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Coronavirus

One Epidemic Prepares Us for Another – But the World Often Forgets the Lessons

The fight against COVID relies in great part on the insights gained from battle against a previous epidemic – AIDS – one that continues to unfold. Many frightening elements have been repeated from one crisis to the other – among them, reluctant governmental acknowledgment of the danger, misinformation, and bias against specific communities. At the same time, many reassuring elements have remained, including scientists whose resolve today has been forged in the ongoing struggle against AIDS.

The National Herald spoke to several scientists – Dr. Robert Gallo, the renowned co-discoverer of HIV, as well as to Dr. George Pavlakis, a senior investigator with the NIH’s Center for Cancer Research and the head of its Human Retrovirus section, and Dr. Demetre Daskalakis, a prominent activist researcher who serves as the CDC’s Director of the Division of HIV/AIDS Prevention (DHAP) – on the parallels between the two viruses and the response to each. Dr. Gallo is also the co-founder and international scientific advisor of the Global Virus Network (GVN).

The National Herald: Who wouldn’t want to forget that the COVID virus exists. We will all forget, of course. It has happened before.

Dr. Robert Gallo: We have a memory span that is roughly a generation and a half, about 30 years. We forget every single pandemic. In the 1960s we had healthy respect for epidemics and pandemics. After that, science became all about degenerative medicine – like we didn’t have to worry about infectious disease anymore. We had antibiotics, we had good nutrition, proper health systems, so we forgot about it.

TNH: Compare COVID-19 to previous epidemics.

Dr. Gallo: Compared to AIDS, COVID-19 is simple in numerous ways. Learning the cause was simple. HIV was the opposite. And we have special problems with HIV vaccines in that the antibodies don’t last.

TNH: But, though a vaccine against AIDS has not been developed, the fight against HIV has had many benefits.

Dr. Gallo: AIDS proved, for the first time in the history of medicine, that you can have antiviral therapy, that you can treat viral diseases. With molecular virology advances, it was proven that we could mount laser-sharp attacks on a virus and get into a certain step of its now-known cycle of reproducing itself.

Dr. George Pavlakis. (Photo via Twitter)

TNH: Dr. George Pavlakis, share with us some of your insights from the field of molecular virology.

Dr. George Pavlakis: The war against AIDS and HIV has created a large number of virologists, vaccinologists, and immunologists that for many years now have been trained not to be discouraged by failure. The vaccine has not been achieved yet, but this process created a community of scientists cooperating internationally to attack difficult problems. This was ready in place to address COVID, and is directly responsible for the rapid progress that we made.

Dr. Gallo: With HIV you have a chronic virus infection. You have time to use antivirals. With COVID, by the time you know someone is infected, you are often faced with serious problems, the inflammatory stage.

Dr. Pavlakis: So, for a disease like COVID, vaccines commanded the major effort and investment, because the disease can be very rapid and for the minority that have severe pre-existing disease, the virus can destroy their lungs, their kidneys, create problems in the vasculature, or in the brain. We’re talking about 2% of the people, but that happens very rapidly, and there may not be enough time to detect it and address it by drugs. Hence the significance of prophylactic vaccines.

TNH: Tell us about governments’ responses to both diseases.

Dr. Gallo: Governments have too much control. Did all governments agree to do the same things? No. So which government would you pick? We need government for money, for oversight. You must have some representation of the people also. But running everything? Do I need half a dozen people coming into a room telling me every night things that we know better as scientists?

This time, the government sort of recognized it. The president recognized COVID’s existence. Barely. But this is in your face. AIDS was not so much in your face. In president Reagan’s case it was closer to his face than we knew, but it wasn’t obvious, right? COVID is different. It’s respiratory. But President Trump was kind of dissing it, minimizing it. So, it’s different, but not better – just different.

Dr. Robert Gallo.

TNH: Certainly, not only governments are under fire.

Dr. Gallo: The WHO has strengths and weaknesses. It doesn’t have significant money, and by its very nature, it can’t be very active, scientifically. They rely on their contacts… They can’t always be up to date, you can’t expect miracles from them. Overall, they do a decent job. I’m not anti-WHO, but sometimes they’ve set policies with which we’re not in agreement with, which they could be more open to discussing… So I do believe that something like the GVN and the WHO should be joined at the hip.

TNH: The GVN is building a biomedical community with centers in America, Europe, Russia, China –everywhere.

Dr. Gallo: “But not with governments. Only government scientists. Governments signing things is usually fluff. What is needed is grassroots, scientists that are really cooperating and collaborating.

TNH: Dr. Demetre Daskalakis, what did the HIV crisis reveal regarding embedded social determinants of vulnerability?

Dr. Daskalakis: The first lesson from HIV also has to do with the folks who are overrepresented in the COVID pandemic. The only people that were surprised that Black and Latino individuals were overrepresented were people who really didn’t do infectious disease and public health. The bottom line is that many of the infections that we see as public health concerns always tend to go along these lines, because of the historical inequities experienced by the populations… including the history of healthcare and other interventions not serving them. This rapid pandemic has just accentuated what’s there. As we work to address the health equity issues, it becomes critical that the conversation go beyond health equity and into the social justice that needs to happen.

Dr. Gallo: We realized the importance of communities then, but did things change after that for communities? I would say we are more aware of different minorities and their problems – but are we doing something about it? We have an outreach program in Baltimore. We got set back a lot by the opioid epidemic. We are making great strides, but we’re doing much better in Africa than we are in Baltimore. What about that?

Dr. Demetre Daskalakis, honored with the Esperanza Award at the Cielo Gala in 2016, has been named the CDC’s Senior Vaccine Equity Lead. (Photo by Eleni Sakellis)

NH: COVID has taken attention away from the HIV/AIDS crisis. Where do we stand on that front?

Dr. Daskalakis: We’re still sifting through the impact… I’m optimistic that the lessons we’ve learned, specifically around telemedicine, home testing, and some of the other innovations, will really help.

Dr. Gallo: It’s another reason to get rid of COVID, isn’t it? To get everybody vaccinated and get it out of the way – because it’s a solvable problem.

TNH: The word `solvable’ seems to have acquired disturbing undertones. Rather than universal relief, the vaccines that could get COVID greatly out of the way have been met by some groups with a skepticism that crosses into the outrageous… and attacks on science itself.

Dr. Daskalakis: Science can be an ivory tower, and making sure that you bring it to the level of understanding and into a [social] context of understanding is critical. Sometimes the voices that are talking about science aren’t necessarily the ones trusted by the community. For some populations, some of the voices speak to them; but, when you think about the populations that are not really hearing those messages, the solution has to do with identifying ways to work with trusted messengers to get the word out in a way that is comprehensible and believable.

Dr. Pavlakis: It’s human nature. Prevention has its limits. But realize that Asian societies lived happily with masks for a long time. Sometimes, in the West, we behave like spoiled brats. We don’t want any sacrifices, any difficulties. We demand that things always go our way. And, if they don’t, if we have even temporary difficulties, if we have to sacrifice a few months to a strict discipline in order to get rid of a problem, parts of society will sometimes revolt, because they just don’t want to follow any sane restrictions.

Dr. Gallo: I guess the first thing is perseverance, that you can’t get discouraged by difficulties. When there’s failures or setbacks, you just have to pick up what must be solved, and try from a different perspective. Also, not letting wrong statements or peculiar theories get you down, and not wasting time looking for blame. Another lesson is the need for much stronger local public health, which I think has gone down in America since I was a child. Local public health enables adequate information. Another lesson is maybe to not over-rely on government.

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