Sten H. Vermund, the new dean of Yale School of Public Health, held a standing-room-only audience rapt for more than hour on March 29 with tales of his work fighting AIDS from 1980s New York City to present day Mozambique.
Vermund’s talk—the 69th annual Lecture of the Associates of the Cushing/Whitney Medical Library and given at the library—was something of a coming out for the bewhiskered epidemiologist and pediatrician. Titled “HIV/AIDS from A(labama) to Z(ambia): Research and Response since 1981,” his presentation represented his first major public speaking event since taking the helm of the Yale School of Public Health on Feb. 1.
Vermund, M.D., Ph.D., guided his audience from the frustrating early days of the AIDS crisis when death rates were over 90 percent to the triumphant introduction of viral inhibitors that have saved millions of lives. A major theme of his talk was the central role of public policy in fighting the scourge. Countries that choose ignorance or moralistic approaches to sex and intravenous drug use— such as the United States in the 1980s, South Africa in the early 2000s and Russia today—inevitably face raging epidemics, he said. He cited as an example of such an approach a 1980s American public health ad reading, “With AIDS around, gonorrhea, syphilis and herpes are fair warning. Stop.”
But “stop” is not an effective, specific message, he said. “One of the saddest memories I have of the 1980s is how reluctant we were to actually talk about effective AIDS prevention. It was absolutely a function of the politics of the time, in contrast to the pragmatic approach of the Western Europeans.”
By contrast, countries such as Thailand and Uganda, whose presidents required every government minister to discuss AIDS at every public event, have shown that aggressive, frank public education efforts can lower prevalence rates and change behavior, Vermund said.
Using slides that were sometimes one week old and others that were 30 years old, Vermund revisited the mystery, fear and prejudice that surrounded AIDS in the 1980s. The ignorance extended even to some New York City public health workers who falsely insisted to Vermund that heterosexual men were somehow immune, he said. After the death of Rock Hudson—one of then-President Reagan’s closest friends—the federal government’s money spigot opened and research took off, recalled Vermund, who headed the Epidemiology Branch of the National Institutes of Health studying AIDS from 1988 to 1994.
We are still, in my view, a decade, two decades, perhaps more, away from an HIV vaccine that can be deployed to millions of people.
Sten Vermund
The breakthrough came in the mid-1990s with the introduction of triple therapy antiviral drugs that can prevent the onset of the disease in patients who adhere to the medications. But just as the disease came under better control in the West, it skyrocketed in poorer countries—adult HIV infection rates in Africa reached as high as 40 percent in the most afflicted nations. The challenge was to get the expensive drugs to people who couldn’t afford them. That effort has largely succeeded thanks to programs such as PEPFAR introduced by President George W. Bush, making him “a very popular figure” in Africa, he added.
Vermund talked of his recent work in Mozambique where he and his colleagues are seeking distributing anti-viral drugs to remote areas and addressing male attitudes that hinder treatment of children. He noted, “If beer and soft drink distributors can get into the rural regions, we must learn to do so, too.”
In response to a question from the audience, Vermund said he is skeptical that a vaccine will be developed any time soon. The virus’ constant mutation, many variants and other factors make immunization “one of the toughest biological challenges you could ever imagine,” he said.
“We are still, in my view, a decade, two decades, perhaps more, away from an HIV vaccine that can be deployed to millions of people,” Vermund said.