This is a really interesting book which gives an explanation of how AIDS got going.

THE RIVER
The River - A Journey Back to the Source of HIV and AIDS.
Edward Hooper, Penguin Books, 1999 ISBN: 014-028377-3, £10.99p

This book is over 1000 pages long, 870 of which are the book itself, and the rest foot notes, index, glossaries, etc. It is a highly readable technical book on a complex topic, but understandable to the layman, and an important attempt to address the issue of the origin of AIDS.

The central thesis of this book is that the AIDS epidemic was caused by SIV infected batches of CHAT, an experimental oral polio vaccine, being given to somewhere close to 1 million people, in the Congo, Burindi / Rwanda area of Africa in 1958. CHAT was developed by a scientist callled Hilary Koprovski, at the Wistar Institute, Philadelphia. At that time, polio was seen as a serious threat to children's health, especially in America. Polio came to prominence because President Roosevelt had been crippled by the disease, and large post WW2 campaigns 'The March of Dimes' collected millions of dollars for research. Driven by this public concern and money, different groups of scientists competed to perfect a safe polio vaccine. The first successful vaccine was developed by Jonas Salk, a 'killed' vaccine, the two main 'live' vaccines following this, being the Koprovski, and that of Albert Sabin, the eventual winner being Sabin's.

The first known HIV positive blood sample is L70, taken from a Bantu male in February 1959, in Leopoldville, Congo, by Arno Motulsky. The precise identity of the donor is not known. Hooper concentrates attention on the experimental chimpanzee research station at Lindi, near Stanleyville, run by Ghislain Cortois. Chimpanzees are important to the explanation of the origin of AIDS because chimp SIV (Simian Immunodeficiency Virus) is closest to HIV-1. Somehow SIV jumped the species barrier. That many of the Linndi chimps were infected with something does not seem to be in doubt. Caging several chimp sub-types together provided opportunities for different SIV strains to intermingle and increase in virulence. Chimps at Lindi suffered from klebsiella pneumoniae, a type of infection often also found in AIDS patients.

Other theories about the origin of AIDS include people eating uncooked monkey meat, or being bitten by monkeys. There is also the 'rural clinic' hypothesis, with virus transferred via dirty hypodermic needles. Hooper alleges that chimpanzee kidney tissues were taken back to Philadelphia, or to Belgium, and used to culture the polio virus used in CHAT vaccine. Mysteriously, nobody can prove that chimp tissues were or were not used, because the precise culturing protocols were not recorded at the time, or were destroyed afterwards. Koprovski in the published scientific literature at the time was vague about the culture, much later denying that chimps were used. In the wake of the CHAT/HIV theory, few if any of the scientists involved are telling.

One of the aspects Hooper does not concentrate on is the biological warfare connection. It is perhaps an incidental fact that in September 1960, there was an attempted US bio-assassination of Patrice Lumumba, in Leopoldville. Some of the people on Koprovski's team were associated with germ warfare - not least Koprovski himself, who worked on VEEV (Venezuelan Equine Encephalomyelitis Virus - an incapacitating agent) during WW2. Some of Koprovski's trials resemble the Cold War virus releases on the New York subway, or in poor black districts of US cities. Stanley Plotkin, one of the team, was due to be conscripted into the US Air Force, but instead was called up into the EIS (Epidemic Intelligence Service - the CDC Atlanta) and was assigned to work on anthrax, but found himself at Wistar on polio vaccines. Odd. Joseph Pagano, similarly had an anthrax connection, and Agnes Flack, of the Clinton Farms, the pith-helmeted woman vaccinating 'a sea of Africans' in the famous photograph, taken during the Feb-April 1958 Ruzizi campaign, worked on the WW2 Manhattan Project at Oak Ridge. How the biological warfare angle ties in with mass polio-immunisation is not clear. The CHAT hypothesis could be undermined, if it were shown that some covert bio-warfare projects were riding piggy-back on Koprovski's efforts.

Testing of CHAT started on people who could not give their informed consent. US trials of Koprovski's vaccines took place at Sonoma, a mental home in California; Woodbine, New Jersey, a similar home for handicapped children. Babies of prisoners born at Clinton State Farms, New Jersey, were also injected with CHAT, and another test took place in the residential district of Moorestown, New Jersey. Significantly, a former New Jersey Clinton Farms baby may well have been one of the first US AIDS cases; a 16 year old girl who in 1973 gave birth to a baby who died of AIDS in 1979. This cannot be proved because the medical records will not be released. Koprovski also did a trial in Belfast, but this was not successful. Despite this, mass vaccinations still took place in Africa.

The vaccines were manufactured at the Wistar Institute, and at RIT in Belgium. Chimpanzee kidneys are believed to have been supplied to both of these labs by air, from the Congo. More controversially, it is also claimed that some of the vaccine could have been manufactured in Stanleyville. A large modern laboratory was built there, as well as $40,000 US government money financing of the Lindi chimp camp itself. Though Hooper does not explicitly say this, the investment points towards the intention of expanding production capacity, perhaps providing vaccines all across Congo, (14.7 million population) and other African countries. Koprovski attempted to persuade doctors in Kenya to vaccinate, but they knew of the Belfast trial and declined to participate. Africa would be used as a massive laboratory, prior to releasing the vaccine in America and Europe.

Three things went wrong here. The first was that for internal US medical establishment political reasons the Sabin vaccine overtook Koprovski's. Knowledge about that 1956 Belfast trial by Dr Dick and Dr Dane being one of the factors here. Koprovski was liked as a flamboyant character, a raconteur and bon vivant who could play the piano to concert standard, but who was also distrusted. The jump from small scale trials in US mental hospitals and a prison, to massive innoculation campaigns in Africa demonstrates his undue haste.

The second crisis concerned the acceptance of the use of monkey kidney cultures by the scientific community. The later discovery of SV40 eventuallyforced a switch to sterile, non-monkey cultures, but concern was already being felt in the mid 1950s. A row about Koprovski's use of monkey tissue was probably among the reasons why he was forced to leave the Lederle Laboratory to work at Wistar. In 1955, an accident where many monkeys were suffocated in transit at Heathrow Airport, caused the Indian government to embargo exports, sending panic through the scientific community. The establishment of the Lindi chimp farm can be understood as a response to this - an effort to ensure a secure route of supply. In autumn 1958 an outbreak of hepatitis among the chimpanzee handlers at Holloman AFB in the US was another reason why the safety of using monkeys could have been questioned.

The third problem was the political situation in the Congo, the period of post-colonial independence, and the mass exodus of doctors from the territory. The Lindi chimp farm closed, and also with it, the Stanleyville laborarory. That something did go seriously wrong with Koprovski's vaccine programme seens certain for two reasons; first, the general evasiveness about the precise constitution of the culture medium, both at the time and afterwards. Hooper shows that in earlier experiments, Koprovski claimed to have used chick embryo material when he was in fact using monkey kidney. Reticence in scientific literature at the time is understandable - (protecting trade secrets) but does not compare favourably with reports written by Sabin and the researcher Jezierski. The second reason why we know that something must have gone awry is that a promised scientific paper about their use of chimpanzees never appeared.

The recent test of supposed early CHAT samples by laboratories (see Nature Vol 410, pp 1045-47) was said to disprove the CHAT-HIV theory, because chimpanzee DNA could not be found inside the culture. However, testing possible pre-production seed pool batches made in the uSA or Sweden is not the same thing as testing production batches given to Congolese people, which may have been manufactured in the US, Belgium or Stanleyville itself.

Hooper analyzes early AIDS cases, perhaps the most famous being the HIV+ tissue sample from David Carr, the Manchester sailor and printer, who died of massive immunological collapse in August 1959. This case turns out to be an example of laboratory contamination. Carr, from Naseby Road, Reddish, was in the Royal Navy, but aside from one visit to Gibraltar and another to Sweden, served in Londonderry and Devonport. The possibility that he might have visited Porton Down is not explored.

An important factor of the spread of AIDS outwards from Rwanda / Burundi across Africa, was the early 1960s internecine conflict between Tutsis and Hutus. Refugees fled to Tanzania. During the 1978-9 conflict between Tanzania and the Ugandan forces of Idi Amin, soldiers camped in the same region, and then invaded Southern Uganda. Prostitution between refugee women and Tanzanian soldiers spread the virus northwards.

It is clear reading Hooper, that there has been a scientific establishment cover up. Near the beginning, the CHAT-HIV theory was put forwards by New York writer Louis Pasteur, but he found it impossible to get his papers published. At article in Rolling Stone magazine brought down a law suit from Koprowski. Some scientists may privately believe the theory, but dare not speak out in favour of it publicly - some who did have lost their jobs. The reluctance of institutes with remaining vials of CHAT has also been indicative. Some of the stocks were destroyed, once the theory began to be publicised. Some of the scientists involved now cannot remember the proceedures used. Some of them have died. Papers have gone missing or have been destroyed, and others have been withheld. It is clear why some scientists would cover-up for this, to protect science as an institution, and to protect public confidence in the world wide polio vaccination campaign, which is fairly close to eliminating the disease altogether. The fear of US law suits, or political fall out and appeals for compensation from African countries hit hard by AIDS will also be a factor. In some ways, the case is similar to BSE, but it also has implications for genetic modification, and xenotransplantation. I started off not wanting to believe the CHAT-HIV theory, but as I read on, the clearer it became. More investigations need to be carried out. The cover up is all the more deplorable, because it prevents people from learning the lessons of what happened here.
Stephen Booth