Office of NIH History
In Their Own Words: NIH Researchers Recall the Early Years of AIDS
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Curran: We were, yes. The most important aspect of starting the project was the trip to Zaire where Tom Quinn, and I think a man named [Dr. Frederick] Fred Feinsod or something like that...

Hannaway: Yes, that is his name.

Curran: Joe McCormick from the CDC; Sheila Mitchell, who was a technician who worked on AIDS, and [Dr.] Peter Piot, who was with the Institute of Tropical Medicine [ITM], visited Zaire with these NIH colleagues. The initiation of that visit had been a combination of Dick Krause talking to the head of ITM at the time and Joe McCormick talking to some of his colleagues in Zaire. It looked as though, for a while, that the NIH and the CDC would be making separate visits, but we got together and made a cooperative visit.

During that visit-it was a remarkable visit–Tom and Peter and Joe were the principals, with Sheila doing the laboratory studies. They were able to determine, with a man named Dr. Kapita, who was the head of medicine at Mama Yemo Hospital, that there were a lot of cases of this illness and wasting syndrome occurring. It was a fairly new phenomenon that he had been seeing with increasing frequency since the late 1970s. They were able to get quite a few blood specimens, interview a few people, and they came back and published a summary article in the Lancet. After they came back, the CDC and the NIH were absolutely convinced that there was an epidemic in that city, Kinshasa, and that there should be some additional scientific commitment to a project there. And we agreed to do it together.

That created all kinds of benefits and some problems. Overall, there were an enormous number of good things that happened from that project. Enormously important scientific data came from this project. Tom and I were the U.S. coordinators.

Hannaway: That is what he says. He says he talked to you all the time.

Curran: There were hundreds of publications and some very important work. And the people who worked on the project were some outstanding people. Peter Piot is now the head of the U.N. AIDS Program. Tom Quinn has remained among the most productive researchers in AIDS. And [Dr.] Jonathan Mann was our first project director.

Now, Jonathan had never been to Africa. But he was an enormously productive physician and scientist who spoke fluent French. His wife was French, and he had studied in France. He had been a state epidemiologist in New Mexico. I met him and was very captivated with his abilities and his fluency in French. And his desire to do something like this was very important. So he went over to initiate the project along with [Dr. Henry] Skip Francis, who was the NIAID assignee and who now is a senior official at NIDA.

Hannaway: Right.

Curran: Jonathan Mann was the director. The CDC was putting up about 60 percent of the money, the NIH was putting up 30 percent of the money, and the Belgians the remainder. The Belgians had assigned [Dr. Robert] Bob Colebunders, a clinical investigator, and then Skip Francis was the laboratory director. They started a project that, before it ended, had 220 staff and maybe a $2 or $3 million annual budget, an enormous number of extremely competent Zairian professionals; an awful lot of good work was done there.

Jonathan left after two years, and became the founding director of the AIDS program at the World Health Organization, initially with $500,000 and two staff. He built up the program to about 200 people and $100 million a year. Then he resigned and went to Harvard to start the Human Rights Institute. He is the dean at the Allegheny School of Public Health now (1998). [Dr. Jonathan Mann died in the 1998 Swiss Air crash on the flight from New York to Switzerland.] Jonathan was replaced in Zaire by [Dr.] Robin Ryder, who was an NIH-funded investigator from Boston University and who had been at the CDC at one time. Then Skip Francis was replaced by [Dr. Christopher] Chris Brown.

Harden: Yes.

Curran: Chris Brown was an immunologist. He had worked in an intramural NIAID laboratory. Chris came over to Zaire with his family. Then there was a man named [Dr. Donald] Don Thea who came from [Dr.] Gerry Keusch's group from Tufts. So we had an extra partner. We also had the Armed Forces Institute of Pathology involved. It was a partner too. Robin Ryder was then replaced by [Dr. William] Bill Heyward and [Dr. Michael] Mike St. Louis from the CDC, and then the walls came tumbling down due to civil war.

Hannaway: That was 1991, wasn't it? The early 1990s, anyway. But since then the CDC has cooperated with the NIH in other African countries.

Curran: We started a project in Côte d'Ivoire, and then we started another project in Thailand. And we cooperated with the NIH in Thailand. I think the CDC has collaborated with the NIH in Côte d'Ivoire too.

Harden: We are moving into our final questions. You have been very good about going into detail.

Curran: Not too much, I hope.

Hannaway: You are telling us all sorts of new things.

Harden: I wanted you to know that this interview was not going to go on much longer. But we want to ask one or two more general kinds of broad, speculative questions. Has the AIDS epidemic changed the way that the CDC and the NIH interact, or the way federal science agencies interact in general?

Curran: Well, I was not around before the 1970s. I think that there is always going to be a certain amount of both brotherly collaboration and competition between the agencies. Of course, I am still very involved with the NIH now that I am in academia. I am very involved with NIAID and OAR [Office of AIDS Research], and NIDA [National Institute on Drug Abuse] and other agencies. I love the NIH and I love the CDC. I describe the NIH as the world's premier research agency. The CDC is really primarily the world's premier public health agency.

Now, that does not mean that the NIH does not do any service, and it does not mean that the CDC does not do any research. A lot of people at the CDC may think that the CDC is a research agency; and there are some people who are in the service aspects of the NIH that would say, “We serve.” But it helps our understanding fundamentally to say that the NIH is a research agency, and that the CDC is a service agency; and, therefore, derivative from the CDC's mission comes a lot of applied research and a need to respond directly to problems. With the NIH, derivative of its mission is the need to find relevance for research. So there is a need for the two agencies to cooperate and collaborate together.

The other thing is that the constituencies for the NIH are, at one level, research institutions, which are very good at stimulating and harnessing new discoveries. To the extent that anybody can do it, the NIH can do it. The CDC's constituencies are more action agencies, and the CDC has a broader network of action agencies around the world than the NIH does, is also more involved with health departments and regulatory issues, and has more of the public health authority. So we understand the differences between the agencies as a natural reason to cooperate and collaborate on certain problems.

The other parts of your request involved the questions of how the Public Health Service works, and how the HHS works, and how individual personalities interact.

Harden: And will there be a Public Health Service?

Curran: My concern now is that it has been diminished so much in the current administration. I am not aware that there is the same kind of intense communication that there used to be. There used to be agency heads' meetings at least every couple of weeks or so.

Harden: Not anymore?

Curran: I do not know. And they all work directly for the Secretary now. With AIDS in the 1980s, we would have meetings every couple of weeks that were chaired by the assistant secretary for health. I do not think that is necessary anymore, but whenever there was so much communication between the groups and a need to collaborate, even if there were issues of competition, there was somebody who was able to rise above that because of the kind of relationships and communication that we had.

So I think that, in general, the NIH and the CDC would usually pull together before there was a major problem. One of the things I found most rewarding during the AIDS epidemic was the work I did with my colleagues at the NIH. I grew to respect deeply many of the talented people there who worked so hard.

Harden: Do you think the AIDS epidemic changed the way the CDC does business in terms of its funding and its standing in the government? The CDC has been the one agency that people in the United States have known about, because it has been the agency that has always been there when some disease crisis happened. But, of course, it was really suffering from the funding cuts in the early 1980s. Has it recovered?

Curran: The CDC received a lot of AIDS funding. That does not necessarily translate into fiscal health for an agency. I think that the concern about emerging infectious diseases and the concern about AIDS has led the country to appreciate the need for that type of response. There was antibiotic resistance, tuberculosis resurgence, the AIDS epidemic, Ebola. These are the kinds of things that I think legitimize that concern. Although everyone believes in prevention at a superficial level, the CDC is involved in disease prevention interventions that are often controversial.

Hannaway: Yes. People do not want to be told not to do things.

Curran: For example, “Do not smoke.” Also register and control firearms to eliminate firearms-related deaths, practice family planning, use condoms.

Hannaway: Wear seat belts to improve car safety.

Curran: And use contraceptives; exert more control in the meat industry to help prevent the appearance of lethal E. coli bacteria in Jack in the Box hamburgers. Because of these unpopular policy positions, the CDC gets itself involved in controversies. The NIH is a safer agency, in terms of political interference, because it sticks to research. I think that if there is a generic jealousy between the NIH and the CDC, the NIH people would say that the CDC gets too much credit, too much visibility, too much press, and is a little too saintly. The CDC people would say that the NIH has all the money, has direct contact with the Congress, has all of the academics behind them–every party loves them. The CDC has trouble sometimes with some of the different parties and groups. But I think the country should be proud to have two such agencies; and I worry about the health of both of them, because I think they do go in parallel.

Hannaway: Would you just comment briefly on how AIDS has changed your life? Did you or your family experience any negative fallout from your involvement in AIDS?

Curran: My daughter had her seventeenth birthday last night. She was born two weeks before the first case of AIDS was reported, just about a week before I received the first draft of the MMWR article. My son was two at the time, and so I have really not had a family life without AIDS. I constantly think that I am the last generation to go through life without AIDS.

Harden: Yes, that is an excellent point.

Curran: My kids have always had AIDS in their lives. Their sexual lives occur in the context of AIDS. That may be true for the rest of history. The world is different now.

Hannaway: Yes.

Curran: I am often asked, usually not by experts like yourself, however, for my “perspective” as I get older and the epidemic gets older. I think that, on the one hand, it is a horrible epidemic, and it is now in a kind of a slow phase, not scientifically, but in a slow phase with respect to public concern, as the horizons become certain in the United States. But throughout the world, it is getting worse all the time. There is an enormous amount of uncertainty in the long run, say, for the next 50 years with AIDS, in terms of adequacy of therapy and the availability of vaccines. It is not an epidemic that we have a lot of confidence in controlling. We have millions of human incubators wandering around the planet, immunocompromised people, carrying other organisms around with them, much like they did multi-drug resistant tuberculosis; and there are a whole lot of things we do not know yet about AIDS. There are a many acts of the play still to follow.

I do not know what would have happened if there had been no AIDS and what I would have done in my career. I guess my life in public health would have reflected other experiences. AIDS is an epidemic that I am humbled by, but that I feel grateful to have learned from. Does that make sense?

continued on Page 08

 

 
 
 
       
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