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Interview with Dr. James C. Hill

This is an interview with Dr. James C. Hill, the Deputy Director of the National Institute of Allergy and Infectious Diseases in his office at the National Institutes of Health in Bethesda, Maryland, on October 4, 1988. The interviewer is Dr. Victoria A. Harden, Director of the NIH Historical Office.

Harden: Dr. Hill, could you summarize your career before 1981 for us and indicate your special areas of interest and how they helped to prepare you for thinking about a new infectious disease?

Hill: I have a Ph.D. in microbiology from the University of Arkansas, and my graduate background is in research on fungal physiology. I went into the Navy Medical Service Corps as a research microbiologist and was stationed at Naval Biological Laboratory, Naval Supply Center, Oakland. There I worked for about two-and-a-half years on meningococcal disease and helped set up the Neisseria reference laboratory, a World Health Organization reference center, for meningococcal and gonococcal strains. I worked with Dr. Neylan Vedros. I then came back to the Naval Medical Research Institute in Bethesda and spent five years working with Dr. Emilio Weiss, who is well-known primarily for his work in rickettsia physiology but who was also working on meningococcal disease and vaccine development. I worked with him on meningococcal physiology and vaccine development.

I then was offered the job as the bacterial vaccines program officer at NIAID in 1974 in what was then the Infectious Diseases Branch run by Dr. George Galasso. That branch later became the Development Applications Branch after Dr. [Richard] Krause came to NIAID and reorganized its extramural programs. I spent nine years as the extramural program officer for the development and testing of bacterial vaccines, such as meningococcal, Hemophilus influenzae, pneumococcal, and pertussis vaccines. In this role, I obviously gained some experience in the development of RFPs [requests for proposals] and the award of contracts for research. I mention this because it leads into how I became involved in the AIDS area.

While I was in that position, the first cases of AIDS were described, and in the spring of 1983, the then scientific director of NIAID, Dr. Kenneth Sell, asked me to work on the establishment of a contract for AIDS research. Dr. Sell had previously been the executive officer and commanding officer at the Naval Medical Research Institute at a time when I was there. He knew my experience in contract awards and development of RFPs. At that time he envisioned that the NIAID intramural program would develop a large contract to gather specimens, all kinds of specimens, from persons with AIDS to see what was causing the disease.

You remember that in the spring of 1983, the causal agent was not yet discovered. It wasn't even certain that it was an infectious disease, although a lot of people thought that it probably was. Dr. Sell wanted to mount a major intramural contract that would gather samples from persons with AIDS, including fecal samples, urine samples, blood samples, sputum samples–any sort of body fluids that you could think of. He wanted to store them for research in order to see if we could determine what causes this disease. He needed somebody to help set up this contract, and he approached me and George Galasso, who was my boss at the time, about whether I could come over and assist in setting up this contract. I did it as a favor to the intramural program to help it get started, and I wrote the RFP.

Then Dr. Sell asked me to join the intramural program as his assistant. In July 1983, I became the associate director of the [NIAID] intramural research program. My involvement from that point on in AIDS was in helping Dr. Sell administer the intramural program, which was gradually developing major research areas in AIDS. The contract that was set up was taken over by Dr. Richard Wyatt, who is now in Building 1, as the principal investigator.

A number of intramural projects were going on in AIDS. You know Dr. [Anthony] Fauci's work on immune deficiency was on going. He was involved in that from the early days when people with this kind of immune deficiency were first identified. Dr. Sell himself had a group at that time. Dr. Tom Folks, who for the last two years has been in Dr. Fauci's lab and has now gone to the Centers for Disease Control [CDC], was then in Dr. Sell's group. Dr. Sell, even though he was a scientific director, had his own research group.

Gradually the intramural program began to acquire more and more AIDS projects. My involvement with AIDS was assisting Dr. Sell in the overall administration of the intramural research program. When Dr. Krause left the institute in 1984, Dr. Fauci was selected the director. I knew Dr. Fauci as an intramural lab chief when I was the associate to Dr. Sell. Dr. Fauci asked me to take the position of special assistant to the director, a position similar to what Dr. Jack Whitescarver had under Dr. Krause. I came to him in that job and also as his AIDS coordinator for the Office of the Director of NIAID. I stayed in that role for about a year, until we hired Maggie [Marguerite] Donoghue, who then became Dr. Fauci's AIDS Coordinator. I stayed on as his assistant, handling congressional liaison and liaison with constituency groups. This is how I became involved with AIDS research.

Harden: When Maggie left the Institute, who took her place as AIDS coordinator?

Hill: After Maggie left, Debbie [Deborah] Henderson held that job for about a year. She moved on to the FDA, and now Dr. Margaret Hamburg has what is the equivalent of that job. Now there are two people who cover AIDS for Dr. Fauci. Dr. Zeda Rosenberg handles the scientific part with Dr. Fauci. She works with him closely on manuscript preparation, liaison with the lab, and on a lot of scientific aspects. Dr. Hamburg deals with scientific aspects as well, but she is much more the AIDS coordinator in this office. She is Dr. Fauci's liaison with the [NIH] Building 1 office and with downtown [Department of Health and Human Services], and she deals with his role as an AIDS spokesman.

Harden: Did the advent of a new infectious disease surprise you as it seemed to surprise a lot of people? Could you, from your own microbiological experience, put this disease in the context of the other sexually transmitted diseases?

Hill: I guess the answer is both yes and no. It surprised me to a certain extent. There were so many theories as to how this disease was caused and how unusual it was. While a lot of people thought it was an infectious agent, we thought it might be caused by some sort of drug use. There was even a proposal that it was some sort of mercury poisoning. It also seemed to be a result of a combination of activities, since initially it was mostly a gay men's disease. Even though it began to look more and more like an infectious disease, it did come as a surprise, mainly because the idea that an infectious disease existed but had not shown up before was devastating. Even microbiologists didn't understand it, and the public and the scientists had become very complacent in the last few years, in the last few decades, because antibiotics could hit pretty much everything, in spite of the fact that a lot of tolerance had developed.

In another way, it was not too surprising because there had been a couple of similar forewarning jolts–for example, Legionnaire's disease. It was quite a surprise to us to discover an infectious agent that was totally new, and you know that it was a very scary thing when it happened. Legionnaire's was very mild compared to what AIDS has been, but it was very scary when it turned out to be a new infectious disease. Toxic shock syndrome–it took a while to figure out what was causing that, and that clearly was a new infection, at least a new disease that hadn't been described before. So I guess in a way those two events made us realize that a new infectious disease could exist, but this one was so devastating that I guess it did surprise people. I think it may have surprised us more because we were all hoping that it really couldn't possibly be true.

Harden: From your experience over the last few years with AIDS, how do you evaluate its impact? Certainly it has proved fatal, and that, of course, makes a major difference. How would you compare it with the impact of the other sexually-transmitted diseases?

Hill: Obviously, it's been a whole new ballpark to an extent. Historically not so much, because there was a time when syphilis was not curable and people lived long lives with syphilis, went through various stages, and it killed a lot of people. Gonorrhea certainly caused a lot of problems as well. But most of the sexually transmitted diseases were fairly slow in causing a disease, you lived with them for a long time, or they were not life-threatening. They caused problems that we recognize now as being severe sexually transmitted diseases. We just didn't recognize the importance of things like pelvic inflammatory disease, which causes sterility and death in a lot of women.

I think that certainly in the modern era, there are no sexually transmitted diseases that can be compared with AIDS. For the most part, they can be handled just like a lot of other diseases. Except for a little bit of a scare about the penicillin-resistant gonorrhea, and there were other drugs that promised to deal with that, most of the sexually transmitted diseases certainly can be handled. Herpes is not such a case. Before AIDS came along, there was this enormous scare over herpes. But again, not a lot of adults, and particularly young, productive, healthy adults, died of herpes. That time it seemed like a tragedy. Now it almost seems like an inconvenience, to have gonorrhea, herpes or even syphilis. And while these diseases still cause problems in other countries and in the United States, and they are serious diseases, causing infertility and death, in comparison to the sheer horror of AIDS–the debilitating, wasting, way in which very young productive people die–I don't think anything, at least in the modern era, quite compares with it. Again, this is if we look at it in the perspective of this country. If you look at the Third World countries, you see the numbers of people who die every year from malaria, and from other infectious diseases, you look at it from a different perspective. But from the standpoint of this society, in this country during the last several decades, it has been more a traumatic thing compared to the other sexually transmitted diseases and other infectious diseases.

Harden: It seems to me traumatic also because none of the other diseases in recent decades had caused the same degree of behavioral fear. People seemed to have changed their behavior since AIDS came along.

Hill: There are social aspects involved in this disease that are just not really the same as in other sexually transmitted diseases. Although the incidence of gonorrhea or syphilis may be considerably higher in gay men, for example, those diseases do not have the clear association of making an individual stand out as being a gay person simply because he has contracted one of them. Early on, and even now to some extent, many of the persons who had AIDS were homosexual men or were intravenous drug abusers, people who are disenfranchised and discriminated against in society. Thus social ramifications in this case are far more complex, involved, and frightening to those people who have the disease than was the case with the other sexually transmitted diseases.

Harden: Could you recall when you first heard about these unusual cases of Kaposi's sarcoma and Pneumocystis carinii pneumonia [PCP]? How did your own thinking evolve?

Hill: It was 1981-82 when we heard about the CDC report. But you really couldn't take it as a base period. These were a few isolated incidences. It just didn't seem like something that was going to have quite the ramifications that eventually emerged. It was almost like, “Here's an interesting sort of disease anomaly.” It was very slow, and I think a lot of scientists were very slow in recognizing what it was. It was interesting that it was hitting gay men only, and a couple of other groups. But there was no particular appreciation that what we were standing on was the edge of something as devastating as it turned out to be.

Harden: Were you getting any reports out of Third World countries at this point?

Hill: I don't recall, but again, you've got to realize that in the early days of this, I was not working in this area. I was the program officer for bacterial vaccines. I was neither in the intramural program working with the people who were involved in this area, nor was I involved in the sexually transmitted diseases program directly at that time. Professionally I was not really privy to any more information than anybody else at NIH working in another area would be. My appreciation for it really began to develop in 1982-83, recognizing the concern and what was happening. I was in an extramural program that was not really involved in this area until Dr. Sell asked me to get involved with his contract. From then on I've been involved, not so much as a researcher, but as a science administrator and in policy administration of the institute. So it's hard for me to remember exactly what the early thinking was. There certainly was no real comprehension of the seriousness of this. Probably not as much as the people working much closer in the field. I was really just on the periphery.

Harden: As I recall, between 1981 and 1983 there were just a few brief news accounts, and I wondered, “What does it really mean?”

Hill: I think I had just a little bit more information than that but not much more. I would see the CDC Morbidity and Mortality Weekly Report [MMWR], but I was looking at it from the standpoint of a meningococcal disease or whatever. I would see occasional reports, and then a few weeks later there would be another report from CDC on something about it, and a few weeks later something else. So, I began to become aware of it, but my awareness really only picked up in the early part of 1983.

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