What the Bungled Response to HIV Can Teach Us About Dealing With Covid-19

NARRATION: At a pandemic simulation in October 2019…

ARCHIVAL (EVENT 201, PANDEMIC EXERCISE, OCTOBER, 2019):
NARRATOR: It began in healthy looking pigs.

NARRATION:…public health leaders gamed out the scenario…

ARCHIVAL (EVEN 201, PANDEMIC EXERCISE, OCTOBER, 2019):
CHRISTOPHER ELIAS (BILL & MELINDA GATES FOUNDATION): Understanding where the supplies are.
EXERCISE PARTICIPANT: Broadcasting accurate information.
STEPHEN REDD (US CDC):It’s really a war footing that we need to be on.

NARRATION:..finding massive gaps in our ability to respond.

ARCHIVAL (PANDEMIC EXERCISE, OCTOBER, 2019):
NARRATOR: Sixty-five million people died in the first 18 months.

NARRATION: There have been decades of similar warnings urging us to prepare ever since we failed to contain another devastating pandemic…HIV/AIDS.

ALLAN BRANDT: We really learned a lot from HIV. So, it’s very difficult watching the world respond to an epidemic like Covid-19 without looking back and the the flags were going up and the warning bells were rung.

THE LESSONS OF H.I.V.

ARCHIVAL (ABC, NIGHTLINE, 12-17-82):
TED KOPPELL: It’s mysterious, it’s deadly and it’s baffling medical science.

NARRATION: In 1981, when a terrifying new disease was reported to be killing gay men.

ARCHIVAL (NATIONAL LIBRARY OF MEDICINE, 1984):
DR. ANTHONY FAUCI: We were dealing with a very special unprecedented situation.

NARRATION: Dr. Anthony Fauci was a researcher at the National Institutes of Health.

DR. ANTHONY FAUCI (DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES): I knew it was an infection because it was acting like a sexually transmitted disease, and it was killing people.

ARCHIVAL (NBC, NIGHTLY NEWS 6-17-82):
ROBERT BAZELL: The condition severely weakens the body’s ability to fight disease.

DR. ANTHONY FAUCI: I said whoa…we really have an issue here. It seems to be spreading and spreading.

NARRATION: According to Allan Brandt, the early response to HIV offers important lessons about epidemics.

ALLAN BRANDT (HISTORIAN OF MEDICINE, HARVARD UNIVERSITY): The United States was extremely poorly prepared to deal with HIV disease in the earliest years. We didn’t have a recent history of massive infectious epidemic diseases. We didn’t have a sort of preparedness apparatus.

NARRATION: But that wasn’t always the case.

ARCHIVAL (NATIONAL LIBRARY FILM, 1936):
NARRATOR: For centuries, it has been well known that epidemic diseases follow the lines of commerce and travel. Many outbreaks of smallpox and cholera were brought in by vessels.

NARRATION: In late 1870s, the United States started a sophisticated quarantine and surveillance system to try to prevent deadly infections coming in from overseas.

ARCHIVAL (NATIONAL LIBRARY FILM, 1936):
NARRATOR: Every precaution is taken by the quarantine officers to prevent the introduction of disease into the United States.

ARCHIVAL (NATIONAL LIBRARY FILM, 1936):
NARRATOR: Thousands of aliens have had to undergo an examination at the hands of the public health service.

ARCHIVAL (NATIONAL LIBRARY FILM, 1936):
NARRATOR: An airplane which might bring in the yellow fever mosquito. The passengers and crew are inspected for symptoms of the disease.

NARRATION: Tracking and treating contagious infections was an essential job for local health departments.

ARCHIVAL (NATIONAL LIBRARY FILM, 1954):
NARRATOR: Cases are tracked down to prevent spread of the disease.

NARRATION: But in the mid 20th century, with breakthroughs like vaccines and antibiotics, infectious disease was seen as a problem of the past…and much of the quarantine system was dismantled.

ALLAN BRANDT: Infectious disease went from a field that was right at the center of almost all medicine, to really a more marginalized field. By the early ’80s, when AIDS emerged, we had let our public health infrastructure deteriorate and it was poorly funded, really poorly structured.

ARCHIVAL (CBS, EVENING NEWS, 8-2-82):
DAN RATHER: Federal health officials consider it an epidemic, yet you rarely hear a thing about it.

ARCHIVAL (NBC, 6-20-83):
ROBERT BAZELL: Scientists do not know what causes the disease, but they strongly suspect it is a virus.

DR. ANTHONY FAUCI: When I first began taking care of infected patients that was the scariest part. That you couldn’t even begin to develop countermeasures if you didn’t even know what you were dealing with.

NARRATION: Scientists and advocates begged for money for research and public health outreach.

ARCHIVAL (HOUSE HEARING, C-SPAN, JUNE, 1985):
REPRESENTATIVE HENRY WAXMAN (D-CALIF., CHAIRMAN, SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT): The administration’s AIDS budget had little room for basic research even on the virus, much less on treatment for the disease it causes.

ARCHIVAL (CONGRESSIONAL HEARING, 8-2-83):
ROGER LYON: This is a health issue, this is not a gay issue. This is a human issue.

NARRATION: President Ronald Reagan, who for years wouldn’t even say the word AIDS in public, offered little.

ALLAN BRANDT: One of the things about epidemics is that the clock is always moving, and that was really true with HIV. Many people died because of the very slow and resistant and inadequate and inconsistent responses.

ARCHIVAL (CBS, EVENING NEWS, 5-18-83):
DAN RATHER: The incidence of AIDS has doubled every six months.

ARCHIVAL (RAINBOW HISTORY PROJECT, 10-22-86):
PATIENT: This is a real disease and a lot of people are going to die. And people have to stand up and become educated.

NARRATION: With no cure or vaccine, prevention was key and required clear instructions about how to avoid spreading the disease.

ARCHIVAL (NBC NEWS, 6-20-83):
ROBERT BAZELL: All of the evidence indicates it can be transmitted only by sexual contact or mixing blood.

NARRATION: Dr. Lawrence Mass, a founder of the advocacy group, Gay Men’s Health Crisis, says the government failed there, too.

DR. LAWRENCE MASS (CO-FOUNDER, GAY MEN’S HEALTH CRISIS): There was the whole business of sex education. You want to teach people about condoms and elimination of HIV transmission among drug users. I mean, their approach was just – don’t discuss these things.

NARRATION: So, activists had to take it upon themselves to teach the public to avoid infection.

ARCHIVAL (CBS, 9-11-85):
MAN: AIDS hotline. Can I help you?

ARCHIVAL (NBC NEWS, 6-20-83):
NEWS REPORT: The message—avoid risky sex and you’ll avoid AIDS.

ALLAN BRANDT: We really didn’t have effective public health communications. We really didn’t address how people could and should appropriately reduce their risk. The response was just to utilize denial and look the other way.

ARCHIVAL (CBS, SUNDAY MORNING, 6-4-17):
CROWD: Act up! Fight back, fight AIDS!

NARRATION: Testing and contact tracing were also key to stopping the disease’s spread. But after the virus that causes AIDS, HIV, was identified in 1983…

ARCHIVAL (ABC NEWS, 4-23-84):
NEWS REPORT: A blood test will be ready in six months and it could at least tell a potential AIDS victim if he is carrying the virus.

NARRATION:…instead of being seen as a life saver, the test was controversial. Fearing discrimination, many refused to be tested.

ARCHIVAL (CBS NEWS, 11-7-85):
JOHN SOLOMON: I have nightmares about them coming and locking me up, that I’m going to be quarantined.

DR. LAWRENCE MASS: Gay people had no civil rights protections. We were surrounded by explosive homophobia. People did not want to even ask for HIV tests because of confidentiality issues.

NARRATION: After several years, when the first AIDS drug, AZT, was approved testing gained acceptance. Its impact was huge.

ALLAN BRANDT: We really saw very clearly in HIV how crucial it was to know who was infected. The test actually became a kind of protection, because now you really could find out if they posed a risk or if they needed medical treatment.

NARRATION: But by 1988, 50,000 Americans had contracted AIDS. Nearly all died.

DR. ANTHONY FAUCI: It was the dark years. It was terrible. And although a lot of activity was going on, a lot of research, you would see a lot of people sick and gaunt. I mean, it was horrifying what you saw.

NARRATION: HIV is now a treatable disease and while the way it spreads is very different from coronavirus, its tragic early years taught us a lot about how to fight a pandemic.

ALLAN BRANDT: We learned that we would need a critical health infrastructure, we need good testing, we need excellent surveillance, and we need to take advantage of everything we know in real time to avoid the massive global spread of disease.

NARRATION: In 1992, with AIDS deaths rising, the National Academy of Sciences issued a call to renew our vigilance against infectious disease.

ALLAN BRANDT: They said we really need to be ready for the next pathogen. They even lay out different kinds of organisms, including diseases that are passed from animal populations to human populations.

NARRATION: Over the next quarter century.

ARCHIVAL (TED TALK, 2015):
BILL GATES: If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war.

NARRATION: White papers, national security agency plans, and presidents warned about the potential threat.

ARCHIVAL (11-1-05):
PRESIDENT GEORGE W. BUSH: If we wait for a pandemic to appear, it will be too late to prepare.

ARCHIVAL (12-2-14):
PRESIDENT BARACK OBAMA: We have to put in place an infrastructure that allows us to see it quickly, isolate it quickly, respond to it quickly.

NARRATION: But time and again, preparedness lost out to budget austerity.

ARCHIVAL (WHITE HOUSE PRESS BRIEFING, C-SPAN, 2-26-00):
PRESIDENT DONALD TRUMP: Rather than spending the money and I am a businessperson I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.

ARCHIVAL (SKY NEWS, 4-3-20):
NEWS REPORT: Brooklyn’s biggest hospital is an emergency room that’s become a battle zone.

NARRATION: When Covid-19 struck it became clear, the United States had failed to heed the lessons of the past.

ARCHIVAL (SKY NEWS, 4-3-20):
DR. EITAN DICKMAN: We’re seeing a lot of very, very ill patients.

ARCHIVAL (SKY NEWS, 4-3-20):
NEW REPORT: Triage tents at the front to tend to the living. Refrigerator trucks at the back to carry the dead.

NARRATION: The federal government had not strengthened our public health infrastructure, or put adequate pandemic protocols in place. There were shortages of critical life-saving equipment…

ARCHIVAL (WHITE HOUSE TASK FORCE, C-SPAN, 4-2-20):
PRESIDENT DONALD TRUMP: The states should have been building their stockpiles.

ARCHIVAL (NBC, NIGHTLY NEWS, 3-31-20):
GOVERNOR ANDREW CUOMO: It’s like being on E-bay, with 50 other states bidding on a ventilator.

NARRATION …and test kits needed to track—and stop the virus’ spread.

ARCHIVAL (U.S. HOUSE OVERSIGHT AND REFORM COMMITTEE, C-SPAN, 3-20-20):
DR. ANTHONY FAUCI: That is a failing. We’re not set up for that. Do I think we should be? Yes.

NARRATION: Dr. Fauci and Dr. Deborah Birx, the government’s top coronavirus scientists, were shaped by careers working on AIDS, which has killed over 30 million people around the world.

DR. ANTHONY FAUCI: I took very seriously to make sure that what I said was never sugarcoating because, when you’re dealing with any public health challenge, particularly a disease of the nature of HIV, communication with the public is as important as the science that we do.

ARCHIVAL (WHITE HOUSE BRIEFING, 3-16-20):
DEBORAH BIRX (WHITE HOUSE CORONAVIRUS RESPONSE COORDINATOR): The HIV epidemic was solved by the community: the HIV advocates who stood up when no one was listening. We’re asking that same sense of community to stand up against this virus and if everybody does what we ask for – social distancing, not going in public in large groups – we will see a dramatic difference.

ALLAN BRANDT: Public health problems are inevitably, deeply political, divisive. Are there ways that we can reduce our risks in the face of something that’s highly transmissible? The answer is clearly, yes. But often, those notions are resisted for political reasons of one kind or another. We’ve really resisted now over several generations the kind of thinking that’s really required in this kind of global moment. All these things we know, and we haven’t invested, so the question I’m going to be asking is, “Why not? What are the obstacles to doing things that we know?

(END)