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Lessons of AIDS help fight against SARS

May 19 2003

Twenty years ago this week, scientists identified the virus that causes AIDS, a discovery that met with a tragic complacency which only changed after the disease had claimed as many lives as a world war.

The battle against AIDS continues its forlorn path but, say experts, at least some lessons from this catastrophic early response have helped the fight against another novel disease, Severe Acute Respiratory Syndrome (SARS).

HIV/AIDS and SARS are respectively the last major new disease of the 20th century and the first of the 21st century, and they have intriguing parallels.

They are not limited by climate or geography; there is no cure or vaccine for either; and they have the ability to spread quickly and insidiously. Their lethality is of course different, yet they each can ruin lives, socially disrupt a vulnerable country and cripple its economy.

Experts say it is precisely the spectre of an AIDS-style juggernaut which is driving the frenzied, unprecedented collaborative effort against SARS.

Crossing borders and encircling the globe, the mission is uniting thousands of researchers, epidemiologists and health workers to detect the SARS virus, find and exploit its weaknesses and set down barriers to circumscribe its spread.

"We have learnt that in an emergency health situation, introverted, competitive scientific research or academic research is not going to be the solution to controlling an emerging disease efficiently," said Klaus Stohr, a SARS fighter at the World Health Organisation (WHO).

"The solution has to be networking, being open-minded, collaborative and setting aside the individual competitive interest and sharing information in an altruistic way."

Another hard-won lesson, he said, has been to have an efficient disease detection and surveillance system.

"You cannot fight the disease when it's not detected. It will spread and linger for longer periods of time. It will cover a larger area, it will affect more people, it will be much more difficult to control."

Records have been broken, both in the lab and in the public-health arena, by SARS.

Less than six months after the disease emerged, the coronavirus was isolated and genetically sequenced and a first generation of diagnostic tests developed. A panoply of preventive measures ranging from hygiene advice to travel warnings and quarantines was set in place around the world.

The good start looks set to be sustained.

Corporate money is being pumped into the search for a SARS cure, and the US and other governments are moving to set up incentive funds for research into a vaccine.

Compare this extraordinary progress, then, with the early phase of HIV/AIDS.

The disease had spread for more than two years before HIV was isolated, an achievement marked by publication in the US journal Science on May 20, 1983 by a team led by France's Luc Montagnier.

As the epidemic widened, investments began to be made in the search for treatment.

The financial commitment eventually became huge, giving birth in the mid-1990s to anti-retroviral drugs that suppress HIV. But the only beneficiaries, until pricing strategies started to change a couple of years ago, were people in rich countries who could afford to pay for these drugs.

As for vaccines, corporate interest - again, until very recently - was negligible, partly because of the lack of incentive funds that, ironically, are emerging for SARS.

Why was there such a big difference in the response to these two powerful threats at their all-important early stages?

One reason has been the advent of gene sequencing, the Internet and email, which did not exist in the early 1980s and which have been potent tools in the war on SARS.

But it is not just that, said Seth Berkley, president of the New York-based International AIDS Vaccine Initiative (IAVI).

The major difference, he suggested, is public perception: people are afraid of SARS because it can be caught accidentally, by breathing in infected droplets from someone in close proximity.

In contrast, HIV is mainly caught through sex, and so was initially snared by taboo.

In the early stages of the pandemic, the disease seemed restricted only to homosexual men - indeed, at one point, it was going to be named gay-related immunodeficiency, or GRID - and this bred indifference or even contempt among the mainstream population.

Some conservatives seized on it as a moral issue, thus stigmatising HIV and driving it underground, where it spread like wildfire and entered the population's mainstream, Berkley said in a phone interview.

That critically delayed the transparency and honest debate on which a good prevention campaign and research funding are built. That hindrance does not exist in the case against SARS.

Despite these differences, said Berkley, there is plenty of evidence to point to a major and enduring improvement in the global response to new health threats.

"The world is working better today," he said.

"True, there were some countries which were not necessarily forthcoming about what was going on [about the SARS outbreak], but as soon as the nature and magnitude of what happened emerged, those countries rapidly changed their way of working.

"It took seven, eight, 10 years or longer before all countries began to do the same for HIV."





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