Aids in Africa
The virus causing acquired immune deficiency syndrome (AIDS) was identified three years ago. Since that time, the press has regularly charted the spread of AIDS, and, gradually, the world has come to realize that AIDS may well become the most killing disease in the history of humankind.
This point was brought home on a recent NBC evening news broadcast. Researchers now believe that AIDS was first acquired by humans in the general region where Uganda, Ruanda and Tanzania intersect west of Lake Victoria. The NBC segment reported that in the last four years, some 3000 people in Rakai District in southwestern Uganda have died from AIDS. This is more than one percent of the district's population. Not many families have escaped untouched, and the death rate is increasing.
Suffering has long been a companion to residents in this part of Uganda and neighboring Ruanda. In both countries for the past two decades, politically dominant groups have unleashed genocidal, campaigns against less powerful groups. I traveled through the area in early 1983 interviewing people about the forced evictions by the political machine of Milton Obote, then the President of Uganda, that drove more than 100,000 people from their homes. This displacement proved to be a mere warm-up for a campaign that left hundreds of thousands dead in the Luwero triangle area alone.
What can be done about the latest scourge in this part of Africa? A number of suggestions have been presented; most of them involve using Africans as guinea pigs for vaccine experiments that are no permissible in the Western countries where the vaccines were developed. Dr. James B. Wyngaarden, Director of the National Institutes for Health, was quoted in the Washington Post (12/9/86) as stating that African nations "would be a logical place to test a vaccine because the natural infection rate is so high in these countries." He went on to note that there are political problems with such a proposal. Dr. Wyngaarden failed to indicate what constituted a "natural" infection rat.
More recently, a French researched has begun to undertake tests on an experimental AIDS vaccine in Zaire. He has claimed that his willingness to take part in the experiment himself shows that he is not putting his subjects at risk. In neither the US nor France do codes for the development and testing of vaccines take such gestures into account. Informed and voluntary consent are the rule.
Regarding research on vaccines for disease such as AIDS, the Council for International Organizations of Medical Science (CIOMS) suggests that greater risks can be taken where greater number of people are affected. The risk/benefit issue is an important, but slippery one. According to the Nuremberg Code for international research (Principle 6) "the degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment." This is so vague, however, that humanitarian importance could be interpreted in vastly different ways depending on whether the individual, family, tribe, nation or, in the case of AIDS, even the world were used as the unit of analysis.
Perhaps the best way to proceed at this point is through a two pronged approach. Instead of asking Africans to bear the brunt of the risks involved in developing an AIDS vaccine, Western governments could decide that an AIDS vaccine is a priority research topic and change the standards so that research can be done with informed volunteers in the West. In industrialized countries, those volunteering for the experiments can be kept in medical facilities which can better monitor, immediately, the success or failure of the vaccine experiments being undertaken.
This does not leave Africa or Africans out of the picture. A number of Western medical research organizations (including the Center for Disease Control in the US) have collected blood samples from populations living in AIDS affected regions for the past 25 years. Many of these samples are still frozen. Wouldn't it make sense to examine these blood samples to find out when and where AIDS first appeared? The people whose samples showed AIDS positive might still be alive. All it would take to "discover" an AIDS vaccine is to locate one person who was infected but has managed to develop immunities to the disease. While this kind of tracking down of individuals would be difficult, it would be time well spent. Besides, if it proves impossible to find participants from earlier medical experiments (because they move around so much or because they live in inaccessible places) is it really responsible to use similar subjects for vaccine research when subsequent monitoring would be equally difficult?
Of course, if one person is found in Africa, whose body has developed anti-bodies to the AIDS virus, then it would certainly reduce the profits and recognition at stake in some of the current research. The notion that there are few profits to be made in research on Third World diseases is, in fact, at the heart of the current AIDS dilemma. If Western scientists and pharmaceutical companies had been keeping abreast of medical problems in the Third World, they could have begun AIDS research five to ten years earlier.
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