It is a long, slow dance in which he and HIV are engaged; on the good days, Pontiano sees the incremental steps forward. On the bad ones, the virus seems always out of reach, with one more manoeuvre in its arsenal, one more way to keep from giving up its secrets. But Pontiano has a vision, of a world without AIDS – some days he thinks he might see it in his lifetime. Certainly, he can imagine it for his children.
And most days, that is enough to keep him going. In medical school at Uganda’s Makerere University in the 1980s, where he studied a few years after Lydia Mungherera, Pontiano had plans to be a pediatrician. He had a twinkly sense of humour and a warmth that drew children to him, and he thought he would enjoy clinical medicine. But a year of internship in a Kampala hospital had him rethinking a lifelong plan to be a doctor. ‘It was monotonous,’ he confessed. ‘There were long hours of working, but you could see that the following day you were doing the same thing.’ After the internship, he found a post as researcher at the Uganda Virus Research Institute and quickly realized that he liked research much better. ‘Every day that comes there is something new, there is something exciting,’ he said, enthusiasm undimmed b y twenty years in the field. ‘With every experiment, you are looking forward to something.’
The Virus Research Institute was founded in 1936 at Entebbe, on the shores of Lake Victoria forty-five kilometres outside the Ugandan capital. For the first fifty years, its researchers worked on yellow fever and other tropical bugs. But around the time that Pontiano finished his medical studies, something else was brewing on the shores of the lake. For the practical portion of his final exam, he was required to diagnose a wasted patient with a severe respiratory infection and unhealed abscesses on his skin. Pontiano correctly concluded that this was Slim, the new disease spreading among fishermen and traders in villages along the lakeshore. And it wasn’t confined to fishermen. First one student in his class died, then another. ‘By the time I finished my internship, there were many: it went up that fast. Then it started to be my relatives and friends.’
At twenty-eight, Pontiano went to work in the institute’s collection of low white bungalows and joined a team considering this new germ. He introduced HIV into tissue cultures of healthy cells and watched through a microscope in horrified fascination as, within a day, the virus caused the cells to warp, swell and die. He and his fellow researchers turned to discussing a vaccine – it had been clear since the day HIV was identified that a vaccine was an imperative. Everyone working in AIDS knew that it would be possible to prevent some HIV infections by persuading people to change their behaviour – not to share needles, not to have unprotected sex. But with sex and drugs, just like smoking or seat belts, behaviour never changes completely.
People being people, they go on taking risks. And in much of Africa, they can’t get access to prevention materials such as condoms or the clean water to formula-feed babies. That leaves vaccination. Through history, it has proved to be the only way to halt most epidemics, and the only way humanity has ever deliberately eradicated a disease – first smallpox and, imminently, polio and perhaps measles.
A vaccine is, in essence, a trick: it is made up of all or part of a microbe, killed or altered so it can’t cause infection, and introduced to the body, which thinks it is being attacked and provides an immune response – making proteins called antibodies to wipe out the invader.
Then, if the person later runs into the real germ, the antibodies are on standby, primed to recognize and kill the virus. Pontiano and his colleagues were hunting for two types of vaccines against HIV. The first, called a therapeutic vaccine, would be for people already infected – it would stop the progress of the disease. The second, more conventional vaccine would prevent people from becoming infected by triggering their immune system to neutralize the virus when it entered their system. Both would help, and they knew that the latter kind, in particular, would have a massive effect on the spread of AIDS, the kind of impact that nothing in the global health arsenal today can hope to have.
I have followed the hunt for the AIDS vaccine through the years, struggling to unravel the complex science of it. Much of what I know I have learned from Pontiano, whose institute I first went to visit in the early days of African vaccine research and where, over the years, I have returned to hear the latest news. Pontiano is an unassuming and gentle man who delights in a joke and has a palpable interest in people – not what you might expect in a scientist who can get lost in a lab for hours. He has led Africa’s efforts in the quest for a vaccine, in both the pure science and the equally complicated moral questions that accompany research in a place this poor and this desperately in need of solutions.
The search for a vaccine kicked off shortly after the discovery of the virus, in an era of supreme faith in technology. Margaret Heckler, the U.S. health and human services secretary under Ronald Reagan, said with great confidence in 1982, ‘We hope to have a vaccine ready for testing in about two years.’ She concluded, ‘Yet another terrible disease is about to yield to patience, persistence and outright genius.’
Extract from 28 Stories of AIDS in Africa by Stephanie Nolen, published in the UK by Portobello Books.