The duration of the HIV pandemic is astounding considering how much medical research has been conducted over the last 40 years and the billions of dollars that have been spent trying to slow him down. Although there are more than 30 drugs to treat HIV infection there is still no vaccine to prevent infection. In my opinion, there is a high likelihood that HIV will keep on his path of destruction for another 40 years if not indefinitely. We are at risk of becoming voyeurs, observing at a distance, a pandemic that refuses to yield to our efforts to eradicate it.
Thank you for including me in this series of conversations. I hope you will do more of these in the future. The stories from other viruses are important for all of us to hear. For me in particular, I might be able to take advantage of what other viruses have learned over the last thousands of years. Although COVID-19, H2N2, and I traveled in different circles, each of us has been able to start our own pandemic by taking advantage of similar human frailties and prejudices, as well as humans’ so-called economic and technical advances, which has worked to our advantage to start our own pandemics.
At this point, I don’t want to quibble with either H2N2 or COVID-19 about who is the virus that has been most patient or will survive the longest. I just hope that they appreciate how long it took me, and how difficult it was, to develop the right mutations to enter into humans and create my very own kind of a pandemic which, I am happy to say, is still going on decades after I started it.
Even as a young virus I had lofty ambitions to be one of the first non-influenza viruses to create a pandemic of enormous proportions that would be invincible. I thought carefully about how it could be accomplished, setting before me specific achievements before making the leap from my host into the first human. Much of what I am going to say is no longer secret. It has gradually been discovered over the last four decades by thousands of scientists and researchers at a cost of billions of taxpayer dollars in an attempt to stop me. They have not been successful. Most of the discoveries about me are published in scientific and medical journals or presented at international conferences attended by tens of thousands of individuals. However, knowledge is something that does not necessarily guarantee success in controlling a virus like me. The evidence for that is that I have been able to continue my very own pandemic for four decades, roaming the globe unimpeded, as I look for new humans to infect.
In order to establish the pandemic of my dreams, I needed to successfully execute five distinct steps. First, I needed to replicate myself in a host that was closely related to humans. Second, I needed to discover a way of getting from my animal host into humans. Third, my human to human transmission required a behavior and means of transmission that was necessary for human survival, resistant to behavior change, problematic to control by public health authorities, and politically charged. Fourth, following infection, I needed the infected humans to be well enough to survive for long enough to infect additional humans for years without their contacts knowing that they were being exposed to a lethal infection. Fifth, in order to be reproduced continually in humans, I needed to paralyze their immune system so that they would be unable to eliminate me, either by their own immune system or by a vaccine.
Allow me to briefly review each step. I am incredibly proud of the success that I achieved. My first challenge was to pick a different host in a different location from the influenza epidemics where I could work quietly and undisturbed. I selected an obscure and isolated forest in central Africa. I won’t reveal the specific location as I don’t want a bunch of scientists tramping around disturbing the wildlife to locate it. And I may need to return someday to rejuvenate my genes. For the animal host, I picked chimpanzees. As far as hosts go, I have nothing against pigs, camels, bats, cats, or ducks. However, I felt it was necessary to select a host that was more closely related to humans because it would be easier to transfer myself to humans if I started in chimpanzees. I was happy with my choice. I had promised them that I would not make them sick or kill them if they allowed me to remain in them while I perfected my mutations. They were cooperative, waiting patiently until I felt I had perfected myself and was ready to launch a new kind of pandemic. However, I don’t really think that they appreciated the extent to which their participation would allow me to spread myself around the world.
Once I felt I was equipped with the right mutations to jump from chimpanzees into humans I was ready for my second step. I needed to find an unsuspecting human to help me spread myself to other humans. It turned out that I was assisted by an unusual ally — African bush hunters. These were men who went into the forest to kill all kinds of animals, including chimpanzees, to help feed people in remote villages. One day, a group of them came and killed my chimpanzees, including the one who was hosting me. They cut the chimpanzees into pieces for what was called bushmeat to be sold in the markets. In the process, one of them cut himself with the machete that was used to kill my host. I leapt at the opportunity. Blood to blood transmission! I had achieved a very important second step – getting from the chimpanzees into the first human.
Now for the third step. Once the bush hunter was infected, he started on his long journey home, selling and trading bushmeat on the way. Having been away from his sex partner for a long time, he stopped several times to have sex with multiple women. He left them a piece of bushmeat as a token of his appreciation and deposited enough of me in them during sexual intercourse to get them infected. None of the women had any idea that they had been infected with me. When he got home, he had sex with his wife, she got pregnant, and a new baby was born. I’ll get back to the baby later. Brilliant, I thought to myself. Humans survive by having sex to reproduce themselves and they would never give up the pleasure that sex produced. What better method of disseminating myself than to take advantage of sexual intercourse? The mutation that allowed my transmission through sex worked.
I should remind all of you that my approach was quite distinct from what H2N2 and COVID-19 used. Their strategy was to infect, and even kill, a lot of people in a short period of time. But that resulted in a brief window of opportunity after infection for transmission to occur, usually less than a month. After that they were no longer infective. Clearly, they are not as smart as I am. Without infected individuals living for years with the ability to continuously transmit virus, the pandemics that they started usually lasted for only one year. I stayed active in all of the humans that got infected with me allowing them to infect others for five or even 10 years until they got too sick to engage in sex. Just to be clear, while H2N2 killed fewer than 200,000 individuals worldwide and COVID-19 has killed 900,000, I have been able to kill 30 million individuals and I am still going strong at a rate of about one million human deaths each year. Sure, that took me 40 years to accomplish, but what’s important in my mind is the total number of people we can kill, not the time that it takes to do it. In another five or six years I will surpass the number of humans who died from the Spanish flu.
Sex is a wonderful way to get yourself around the globe, as humans never stop engaging in it. I also observed that humans regard sex as a matter of privacy and therefore not subject to the same public health control measures of contact tracing that they insist on for COVID-19. This of course works in my favor, although it is difficult for me to understand why someone infected with me would not tell their sexual partner about it. Hard to believe that a pandemic of this magnitude, killing almost a million individuals a year, does not spark a massive outcry for its control. If contact tracing had been implemented early in my pandemic there might be millions of men, women, and children who would be alive right now. In fact, I might not have even been considered important enough to be chosen for this presentation.
The fourth step points out a major difference between myself and the influenza viruses as to how I lulled humans into a false sense of security. This relates to a principle that is crucial to my success — don’t make your host too sick or kill them too quickly. This was something that the Ebola virus, who lived not very far from where I lived with the chimpanzees, never understood. I told Ebola that because she made people so sick, so fast, and killed them so quickly, she was hurting her own chance of creating a pandemic. Because the humans that she infected looked scary sick with fevers, vomiting, bloody diarrhea, and bleeding, humans stayed away from her victims and isolated themselves. So Ebola just faded away after each outbreak and never matured into a full-fledged pandemic. She is still around and experimenting with different mutations and recombinations. I encouraged her to focus on the latter approach, as it offered the greatest possibility for success. My motto? Don’t make your host so sick that they will die before they can infect another person. Humans who are obviously sick just don’t get on airplanes and travel to new locations. For that matter, they may not even leave their home.
The fifth step was to prevent the bush hunter, as well as any future infected individuals, from developing an immune response to get rid of me. While in the chimpanzees I was able to develop a mutation that allowed me to directly infect the exact cells in humans that control the immune response to not only me but also to other infectious agents. As soon as I got into the bush hunter’s blood, I immediately headed for his immune cells and paralyzed their ability to get rid of me. I went on to make billions of copies of myself to get ready for the next opportunity to transmit myself to humans.
My dream had come true. I had made the big leap from my animal host to a human and now, with the assistance of my new human allies, started down the path of creating a pandemic that would never go away.
If you’re wondering, I had a backup plan in case my scheme didn’t work. Since I could reproduce myself in blood cells, I could also get from one human to another through blood transfusions. I must admit that I was too optimistic about that plan. Once the scientists discovered me as the cause of AIDS, they developed an antibody test to detect me in blood donors and eliminated that route of infection. But I can still transmit myself from contaminated needles used by drug abusers.
However, there was one more way that I could infect humans. I really wasn’t thinking of this when I figured out how to use sexual intercourse as my preferred route of transmission. Remember the bush hunter in the Congo who finally got back to his wife and got her pregnant and then she had a baby? Well, I discovered that I could transit myself from the man to the woman and then, during pregnancy or breast-feeding, to the baby. In my defense, in case you are thinking that that was a terrible thing for me to do, I really hadn’t planned on deliberately infecting a baby. It was a consequence of someone having sex and not telling their sexual partner that they were infected with me, if they even knew. When I ran the dilemma by my elders, they reminded me that we viruses don’t discriminate between men, women, children, rich, poor or any other variation of the human condition. To borrow a phrase from the military, it was just part of collateral damage.
You may wonder if there is anything that I am afraid of. A couple of decades ago I started getting apprehensive when I heard about the new drugs that were being developed to slow me down. I could handle one drug because I just mutated around it, but when they had three and eventually 30 different drugs, that was a different story. If the drugs were given in combinations of two or more, they blocked my ability to mutate quickly so I started slowing down. Many of my hosts got healthier and, frighteningly to me, the levels of me in their blood got so low that I couldn’t be transmitted from one human to another. I got so worried that once again I consulted my elders who, as they endlessly remind me, told me to be patient and I would spontaneously develop all of the mutations I would need to escape from the new drugs and resume transmitting myself. The scientists, of course, are not so naïve that they don’t realize that that’s all part of my plan. So, they started working on new drugs and new approaches to stop me. That might be great for rich countries but it won’t help people in poor countries, as the new drugs are really unaffordable for poor people. Want to make a wager? If an effective vaccine becomes available for either me or COVD-19, people in wealthy countries will get it first.
That dilemma didn’t deter the scientists. In order to find out if the new drugs work, the scientists need to do what they call controlled clinical studies. That means one group gets the new drug and another group gets a placebo. Some of their research studies are large, perhaps a thousand or more people. That means 500 research subjects won’t get anything except the placebo, while the other 500 get the drug that works. Most of the poor people in the research studies live in Africa and about half of them are women. Sometimes I get the feeling that the scientists really don’t want poor people to get better so they will always have a population of vulnerable people for their research studies. I don’t know why poor people would ever agree to be in those research studies. But that’s an issue for another conversation.
Something else that I am thinking of trying to change is the way I get into humans. The trick that I would use, and I don’t think it’s really a secret for molecular biologists, involves using one of my most promising mutations, and when I am in humans who are infected with both me and with another virus like COVID-19 (or some other exotic virus unknown in the world of science), creating a recombination. Covid-19 has already infected a good number of humans who are also infected with me. Since I’ve paralyzed the human immune system that will give COVID-19 and me, living in the same cells, a long time to figure out if we can work out some sort of recombination. That way I could infect people through sexual intercourse and also through the respiratory tract membranes or even partner with a virus that could infect just through skin exposure. Out of courtesy, I would ask COVID-19’s permission to enter into a sort of joint venture with her. I’m certain that COVID-19 would agree. She would obtain a major benefit by remaining in humans indefinitely along with me, and together we could keep our pandemic going forever. I would insist that the pandemic be named with my name first.
What’s next for me? I think I am going to be around for a long time as long as public health officials ignore me and have lost interest in preventing millions of new infections each year, especially in people who don’t have any political or economic power. And then there are the millions of migrating victims of war and displacement who can carry me to new locations.
All this is good for me but not for the millions who will be denied lifesaving prevention and treatment. You would think that scientists and public health officials would feel guilty for not using universal contact tracing as a prevention tool to warn people that they were being exposed to a lethal virus. And what about the millions who are not getting lifesaving treatment because they don’t know they are already infected? Meanwhile, I can keep transmitting myself and keep my pandemic thriving.
Before I end this presentation, I wanted to let you in on some of the ideas that I have about a contingency plan. I don’t mind talking about it to you because right now it’s just an idea, although it may actually work to ensure my long-term, if not indefinite, survival. I certainly don’t want to be associated with the viruses that are listed as extinct.
One plan that I have been thinking about may sound like science fiction but who knows? Watching the news about some of the planned space launches to Mars makes my mutations salivate. Just think of what could happen if I could get access to microbes that have been dormant for millions of years, sitting there on Mars, waiting for some grand opportunity to escape to earth. I bet they have a lot of ways of inflicting major damage that none of us know anything about. Here’s how it might work. Undetected microbes from Mars could hitch a ride in the shuttle and come to earth. I could hook up with one of them, providing it’s a good match, and start experimenting with recombination and what kind of damage we could do together. There are some obstacles that I would need to overcome but I’ll work it out. There are a lot of questions about this hypothetical approach, especially how could we ever meet? But after escaping from my chimpanzee host in the Congo, I am optimistic that I can find some sort of solution. The Mars microbes might have some ideas of their own. In my judgment I question why anyone would want to go to Mars and run the risk of introducing some new microbe on earth, especially one that might be uncontrollable. Humans are quick to forget the devastation that we viruses have done in the past by implanting ourselves in different locations and starting key pandemics that have never gone away. You have to be really naïve if you believe the scientists when they say that they are taking all necessary precautions to prevent the introduction of any new infectious agents on earth. What kind of precautions can you take if you don’t even know what the microbes are like on Mars? Some of the scientists are the same ones that took three years before they were able to identify me as the cause of AIDS. 40 years have passed and they still can’t come up with a vaccine.
Thank you for allowing me to share this time with my fellow viruses H2N2 and COVID-19. We sincerely hope that newly mutated and recombinant viruses will have the opportunity to tell their story in the future. It may not be what you want to hear but I am certain it will be interesting.
We have read incredible stories of three pandemic viruses that I have had the privilege of speaking to. We have received some insight as to why and how they created global pandemics that have plagued mankind. They took full advantage of the denials, delays, and underestimates of their terrible potential for devastation.
It is sobering to realize how deliberate these viruses can be. Let us take them seriously. Above all, let us protect ourselves against ignorance, misinformation, dogmatism and those who put their own interests above what can be done to protect mankind from these plagues. Personally, I will not dissuade myself from the realization that these plagues can be used for political aggrandizement, scientific advancement at the price of public good, and commercialization for the sake of profits. Therefore, I will always seek the facts, question authority, diligently pursue the truth and insist that we use our economic, intellectual, and moral strengths to protect every individual from the consequences of these pandemics.
Have a question you would like to ask HIV? Type it below in the comment section and I will see if I can get him to provide some answers.
Many of you provided comments and asked questions concerning this series of conversations. I might include a summary of these comments an answer as many questions as possible in an additional episode of A Conversation with Three Pandemic Viruses.