerns about privacy on the increase, the presidential election fiasco has triggered talk of voting systems that would make Big Brother proud. Several companies, universities (including M.I.T.), and state governments are spending time and money to create ballot-casting devices that incorporate retina scans, fingerprinting, and “smart” ID cards with encrypted signatures. Besides the obvious Orwellian implications, digital technology such as touch screens and online voting will make fraud much easier to commit and harder to detect, since there won’t be any butterfly ballots or dimpled chads to pore over when problems arise. “An electronic system is inherently corruptible,” computer scientist Peter Neumann told the Christian Science Monitor, sounding an ominous note in an otherwise uncritical article. “It’s a disaster waiting to happen.”

The free ride for users of MP3s and e-books may be coming to a swift end. The excellent cybernews site The Register ( is reporting that the computer industry is well on its way to implementing a copy protection scheme in the next generation of hard drives, possibly starting this summer. Any time you wanted to copy or even play a file, your computer would check against a centralized database to see if you were authorized to do so. Think you could just refuse to get a new computer or perhaps find one that doesn’t have this standard built in? Maybe you could, but then you couldn’t open any protected files.

The Register has also reported that cable moguls are hatching a plan to make VCRs unable to record programs restricted by networks. To work with future generations of digital cable, all TVs and VCRs would have to incorporate the protection scheme. If a TV station coded a show as “copy never,” your VCR would simply refuse to record it.

In a story that might—just might—make you see Bill Gates in a new light, The Boston Globe reports, “Giving away money steadily, tens of millions of dollars at a time, Bill Gates has become the single most influential force attempting to reverse the growing health crisis afflicting the world’s poor.” In 1999, his foundation gave $1.44 billion to fight malaria, TB, and other afflictions around the world. This is almost $300 million more than the U.S. government spent that year, and more than one-quarter of the expenditures from all industrialized countries combined.

You may recall the worldwide headlines that resulted when scientists announced in 1996 that a meteorite from Mars contained signs of primitive life. Strangely, an equally exciting announcement made headlines only briefly in Australia last month. Richard Hoover, an astrobiologist with NASA, says that a meteorite contains fossils of at least two types of bacteria similar to those found in other extreme conditions, such as in the Arctic. The 4.6 billion-year-old chunk of space-rock Down Under is just one of six meteorites NASA is studying for microfossils, according to the Herald Sun of Melbourne.

It used to be that there was only one way to make a baby, but the times keep changing. Scientists in Japan have announced that they can now grow sperm cells in a lab using stem cells from a mouse, and they’ll soon be trying the process with adult men. This could develop into a technique in which infertile men could grow their own sperm in test tubes. The Sunday Times of London further notes that the researchers “believe they will be able to reprogramme male cells into producing eggs so that men can both father and `mother’ children. This could allow gay men to be parents together.” An earlier Sunday Times article revealed that Britain’s leading fertility expert has patented a technique for modifying sperm in ways that can prevent or cause certain characteristics in the resulting kid. As a scientist who worked on the project put it: “This does provide the capability of making designer babies, and it will be up to society to decide what to do with it.”

It sure is a good thing that the World Health Organization hasn’t said anything about mad cow disease spreading beyond Britain and Europe, isn’t it? That would be scary. Well, drop that burger, because the WHO has issued a warning to all corners of the globe that animal feed contaminated with BSE—the virus that causes animals’ brains to turn to sponge—might very likely have been shipped worldwide. United Press International has quoted an ineloquent WHO doctor as saying, “We have concerns that there was sufficient international trade in meat and bonemeal and cattle that there has actually been exposure worldwide already….We are certain there was international movement of materials that could have contained infectivity.” The doc stressed that so far they haven’t confirmed any non-European cases of mad cow disease—or its human equivalent, which is acquired by eating tainted meat—but they’re only now putting major effort into tracing the disease around the planet.

Of course, science is still hard at work as the handmaiden of the military. A well-known London scientist has created a working prototype for a “phaser.” Mixing two forms of laser, the device creates an ionized beam that immobilizes people by overloading them with electrical impulses. Kind of like a stun gun, except this scary device never touches the person and can work from over a mile away. Although the phaser is being pushed as a nonlethal weapon, a bigger charge can short out the target’s heart. On a larger scale, the military’s High Energy Laser Joint Technology Office in late December awarded $8.6 million in grants to researchers who are in the process of developing “lethal laser devices.” Despite using the word “lethal,” an article from the Copley News Service details only the antimissile uses of the lasers, overlooking the possibility of frying large groups of people with the flick of a switch.


You’re Going Too Far, Baby

Imagine this: There’s a female subsistence farmer in Burkina Faso, one of Africa’s least developed nations. For years she’s made her living gathering nuts and pounding them into a butter used in food, pharmaceutical creams, and cosmetics sold in Europe. She makes about $80 a month. But recently she and other women formed a collective and landed a contract with an overseas cosmetics company, which ordered an unprecedented 100 tons of butter and doubled her yearly income. As she contemplates her new prosperity, she lights a Virginia Slims cigarette—the international symbol of confidence, independence, and economic empowerment. As she inhales the heady smoke, the well-known tag line drops into her thoughts: “You’ve come a long way, baby.”

This scenario is a dream for Philip Morris, the world’s biggest cigarette maker and a leader in targeting women and minors in the developing world as the next big smoking market. But it’s a nightmare for health advocates, which is why they’ve made this issue the focus of the 11th World Conference on Tobacco OR Health, a six-day gathering of more than 4000 scientists and tobacco-control activists that began Sunday in Chicago. If the tobacco industry’s marketing onslaught isn’t stopped, says Matt Myers, president of Tobacco-Free Kids, “there will be a global health crisis of epic proportions.”

There are already about a billion smokers globally, but only 236 million are women—about 12 percent. By the year 2025, the number of women smokers is expected to triple, to more than 600 million. Over 80 percent of those new female smokers will live in developing countries, places with limited medical capacity and little infrastructure for early cancer detection or other programs to limit the harm of smoking.

That doesn’t seem to bother big tobacco, which is working diligently to build new markets to compensate for losses elsewhere. Among men in industrialized nations, the smoking rate is 39 percent, a sharp drop from 70 percent earlier this century. Only 23 percent of American women over 18 smoked during the 1990s, down from a peak of 33 percent in the ’60s and ’70s. Meanwhile, in the third world, the male smoking rate is up to 59 percent; smoking among females has climbed to 9 percent, rising along with the proliferation of American-style cigarette ads. Such gains translate into big money: Philip Morris’s international tobacco profits have increased 256 percent in the past 10 years, while domestic profits rose only 16 percent.

Tobacco companies began expanding into developing nations in the early ’70s, but focused mainly on the male demographic. Women were initially considered a secondary market. That was partly because of social resistance (only “bad girls” smoked), but also because disposable income among women was practically nonexistent. Instead, tobacco makers focused on more potentially lucrative female markets in the United States and Europe, where they successfully sold “ladies’ brands” by linking them to the growing feminist movement. “You’ve Come a Long Way, Baby” became associated with a whole generation of women joining the workforce in the ’60s and ’70s.

Three decades later, big tobacco is recycling that “smoking = liberation” message for the third world. “I’m going the right way—keeping the rule of the society,” reads a Virginia Slims ad developed for the Asian market and translated by antismoking activists, “but at the same time I am honest with my own feeling. So I don’t care if I behave against the so-called ‘rules’ as long as I really want to.” Surrounding this faux-empowerment copy is an image of a slender woman with ambiguous looks—possibly Asian, possibly European—embracing a fair-haired man, and beneath the woman the words “BE YOU” are written in big, bold letters. Despite the apparent contradiction of telling Asian and African women to “be themselves” in ads featuring a clearly Western aesthetic, campaigns like these are tremendously effective. “These countries want to emulate America like never before,” explains Nancy Kaufman, vice president of the Robert Woods Johnson Foundation in D.C., “so it’s easy for tobacco execs to exploit the idea of freedom and rebellion in their ads.”

Not only do tobacco companies promote a link between smoking and independence, they also deliberately choose images linking smoking to better health. “My pleasure!” states another ad, featuring an athletic blond woman taking a boxing class. In the U.S., most viewers probably know there’s a good chance she’s increasing her odds of lung damage. But a recent study showed that in China, which has the largest number of potential female smokers worldwide, two out of three women think smoking is harmless—not because they can’t understand the danger, but because they simply aren’t being told.

Myers and other health advocates consider it despicable to pitch cigarettes as healthy despite massive evidence to the contrary, but in the developing world tobacco makers are under no real obligation to disclose risks. Even in countries where warning labels are required, tobacco companies are under no obligation to be specific: “Smoking Causes Impotence” was the only warning on cigarette packs in Thailand for many years. Moreover, there are few if any laws banning TV or billboard advertising, no requirements that companies disclose how much they’ve spent on lobbying and “donations” to politicians, and few restrictions on promotion—it’s perfectly legit to provide free street signs for a small village, then plaster the signs with cigarette logos, as one American company did.

No matter where they live, women who succumb to such merchandising face plenty of trouble. “One of the saddest things we’ve learned,” says Myers, referring to the 50-year sweep of smoking through the U.S. and Europe, and into Mediterranean countries, “is that as women smoke like men, they die like men.” Lung cancer and heart disease rates for women are exploding throughout the developed world. In the U.S., lung cancer has surpassed breast cancer as a leading killer of women. Women who smoke and use oral contraceptives have an increased risk of strokes and cancer, and “low-tar” and “light” cigarettes—brands marketed almost exclusively to women—can cause very rare and malevolent carcinomas in lung tissue. Women smokers have a higher risk of osteoporosis and cervical cancer, not to mention complications with fertility and pregnancy.

Tobacco-related illnesses already cost the global economy an estimated $200 billion a year—and this without the added burden of several hundred million women and child smokers in the third world. Fearful of where that number could be in 20 years, the World Bank, an institution that traditionally has supported multinational tobacco companies, has begun to rethink its policies. In a report issued earlier this year, Curbing the Epidemic, the World Bank found that a “falling demand for tobacco does not mean a fall in a country’s total employment level,” subverting an oft repeated claim by tobacco companies that millions of farmers and businesses are dependent on their products.

The World Health Organization—which just released a study showing tobacco companies spent years working to undermine its antismoking campaigns—is also getting into the act. Attendees at this week’s conference will spend much of their time hammering out details for WHO’s Framework Convention on Tobacco Control—a treaty that WHO hopes will eventually be signed by all 191 members of its governing body. It will attempt to restrict advertising, but above all it will try to force manufacturers to fully disclose the dangers of smoking. If cigarette companies violate these regulations, they can be held accountable—as they are beginning to be in the U.S., where a Miami jury recently decreed that five tobacco companies pay $145 billion in punitive damages to sick Florida smokers.

Someday, perhaps, that farmer in Burkina Faso will be sufficiently empowered to sue. “It has not escaped our attention,” says Kaufman, “that the tobacco industry is expanding in locations where the litigation of individual rights is very limited. The industry thinks it won’t be facing lawsuits from women in these countries for a very long time—if ever. But we think they are wrong. That’s what this conference is about.”


Casualties of War

Mbuji-Mayi, Democratic Republic of the Congo—In a dusty field in Kinshasa earlier this month, a military guard snaps its rifles to attention. Fixed bayonets gleam, and the crowd settles into a hush broken only by the sound of babies crying. Laurent Kabila—former guerrilla, one-time smuggler, and now president of the embattled Democratic Republic of the Congo—bends over one of the bawling babies and squeezes a few drops of pink liquid into her mouth. This is the commencement of the Congo’s polio eradication campaign, and while it is grotesque that an effort to save lives begins with a military fanfare, it is also sadly appropriate. For the greatest obstacle to eradicating polio is not poverty or international indifference, but war.

Polio has been extremely rare in the United States for more than four decades. But in the Congolese city of Mbuji-Mayi, 1500 children died or were maimed in a 1995 polio outbreak. Earlier this year in neighboring Angola, where vaccination had been delayed by civil war, 1100 children fell prey to the disease. One of the most common sights in African cities are polio beggars, many of whom scuttle crab-like or simply pull themselves along with their hands, dragging their withered legs behind them.

Yet polio, a scourge so ancient it is depicted on Egyptian stele, is on the run. Before Jonas Salk and Albert Sabin developed their vaccines, its toll topped half a million a year. In 1988, when the World Health Organization launched a campaign to eradicate the disease, that number had already fallen to 35,000. Last year, in strong evidence that the world eradication effort is succeeding, the virus claimed 6000 people, mostly young children.

According to WHO, “Two types of countries are now priorities for the global eradication effort: ‘Reservoir’ countries, which are large geographical areas with high population density, low immunity levels and poor sanitation; and ‘countries affected by conflict.’ As the only country which falls into both categories. The Congo is the single highest priority for the global effort.”

Indeed, notes Martin Mogwanja, the UNICEF representative in the DRC, “Congo is the size of Western Europe.” He pauses to let that sink in, then continues: “It has borders with nine other countries, so as long as polio exists in the Congo, those nine countries must keep vaccinating.” But they can’t, because some of the DRC’s neighbors, such as Zambia and Uganda, are among the world’s poorest nations, while others, such as Angola and Congo-Brazzaville, are, like the DRC, engulfed in war.

On the first of this month’s three immunization days, WHO’s Bernard Fabre, chief of logistics, is most worried about Equateur province in northern Congo.

The original plan had been to distribute all vaccines and equipment through Kinshasa, seat of the DRC government, which has energetically supported the polio campaign. But then a rebel faction captured two-thirds of Equateur, making deliveries from government-held areas impossible. Scrambling, the UN rerouted the supplies through Kisangani, main city of the rebel region. But then that town fell victim to fighting by rival rebel factions and, explains Fabre, is now “split in half.” Fabre shrugs. “Because of the fighting last weekend, the equipment was delayed. I don’t know where it is now. My guess is it’s in Kisangani.”

At least there are no reports of conflict at the moment. The “Days of Tranquility,” negotiated specifically for the polio vaccination, seem to be holding. So, Fabre says, dryly, “It’ll be better than last year.” Two weeks before last year’s vaccination campaign was to begin, the war started, forcing the immunization program to be drastically scaled back. More than 70 percent of the Congo’s children were left unvaccinated.

The polio virus lives only in humans, so if enough people are immunized the virus will run out of hosts and perish. That is the logic behind the polio campaign, which is trying to vaccinate every child in the world under five—10 million in the DRC alone.

That would be a tall order even if the country were at peace. “There are practically no main roads,” says Mogwanja. “Imagine that no road connected New York and Washington—not that the road was bad or blocked, just no road.” Equateur province, covered in dense rain forest, is one of the country’s least developed regions. Almost the only transportation route is the Congo River, which Marlow traveled in Conrad’s Heart of Darkness. Some sites are supplied by canoe. In other provinces, equipment is distributed by bicycle or by people carrying the load on their heads.

Then there are the man-made headaches, such as the fact that civil servants in the DRC get paid only once every few months—and just a pittance, devastating morale. But despite such difficulties, Fabre repeats a phrase on everyone’s lips: “The problem is the war.”

If the rebels even remember that Mbuji-Mayi was the epicenter of the horrible 1995 polio outbreak, they don’t care. They covet the town for its rich diamond mines, and they have advanced so close that the city is now almost on the front line. Many observers expect an assault imminently. But on day two of the polio campaign, peace is holding, people are relaxing at street festivals, and the polio news is mostly good. Overall, more than 50 percent of Mbuji-Mayi’s under-fives were vaccinated on the first day; one site reports that it has already hit 95 percent.

There are problems, of course. A UNICEF report says that 12 zones are inaccessible due to “insecurity.” Mogwanja, however, believes most of these can be reached from the rebel side.

On day three, the bad news hits. Fabre’s hunch was right: The supplies for Equateur province, including about a million doses of vaccine, were indeed in the divided town of Kisangani. Now, fresh fighting has broken out between the rebel factions. Mothers and children are trapped in vaccination sites, terrified to set foot in streets thick with bullets. Just as bad, the vaccine hasn’t left town. About a million children—a million hosts to harbor the polio virus and keep it alive on this earth—live in the territories of Equateur province, where the stranded vaccine should have gone, and almost a third of Kisangani’s children didn’t get immunized.

In Kisangani, the wounded need care. In some areas, disrupted water supplies raise the specter of cholera and other disease, as do putrefying bodies. And while fighting has subsided, the city remains hair-trigger tense. So the polio vaccinations, says Abou Moudi, head of WHO’s office in the DRC, will have to wait.

Two more rounds of immunization days are scheduled for the DRC: one each in September and October. Moudi is frustrated but emphatic. “We’ve been working on this for 11 months, and we could vaccinate everybody,” he says. “If there is peace.”


Human Rights = Public Health

How great a loss was the death of AIDS researcher Jonathan Mann, killed in the crash of Swissair Flight 111? “I’m convinced that if someone other than Jonathan had been the first director of Global Programme on AIDS, the whole response to the epidemic would have been different,” says Peter Piot, one of the earliest HIV researchers and now director of the United Nations AIDS program. “For example,” he continues, “we may have gotten into a repressive approach, perhaps using quarantine. Because let’s not forget that in the early days there were many calls for that.”

Indeed, notes Newsday reporter Laurie Garrett in her definitive book The Coming Plague, by 1987, 81 countries had passed laws against people with HIV or risk groups, usually homosexuals and prostitutes. In Germany, a federal judge declared it might be necessary to tattoo and quarantine people with the virus. Cuba was already quarantining AIDS patients. Some Muslim states were jailing “promiscuous” people, and Chinese officials denied the existence of homosexuals, drug users, or prostitutes in the People’s Republic. In the U.S., President Reagan’s secretary of education, William Bennett, fought Surgeon General C. Everett Koop’s plans for frank education about HIV prevention, favoring instead compulsory testing of all hospital patients, marriage license applicants, and immigrants. Quarantine loomed as a very real threat.

Amid this gathering storm, Jonathan Mann led public health authorities to perhaps their finest hour. Impeccably dressed in bow ties, yet with the gritty experience of running the first major African HIV research program (which, among many accomplishments, showed that HIV could be spread through heterosexual sex but not through mosquito bites), Mann managed to convene more than 100 national ministers of health together in London. There, as Garrett writes, almost 150 nations signed on to a condom-based, compassionate strategy to slow the spread of AIDS. A few months later, he convinced the World Health Organization to make human rights the core of its anti-HIV stratety. These coups played a crucial role in preventing the wholesale repression of people with the virus.

Mann orchestrated this historic consensus from his new position as director of the World Health Organization’s Global Programme on AIDS. At first, recalls Daniel Tarantola, who joined the fledgling endeavor at the beginning, “the program was himself, a secretary, and one typewriter.” Two years later, Mann had rocketed the budget to almost $100 million. His m.o.: hard work, personal modesty, and an eloquence that was at once fiery and logical. “Back at a time when only a few people were screaming” for a humane and effective response, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, “Jonathan was an unbelievably articulate and passionate voice.” Mathilde Krim, founder of the American Foundation for AIDS Research, adds that Mann persuaded people with “the force of the argument, the morality of behaving a certain way, and the practical usefulness of being ethical and respectful of others. He convinced people.”

Mann’s message: AIDS is a global crisis, in which no person or nation is an island. More important, human rights and public health go hand in hand: “In each society, those people who before HIV/AIDS arrived were marginalized, stigmatized, and discriminated against become those at highest risk of HIV infection… The French have a simple term which says it all: HIV is now becoming a problem mainly for les exclus, the ‘excluded ones’ living at the margin of society.”

Mann, who moved to Harvard after leaving WHO, gave a shattering talk at the world AIDS conference two years ago in Vancouver. That was when protease inhibitors arrived, creating a sense of euphoria in the First World, where the expensive drugs were able to prolong life. But Mann warned that this breakthrough threatened the very solidarity among AIDS advocates that had allowed them to hold back repressive policies. In AIDS, he said, “we all started in the same place: with the same lack of treatment and with the same hopes… The industrialized world, shorn of its technologic armor, was forced into developing prevention and care strategies, to listen and learn from the universally available wealth of human experience and wisdom.” He called for individual efforts, including for people with HIV in wealthy countries to “give the equivalent cost of a week of treatment” to give patients in developing countries basic treatment “or relief of pain.”

In December 1996, Mann married Mary Lou Clements, a world-renowned expert on vaccines who founded the Center for Immunization Research at Johns Hopkins University. Clements-Mann, who early in her career worked in the worldwide effort to eradicate smallpox, has conducted more than 100 clinical trials on vaccines, from influenza to hepatitis. She worked on the recently approved immunization for rotavirus, which causes often fatal diarrhea in children in poor countries. She was also working on several HIV vaccines, as well as the first trial of one for hepatitis C.

The couple’s untimely death, not two years after their wedding, was poignant in intimate ways as well. Fauci dined with the couple a few weeks ago and, he says, “Jon and Mary Lou seemed so happy about their future.”