NIH historian Dr. Victoria Harden

Drawing on more than 20 years of research that will be incorporated in a book about AIDS research at NIH, Harden reviewed milestones in the epidemic. Such significant NIH contributions as co-discovery of the agent that causes AIDS, and the first efficacious treatment against the virus, served not only to honor individuals such as former NCI virologist Dr. Robert Gallo (who was in the crowd) and former NCI director Dr. Samuel Broder (who helped develop AZT) but also to underscore the strengths of the intramural research programs.

Indeed, the event began with an explanation of why NIH was in such a good position to address the disease, which first came to public attention in the summer of 1981. According to NIH deputy director for intramural research Dr. Michael Gottesman, five factors contributed to NIH's swift and productive response: a "critical mass" of scientific expertise, especially experts in retroviral biology; research infrastructure, including a Clinical Center willing to admit patients with the new disease; the tight link between clinicians and bench scientists; NIH's close ties with Congress, patient groups and extramural colleagues, who could coordinate efforts; and leadership at NIH that was "not just visionary, but also courageous, both personally and intellectually.There was a willingness to take risks, to drop what you were doing and head in a new direction."

Perhaps the most prominent dropper of what he was doing was NIAID director Dr. Anthony Fauci, who offered personal reflections on the epidemic. He had been an NIAID clinician on the 11th floor of Bldg. 10 when the first report of Pneumocystis carinii pneumonia in a population of gay men was published in June 1981. "It was just a curiosity," he recalled. "I thought it was something drug-related." A month later, when a second report appeared, Fauci said he got goose pimples. "I knew something was terribly, terribly wrong.It prompted a major switch in my research direction. I was able to turn my lab on a dime to focus on a disease that had no name, and, as yet, no microbe."

Dr. Michael Gottesman, NIH deputy director for intramural research, outlined five reasons why the campus was well-positioned to take on AIDS research.
Harden and NIAID director Dr. Anthony Fauci each gave their perspectives on the first decade of NIH intramural AIDS research.

Within 3 years, the HIV/AIDS virus was found, owing largely to what Fauci called "exquisite science" and massive new funding that today represents 10 percent of NIH's research budget. Noted Fauci, "If you put the resources in, you galvanize talent and get extraordinary results.

"We're still in the midst of the pandemic," he said. Some 40 million people worldwide are thought to be infected with HIV/AIDS. "But the amount we've learned has been unprecedented in the history of medicine."

Harden's keynote address focused on the "intellectual history of how the biomedical community came to understand this syndrome." Prior to the AIDS epidemic, NIH had been institutionally unwieldy, a "great ship" that lacked maneuverability, except in its intramural component. It set formal boundaries between its interests, and those of sister agencies FDA and CDC. Despite warnings that infectious diseases were likely to become a major public health issue, NIH focused primarily on chronic diseases.

An explosion of new knowledge in molecular biology took place, roughly between the Hong Kong flu epidemic of 1968-1969 and the advent of AIDS. "There was a major intellectual shift, and lots of new discoveries in molecular biology and immunology," said Harden. Among the best and brightest of that era were an inordinate number of alumni of the NIH Clinical Associates Program. Just as AIDS hit, NIH hosted a cadre of mid-career scientists, "most in their early 40's, and most experienced in clinical work and research." This army of sophistication attacked the new disease piecemeal; Harden recounted the litany of now-famous names in AIDS pathogenesis studies, etiologic work and, eventually, therapy.

Harden's account of the AIDS era through 1990 didn't overlook lowlights along the way, including the inevitable grumbling over first authorship on scientific papers, the tendency of large, well-funded labs to snatch the successes of smaller ones, and the much-publicized international dispute over which group of scientists first discovered the AIDS virus. It was also sobering to realize, as the late deputy director of NIAID Dr. James Hill once pointed out, that actor Rock Hudson's death from AIDS did more to spur increased AIDS funding than any research breakthrough did.

AIDS changed the way NIH works, Harden concluded. It pushed NIH back to its historical roots in bacteriology by underscoring the importance of addressing emerging and re-emerging infectious diseases. It made NIH a household name, ushering in an era of surging public interest in all matters of health. And it had the democratic virtue of opening NIH to the influence of public activists; Fauci characterized NIH's interaction with activists as "very productive."

"AIDS itself is not yet history," noted Gottesman. "There are more people working on it than ever in the history of NIH.We hope one day to declare victory."

The NIH History Day talks are archived at www.videocast.nih.gov, and the Office of NIH History's web site (http://history.nih.gov) has an extensive AIDS history collection.

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