Science taking backseat to politics

By Laurie Garrett

Newsday 23 April 2000

Hoosen Coovadia, Mark Wainberg and Peter Piot are anxious, unhappy men these days, losing sleep and pacing nervously as they watch years of AIDS work slipping through their fingers. They fear their efforts will mutate into a major international fiasco.

For the past five years, their immodest goal has been to stage the 13th biannual International AIDS Conference-the millennial gathering of 16,000 of the world's AIDS scientists and physicians in Durban, South Africa. The conference, sponsored by the International AIDS Societies and the UNAIDS Programme, has consistently set the agenda and tone of AIDS research and treatment.

Significantly, this is the first time a scientific meeting of such scale has convened in sub-Saharan Africa, where HIV rates are among the world's highest. The conference is intended to put scientists, most of whom work in North America, western Europe or Japan, in the middle of a developing country in which 13 percent of the population is HIV-positive and, in some areas, 40 percent of adults are infected.

Now, as the July meeting nears, a political maelstrom coupled with growing scientific disinterest in the conference threatens to reduce attendance from levels of previous conferences-a scene that could leave Africa and other poor, AIDS-plagued regions of the world bitter.

The Durban meeting has become a political lightning rod for many: dissidents who believe that HIV is a harmless virus; African political leaders who are angry about the concentration of wealth and science in the Northern Hemisphere; activists who want multinational pharmaceutical companies to bring down prices on AIDS-related drugs; and even protesters who share the anti-World Bank sentiments expressed last week in Washington.

The biannual conference has routinely been highly politicized. And in recent years many laboratory scientists have shunned it, preferring to attend quieter scientific gatherings convened primarily in the United States.

"In choosing Durban, we understood that we would be setting into motion a chain of events that we would not be able to control," Canadian HIV scientist Wainberg, president of the International AIDS Societies, acknowledged. But he said organizers had not envisioned demonstrations staged by an array of political groups, tension with the host country's government and a debate seen as imperiling global cooperative efforts to combat AIDS.

"Globally, this event has to succeed to demonstrate that developing countries can host such a massive event," said Coovadia, the conference chairman.

But as a global sense of political urgency about AIDS has risen in recent weeks-the World Bank pronounced the AIDS pandemic its "No. 1 priority," and the United Nations Security Council declared Africa's HIV epidemic a "global security issue" - so have a host of protests. In South Africa, President Thabo Mbeki expressed doubts about whether HIV is, indeed, a harmful virus, even whether AIDS is a bona fide epidemic. He recently wrote to President Bill Clinton, denouncing the "campaign of intellectual intimidation and terrorism" he said was being waged against the dissident view.

South African Deputy President Jacob Zuma expanded on Mbeki's remarks this week, singling out the group ACT UP-San Francisco for praise and comparing its belief that HIV is harmless to Galileo's 17th-Century crusade to prove that the Earth rotates around the sun.

Emboldened by such attention, ACT UP-San Francisco and other dissident groups have stepped up attacks on mainstream AIDS organizations; earlier this week they disrupted a meeting there on HIV drug research developments. ACT UP-San Francisco has vowed to attack drug company representatives who, the group claims, are selling toxic HIV drug cocktails.

In response, the drug industry has scaled back its plans for Durban. Glaxo Wellcome has canceled its customary conference briefing on AIDS drugs. Other drug companies have reduced the numbers of scientists they plan to send.

The South African Congress of Trade Unions earlier this month announced it will turn the meeting "into another Seattle," referring to the riots that broke out in that city in December in protest of the World Trade Organization meeting. The unions' targets are also the drug companies, which, they say, are unfairly pricing their products at unaffordable levels.

Several months ago scientists in the United States and Europe circulated an Internet call to boycott the Durban meeting, to protest the Mbeki government's decision not to provide the drugs AZT or nevirapine to pregnant HIV-positive women in order to prevent viral infection of their babies. Cost was not an issue - Glaxo reduced the AZT price to South Africa by 75 percent, and humanitarian groups offered the country free nevirapine. That unofficial boycott has broadened in response to Mbeki's recent statements.

The biannual conference has produced significant events. In 1994 in Yokohama, physicians reported that patients were dying despite the then-available drugs. That spurred a vigorous research effort, and at the 1996 conference in Vancouver, British Columbia, it was announced that cocktails of old and new anti-HIV drugs could prolong lives and possibly eradicate the virus.

Two years ago, the Geneva meeting took a sober shift, with physicians reporting that the miracle drugs touted in Vancouver were more dangerous than previously thought. Further, scientists acknowledged that the new drugs were not eradicating HIV from patients' bodies. Research shifted to a search for a vaccine and ways to improve the treatment cocktails or boost patients' immune responses.

Scientifically, then, the Durban gathering was shaping up to be a pragmatic, but grim, affair. This week, for example, European researchers reported in The Lancet that the first round of anti-AIDS cocktails is not succeeding in half of all HIV patients in Europe, and for those on their third round, the failure rate is 80 percent.

Coovadia, Wainberg and Piot agree that recent developments have put science distinctly in the back seat at Durban.

"We've been pushing to move AIDS into the political arena and now, here we are," Piot, director of the United Nations AIDS Programme, based in Geneva, said in an interview. "Now how do we translate this into something useful?" "We are equally angry," Coovadia said, noting that "no one in South Africa has been more vocal about opposition to the government's position than the organizers of this meeting ... This will amount to a boycott of fellow scientists and not the government." Coovadia hasn't released details on conference registration, but sources close to the meeting say the numbers of scientists and physicians enrolled are far below those at this point two years ago.

A telephone and e-mail survey of dozens of scientists who attended previous conferences found that, except for those scheduled to give speeches, they do not plan to attend. Most said it was too costly and time-consuming to travel to South Africa, particularly given the likelihood that political protest would overwhelm the science.

"If scientists in the U.S. and Europe cannot inconvenience themselves, however trivially given the first-rate infrastructure in South Africa, then it seems to me we will establish and consolidate two cultures," Coovadia said.

"Science for the rich, and science for the poor."