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BRIAN
DEER: THE VAXGEN EXPERIMENT Page 6
And
the Band Played On was a monster hit in America, and
Shilts, the author, makes two observations about
Francis from before the vaccine race. Noting his
early career in medicine, virology and diseases such
as ebola, Shilts notes that when Aids first appeared
"Don Francis viewed his life as an accumulation
of chance decisions that had put him in the right
place" to respond. "Francis had a penchant
for quick conclusions stated in the most dramatic
terms," he adds, with "a reputation for
singular brilliance." Like teachers' praise or
schoolyard snubs, people soak up their own publicity.
And as I skimmed the book's index in a Motel 6 before
the first of two interviews with Francis, I couldn't
help thinking that, whether this penchant and
reputation were real before the book, they would have
been after the movie.
I was
startled, even so, by the confidence of his
performance, in his office overlooking the bay. There
was a Japanese poster for the movie on one wall. On
another was a mounted Philadelphia Inquirer report in
which he featured as an angry young man. He'd a
red-framed sign above his desk for reporters to note.
It said: "Joyful participation in the sorrows of
the world."
In
our first encounter, he fed me his experiment in
digestible, barbecue chunks. Wearing jeans, baggy
shirt and loose-fitting waistcoat, he paced and waved
his arms. There were "perfectly good arguments
on either side," he said, "for this vaccine
working or not working." Then he leant on a
chair, stared moodily across the water and whispered:
"I hate this bug." That was a line from
Outbreak, a Dustin Hoffman movie, and he'd other such
memorable nuggets. "I spend much of my time
protecting myself from my concern," he told me.
I
thought, Dr Francis, please.
It
wasn't that I doubted his compassion. Both of his
parents were doctors, in northern California; the
young Donald grew up to watch flower power bloom and
die. At med school in Chicago, he volunteered at free
clinics. He was secretary of Physicians for Social
Responsibility. He was for civil rights and against
the Vietnam war. His resume was impeccable. But he
admitted to never having gone to Khlong Toei, or
other slums where his subjects were recruited. It was
an awkward omission for the ebola-buster, now on
$300,000 a year.
Success
with AidsVax would make his fortune, but I didn't
think that money drove him on. Chewing over old
times, as veterans do, we talked about the moment in
1984 when French scientists discovered the virus.
He'd set up a lab at the CDC, but told me that he'd
looked for the wrong type of bug. The Americans
thought it would be a leukaemia-type infection, but
the French hunted for a simple cell-killer. Were it
not for this bungle, he seemed to imply, he might
have risen at some heady press conference to be
acclaimed as the discoverer of the cause of Aids.
He
didn't crave something that we all don't dream of.
What he was doing seemed oddly human. He'd blown it
once, I took as the lesson. He didn't plan to blow it
again.
Our
next interview was two days later. It was a formal
tape-recorder job. After an hour in the company's
data room, where modems blink and chatter, I asked
him to explain the anomaly with the vaccine. The
amino acid stuff. If Berman's theory about V3 loop
tips was right, then surely the gp120 from the New
Jersey strain wouldn't do much good in Bangkok.
Francis had an answer. True, the V3 tip on the B part
of the vaccine wasn't the same as the Bs in
circulation. But, he said, it was the same
as on the other prevalent strains - the Es. It would
work on them. "It happens to be identical to the
Thai E that's in that vaccine," he said.
But
this wasn't right. What he said wasn't true. "No
it's not," I interrupted.
"Yeah,"
he insisted.
"No
it's not."
"It
is."
I
rummaged through my papers and read him the amino
acid strings from the V3 tip on the gp120 blob. It
was not one hundred millionth the size of the
infected cell, but not totally out of sight.
"Here we are: Thai E strain is GPGQVF."
"Right,"
he agreed.
"The
Thai B strain is GPGQAW," I continued. "If
you take the B vaccine sequence it's GPGRAF."
The strings were all different. He was talking
nonsense.
"Okay,
okay," he acknowledged. "I'm sorry."
That
surprised me. Lives were at stake. "But you're
not giving the Bangkok junkies the most promising
product, by your own reasoning."
"For
the B virus?" he said. "Possibly. That
possibly could be true."
"Isn't
that unethical?"
"No."
He paused. "No, because it would be unethical if
you told them that this vaccine was going to work. We
tell them to assume no efficacy."
Ah,
yes.
Later
I put to him the safety issue and the fact that
serious opinion suggested that AidsVax could have
long-term risks.
"I
think you have to have a theoretical rationale why it
would cause harm," he replied.
"There
are theoretical rationales."
"Where?"
he snapped. He was beginning to sound annoyed.
I
cited the "deceptive imprinting" work of
Kohler in Kentucky as one example.
"The
question that you're asking is: if you get infected,
subsequently to immunisation, will you have an
increased disease manifestation, or harm accrue from
the vaccine? And that could be. That could be."
Okay.
Nobody was telling the Bangkok junkies. "Don't
you think some of these doubts should be made plain
in the informed consent?" I asked.
"I
think it's more important to say 'we don't
know'," he responded irritably. "And that's
what we say. And we say: 'do not depend on this
vaccine, we do not know if it has effect, if any, and
that's why we are studying it'. I think that's your
ethical responsibility - to really say: 'We do not
know. We do not know if it will cause harm. These are
the data that we have.'"
HIV
was uniquely dangerous, he said, with 16,000 new
infections daily. There was no way to develop the
desperately-needed vaccine that didn't involve taking
risks.
I
said: "But the fact that this is an extremely
virulent and infectious agent doesn't entitle you to
be reckless."
"Agreed,"
he hit back. His voice was rising. "But
shouldn't it stimulate society to take chances to
prevent it?" He said that vaccine developers had
always taken risks, sometimes proportionately even
greater for less threatening parasites, such as in,
say, measles or pertussis. "We have taken the
potential risk to deal with diseases that have very
low mortality rates," he shouted, stabbing his
finger. "With HIV, at least you have the luxury
that this bug is so fucking dangerous that it kills
everybody - that all you can say is that I
would do to these people is shorten their incubation
period - which would be a tragedy." He glowered
at me. Now he'd lost it. It was character revealed by
stress. "But I'm not going to kill any more
people than the virus has already killed."
When
his rage subsided, I drove him home and we sipped a
couple of beers. The view from his house should had
been magnificent, but a fog had settled on the bay.
More: Tough questions for
VaxGen as AidsVax trial fails
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