CROI 2018: Dr. Harold Jaffe looks back — for lessons to inform responses to the next infectious disease outbreak

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Science Speaks is in Boston this week, covering CROI 2018, the 25th Conference on Retroviruses and Opportunistic Infections.

BOSTON – Considering the strides in HIV science to be presented here this week, Dr. Harold Jaffe didn’t at first see the point of dwelling on the history of the epidemic, the topic he was asked to address here this morning. Then, he said, he thought about all the lessons those years had yielded, and how those lessons would continue to inform responses to the infectious disease outbreaks to come.

They included the toll of neglect, demonstrated during the Reagan years, when presidential spokesman Larry Speakes said “What’s AIDS,” and laughed as the epidemic swept across the country and grew, unrecognized, in Africa. They included the need to fast-track drug development and approval when lives were at stake. They included the role activism had played in rousing and informing the responses that began to pay off, and the essential contributions that people affected by diseases offer. And he remembered the critical insights that a workforce of ready and astute physicians provided, and how those insights countered fear, prejudice, and misconstrued clues.

He thought about where he was when it all began, when he had just completed his fellowship in infectious diseases. That the field seemed destined for obsolescence in the age of antibiotics had been summed up by the internationally known infectious diseases expert Dr. Robert Petersdorf who in 1978 had said, “even with my great personal loyalty to Infectious Disease, I cannot conceive the need for 309 more infectious disease experts unless they spend their time culturing each other . . .” In hindsight, though, the need was already becoming clear, in rates of syphilis that were rising steeply from 1976 into the decade that followed, even before the 1981 CDC reports of deadly infections that were taking the lives of previously healthy and young gay men.

The needs all of those lessons pointed to continue. “We continue to be surprised,” he said — by MERS, Dengue, Chikungunya, Zika, Ebola, and cholera.

“Are we better prepared?” Dr. Jaffe asked. “In some ways yes.”

In 2005 the World Health Organization took the promising step of launching International Health Regulations requiring member states to develop basic capacities to detect, prevent and respond to infectious diseases. But, Jaffe added, by 2014 only two-thirds of member states had complied.

The Global Health Security Agenda, a multinational initiative strongly supported by a five-year, billion dollar investment from the U.S., is working to address those deficits, Jaffe noted. But long-term funding for this initiative has yet to be secured.

And the past remains prologue to the next epidemic, with fear of contagion, evidenced during the 2014-2015 the Ebola crisis still over-riding evidence, behavior change still challenged, and, syphilis rates rising once again, in a way that Dr. Jaffe finds eerily familiar.

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