172 Plasmodium falciparum could produce some of this effect. German researchers were convinced that the parasites stimulated an autoimmune response in which red blood cells were destroyed by the victim’s own immune system. Their study did not, however, control for chloroquine use, so they couldn’t rule out the possibility that the drug induced the observed autoimmunity. See K. Ritter, A. Kuhlencord, R. Thomssen, and W. Bommer, “Prolonged Haemolytic Anaemia in Malaria and Autoantibodies Against Triosephosphate Isomerase,†Lancet 342 (1993): 1333–34.
There was also a hypothesis that malaria induced the immune system to release large amounts of tumor necrosis factor (TNF), a powerful human chemical that had a broad range of effects on the body. Usually researchers claimed that TNF played a role in cerebral malaria, but some also speculated it was involved in anemia. The evidence was contradictory and controversial. See R. E. Phillips and T. Solomon, “Cerebral Malaria in Children,†Lancet 336 (1990): 1355–60; I. A. Clarke, G. Chaudri, and W. B. Cowden, “Roles of Tumour Necrosis Factor in the Illness and Pathology of Malaria,†Transactions of the Royal Society of Tropical Medicine and Hygiene 83 (1989): 436–40; and D. Kwiatkowski, A. V. S. Hill, I. Sambou, et al., “TNF Concentration in Fatal Cerebral, Non-Fatal Cerebral, and Uncomplicated Plasmodium falciparum Malaria,†Lancet 336 (1990): 1201–4.
173 P. B. Bloland, E. M. Lackritz, P. N. Kazembe, et al., “Beyond Chloroquine: Implications of Drug Resistance for Evaluating Malaria Therapy Efficacy and Treatment Policy in Africa,†Journal of Infectious Diseases 167 (1993): 932–37.
174 Even as early as 1984 there was widespread resistance in East Africa to Fansidar, particularly its component pyrimethamine. But amodiaquine and mefloquine remained useful alternatives in most of Africa well into the late 1980s. See H. C. Spencer, “Drug-Resistant Malaria: Changing Patterns Mean Difficult Decisions,†Transactions of the Royal Society of Tropical Medicine and Hygiene 79 (1985): 748–58.
175 T. Harinasuta, S. Migasen, and D. Boonag, UNESCO First Regional Symposium on Scientific Knowledge of Tropical Parasites. (Singapore: UNESCO, 1962).
176 A. A. Sandosham, “Chloroquine-Resistant falciparum Malaria in Malaya,†Singapore Medical Journal 4 (1963): 3–5.
177 P. G. Contacos, J. S. Lunn, and G. R. Coatney, “Drug-Resistant falciparum Malaria from Cambodia and Malaya,†Transactions of the Royal Society of Tropical Medicine and Hygiene 57 (1963): 417–24.
178 UNDP/World Bank/WHO, Report of a Meeting Held in Kuala Lumpur, Malaysia, August 10–15, 1981 (Geneva: World Health Organization, 1981).
179 Ibid.
180 Centers for Disease Control, “Plasmodium falciparum Malaria Contracted in Thailand Resistant to Chloroquine and Sulfonamide-Pyrimethamine—Illinois,†Morbidity and Mortality Weekly Report 29 (1980): 493–94.
181 G. Watt, G. W. Long, L. P. Padre, et al., “Chloroquine and Quinine: A Randomized, Double-Blind Comparison of Efficacy and Side Effects in the Treatment of Plasmodium falciparum Malaria in the Philippines,†Transactions of the Royal Society of Tropical Medicine and Hygiene 82 (1988): 205–8; and V. P. Sharma, C. Prasittisuk, and A. V. Kondrashin, “Magnitude of Forest Malaria,†in V. P. Sharma and A. V. Kondrashin, eds., Proceedings of an Informal Consultation Meeting WHO/ MRC 18–22 February 1991 (New Delhi: World Health Organization, 1991).
182 Sharma, Prasittisuk, and Kondrashin (1991), op. cit.
183 M. K. Banerjee, N. Palikhe, B. L. Shestha, et al., in Sharma and Kondrashin, eds. (1991), op. cit.
In Burma the 1976 malarial death rate was 2.5 per 100,000. By 1989 that had risen to 12.3 per 100,000. And as had been seen in Africa, adult cerebral malaria cases increased in both number and severity. By 1989, one out of every three cerebral cases was fatal, despite drug treatment.
184 T. Chongsuphajaisiddhi, A. Sabchareon, P. Chantavanich, et al., “A Phase III Clinical Trial of Mefloquine in Children with Chloroquine-Resistant falciparum Malaria in Thailand,†Bulletin of the World Health Organization 65 (1987): 223–26; H. O. Lobel, M. Miani, T. Eng, et al., “Long-Term Malaria Prophylaxis with Weekly Mefloquine,†Lancet 341 (1993): 848–51; and R. Steffen, E. Fuchs, J. Schildknecht, et al., “Mefloquine Compared with Other Malaria Chemoprophylactic Regimens in Tourists Visiting East Africa,†Lancet 341 (1993): 1299–1303.
185 S. Looareesuwan, C. Viravan, S. Vanijanonta, et al., “Randomised Trial of Artesunate and Mefloquine Alone and in Sequence for Acute Uncomplicated falciparum Malaria,†Lancet 339 (1992): 821–824; and F. O. Ter Kuile, G. Dolan, F. Noster, et al., “Halofantrine Versus Mefloquine in Treatment of Multidrug-Resistant falciparum Malaria,†Lancet 341 (1993): 1044–49.
186 C. M. Wilson, A. E. Serrano, A. Wasley, et al., “Amplification of a Gene Related to Mammalian mdr Genes in Drug-Resistant Plasmodium falciparum,†Science 244 (1989): 1184–86; S. K. Martin, A. M. J. Oduola, and W. K. Mihous, “Reversal of Chloroquine Resistance in Plasmodium falciparum by Verapamil,†Science 235 (1987): 899–901; C. C. Newbold, “The Path of Drug Resistance,†Nature 345 (1990): 202–3; T. E. Wellems, L. J. Panton, I. Y. Gluzman, et al., “Chloroquine Resistance Not Linked to mdr-Like Genes in a Plasmodium falciparum Cross,†Nature 345 (1990): 253–55; and S. J. Foote, D. E. Kyle, R. K. Martin, et al., “Several Alleles of the Multidrug-Resistance Gene Are Closely Linked to Chloroquine,†Nature 345 (1990): 255–58.
187 Similar pumps are thought to exist in other parasites. Entamoeba histolytica, the gay bowel disease agent, appears to have acquired an mdr gene that is 35 percent identical to the malaria mdr. The parasite uses the pump to protect itself from the drug emetine. See J. Samuelson, P. Ayala, E. Orozco, and D. Wirth, “Emetine-Resistant Mutants of Entamoeba histolytica Overexpress mRNAs for Multidrug Resistance,†Molecular and Biochemical Parasitology 38 (1990): 281–90.
188 K. H. Riechmann, D. R. Davis, and D. C. Hutton, “Plasmodium vivax Resistance to Chloroquine?†Lancet II (1989): 1183–84.
189 G. S. Murphy, H. Basri, Purnomo, et al., “Vivax Malaria Resistant to Treatment and Prophylaxis with Chloroquine,†Lancet 341 (1993): 96–100.
190 Ibid.
191 “Rediscovering Wormwood: Ginghaosu for Malaria,†Lancet 339 (1992): 649–51; and E. Tanouye, “Chinese Tea Yields Secret of Its Success Against Malaria Bug,†Wall Street Journal, July 1, 1993: A1; Looareesuwan, Viravan, Vanijanonta, et al. (1992), op. cit.; and J. Karbwang, K. N. Bangchang, A. Thanavibul, et al., “Comparison of Oral Artemether and Mefloquine in Acute Uncomplicated falciparum Malaria,†Lancet 340 (1992): 1245–48.
192 F. Gay, L. Ciceron, M. Litaudon, et al., “In-Vitro Resistance of Plasmodium falciparum to Qinghaosu Derivatives in West Africa,†Lancet 343 (1994): 850–51.
193 Sharma and Kondrashin, eds. (1991), op. cit.
194 See, for example, World Health Organization, “Global Malaria Control Strategy,†Ministerial Conference on Malaria, Amsterdam, October 26–27, 1992; and W. Rooney and K. Thimasarn, “Development of Multi-Drug Resistance in Forest Related falciparum Malaria,†in Sharma and Kondrashin, eds. (1991), op. cit.
195 In addition to the millions of dollars spent on early malaria eradication efforts, substantial amounts of money poured into WHO control efforts and international research. Between 1973 and 1988, for example, WHO received from a variety of sources an average of $73 million annually for malaria control. Most of that was spent on training people at the local level to do such things as apply pesticides or count parasite levels in people’s blood.
The U.S. government spent similar amounts of money, primarily for drug and vaccine research through either the Army or the Agency for International Development. USAID spending averaged around $22 million annually
during the period; military research spending was about $10 million a year. The CDC and the NIH each spent well under $1 million a year on malaria research. See Institute of Medicine (1991), op. cit.
196 By far the majority of all dollars spent on malaria research from 1960 to 1994 were dedicated to the search for a vaccine. Though a promising product failed to appear, the effort pushed on relentlessly, amid indictments and corruption. The biggest funder was the U.S. Agency for International Development, which spent for vaccine efforts over and above other forms of possible control or drug development. As R. S. Desowitz. formerly of the University of London, then at the University of Hawaii, put it: “AID failed because it was run by amateurs who would not heed the advice of professionals. AID failed because it succumbed to sleaze and corruption. AID failed because it fostered mediocre science and over-inflated the meaning of experimental results. It may also be that AID failed because the human constitution is such that no vaccine can a confer protective immunity.†R. S. Desowitz, The Malaria Capers (New York: W. W. Norton, 1991).
In the spring of 1993, Colombian scientist Dr. Manuel Elkin Patarroyo announced results of a field trial of a synthesized protein vaccine against P. falciparum. In 1,500 Colombians the vaccine proved 38 percent effective in preventing infection, he said. A year later, amid much WHO fanfare, Patarroyo announced similar results from a field trial in Tanzania. Skeptics questioned the timing of the Tanzania announcement, which was coincident with USAID plans to cut the vaccine research budget. And they said that such claims had been made before. See “Malaria Vaccine a ‘Good Chance’ for a Breakthrough,†World Bank News XIII (February 17, 1994); World Health Organization, “Malaria Vaccine Could Be Developed Soon: Global Effort Needed,†Press Release WHO/13/13 February 1994; M. V. Valero, L. R. Amador, C. Galindo, et al., “Vaccination with SPf66, a Chemically Synthesized Vaccine Against Plasmodium falciparum Malaria in Colombia,†Lancet 341 (1993): 705–10; and P. Brown, “Malaria Vaccine Passes Key Test,†New Scientist, February 19, 1994: 7.
197 See E. Marshal, “Malaria Parasite Gaining Ground Against Science,†Science 242 (1991): 190–91; and P. J. Hilts, “U.S. Plans Deep Cuts in Malaria Vaccine Program,†New York Times, February 13, 1994: A17.
14. Thirdworldization
1 We’re running scared,†Mahler told New York Times reporter Lawrence Altman in 1986, adding that he couldâ€not imagine a worse health problem in this century … . We stand nakedly in front of a very serious pandemic as mortal as any pandemic there has ever been. I don’t know of any greater killer than AIDS.†See L. K. Altman,â€Global Program Aims to Combat AIDS ‘Disaster,’†New York Times, November 21, 1986: Al.
2 The bell-shaped curve typically seen with epidemics indicated that in any population of people infected with a given microbe, some would eventually have a natural immunity and survive, even if enormous numbers of other people died. The only other disease on earth in 1994 that similarly failed to exhibit a bell-shaped curve was rabies, which was 100 percent lethal in all people in the absence of emergency vaccination. The classic curve was pictured as follows:
In 1986 the bell was still on its upward curve everywhere in the world. In 1994 it remained so everywhere with the exception of a handful of small population groups that took preventive steps to avoid infection and an even smaller set of human beings scattered around the globe who appeared to have been infected and naturally cleared HIV from their bodies, never contracting AIDS.
3 The full extent of all WHO activities relevant to AIDS prior to establishment of the Global Programme on AIDS is outlined in the following: World Health Organization, Executive Board, Seventy-seventh Session, Provisional Agenda item 20, “WHO Activities for the Prevention and Control of Acquired Immunodeficiency Syndrome (AIDS),†EB 77/42, November 25, 1985.
4 The UN agencies were often viewed by government leaders as graceful dumping grounds for powerful foes, corrupt politicians, burned-out or less than brilliant cronies, or influential political allies who happily received payoffs in the form of cushy jobs in wealthy countries for years of successfully bolstering the power bases of their leaders. Certainly not all the 50,000 professionals employed in the UN system were of that ilk; many were bright visionaries who ardently believed in the need for a global community that sought collective solutions to its problems rather than resorting to wars. But all too often in UN history the bright and idealistic were stifled by the bureaucratic, corrupt, and dim-witted. See “The United Nations Agencies: A Case for Emergency Treatment,†The Economist, December 2, 1989: 23–26; R. N. Wells, Jr., Peace by Pieces—United Nations Agencies and Their Roles: A Reader and Selective Bibliography (Metuchen, NJ: Scarecrow Press, 1991); G. Hancock, Lords of Poverty (New York: Atlantic Monthly Press, 1989); and V. Navarro, “A Critique of the Ideological and Political Positions of the Willy Brandt Report and the WHO Alma Ata Declaration,†Social Science and Medicine 18 (1984): 467–74.
5 Fortieth World Health Assembly, Agenda item 18.2, WHA 40.26, 12th Plenary, 3 pages.
6 The statement read:
1. CONFIRMS that WHO should continue to fulfill its role of directing and coordinating the global, urgent and energetic fight against AIDS;
2. ENDORSES the establishment of a Special Programme on AIDS and stresses its high priority.
3. FURTHER ENDORSES the global strategy and programme prepared by WHO to combat AIDS … .
and encouraged the nations of the world to openly share all germane information and cooperate in efforts to combat AIDS.
7 See Annex 2, Resolution 42/8 of the Forty-second General Assembly of the United Nations, “Prevention and Control of Acquired Immune Deficiency Syndrome (AIDS),†WHO/GPA/DIR/89.4, 1987.
8 THE GROWTH OF HIV/AIDS LEGISLATION, 1983–92 (Source: World Health Organization, Health Legislation Unit)
Countries, etc., known to have legislation as of December 1983: Austria, Canada (Alb.; B.C.; Ont.), Denmark, France, Germany, Greece, Israel, Italy, New Zealand, Norway, Sweden, Turkey, U.S.A. (CA; NJ; NY)
Additional jurisdictions introducing legislation between 1984 and 1987: Angola (1987), Australia (1984), Barbados (1985), Belgium (1985), Belize (1987), Benin (1987),* Bermuda (1985), Brazil (1985), Brunei Darussalam (1987), Bulgaria (1985), Burundi (1987), Canada (1985), Chile (1984), China (1987), Costa Rica (1985), Cuba (1986), Cyprus (Sovereign Base Areas) (1987), Czech and Slovak Federal Republic (1984), Denmark (1985), Dominican Republic (1987), Ecuador (1985), Egypt (1986), Finland (1985), [German Democratic Republic (1986)], Grenada (1986), Guatemala (1986), Haiti (1987), Honduras (1987), Hungary (1985), Iceland (1986), India (Goa) (1987), Indonesia (1987), Iraq (1987), Jordan (1987), Kenya (1987), Libyan Arab Jamahiriya (1987), Liechtenstein (1987), Luxembourg (1984), Malaysia (1985), Malta (1986), Mauritius (1987), Mexico (1985), Monaco (1986), Mozambique (1986), Netherlands (1987), Niger (1987), Panama (1985), Paraguay (1985), Peru (1987), Philippines (1986), Poland (1986), Portugal (1986), Republic of Korea (1987), Romania (1985),* Russian Federation (1985), Rwanda (1987), Singapore (1985), South Africa (1987), Spain (1985), Switzerland (1986), Syrian Arab Republic (1987), Thailand (1985), Togo (1987), United Kingdom (1984), Uruguay (1984), Venezuela (1984), Yugoslavia (1986)
Additional jurisdictions introducing legislation between 1988 and 1992: Albania (1992), Algeria (1989), Argentina (1988), Bahrain (1990), Bolivia (1988), China (Province of Taiwan) (1988),* Colombia (1988), Comoros (1988), El Salvador (1988), Equatorial Guinea (1988), Estonia (1992), Gabon (1989), Guinea-Bissau (1989), Hong Kong (1988), Japan (1988), Lebanon (1990), Madagascar (1990), Mongolia (1989), Oman (1990), Saint Lucia (1991), Saudi Arabia (1990), Senegal (1990), Tunisia (1989), Ukraine (1991),* Vietnam (1989)
Date of legislation unknown: Bahamas,* Cyprus,* United Republic of Tanzania*
*Text unavailable to WHO.
See chart on facing page.
; 9 For a flavor of the period, see Panos Dossier, The Third Epidemic: Repercussions of the Fear of AIDS (London: Panos Institute and Norwegian Red Cross, 1990).
10 In addition, Zimmermann revealed that the names of HIV-positive German residents had been forwarded to police authorities, who were closely watching the individuals.
11 These and other details are compiled from a large variety of news, medical, and interview sources. Citing these points would so severely increase the size of this book that I must request the readers’ forgiveness and refer, in addition to the previously cited Panos Dossier, to back issues of two invaluable publications: CDC AIDS Weekly, P.O. Box 5528, Atlanta, Georgia; and AIDS Newsletter, published by the Bureau of Hygiene and Tropical Diseases, London, WC1E7HT.
12 According to a BBC translation, the Soviet decree stated:
The citizens of the U.S.S.R., as well as foreign citizens and stateless persons living or staying in the territory of the U.S.S.R., may be bound to take a medical test for the AIDS virus. If they refuse taking the test voluntarily, the persons, in relation of whom there are grounds for assuming that they are infected with the AIDS virus, may be brought to medical institutions by health authorities with the assistance in the necessary cases of authorities from the Interior Ministry.
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