WEBVTT 1 00:00:00.000 --> 00:00:02.820 Well, good afternoon to a fine Adelaide afternoon, ladies and gentlemen. 2 00:00:02.900 --> 00:00:08.040 Welcome to the Adelaide Festival of Ideas, or perhaps more appropriately, welcome back 3 00:00:08.040 --> 00:00:09.640 to the Adelaide Festival of Ideas. 4 00:00:09.640 --> 00:00:11.900 I'm sure a lot of you have been to sessions this morning and yesterday. 5 00:00:13.180 --> 00:00:14.640 My name is John McDougall. 6 00:00:14.900 --> 00:00:19.260 I work with Professor Alan Snyder at the Centre for the Mind, which is a joint venture between 7 00:00:19.260 --> 00:00:24.740 the ANU and the University of Sydney, and our speaker today is on our board, most serendipitously. 8 00:00:24.740 --> 00:00:30.240 It wasn't prearranged that I should be chairing his session, but I'm most welcome, privileged 9 00:00:30.240 --> 00:00:30.980 to be doing so. 10 00:00:33.620 --> 00:00:39.480 Peter was born in Queensland and was an avid reader and thought his own inner inclinations 11 00:00:39.480 --> 00:00:45.640 were tending towards literature and history, until he was reading Sartre and Hemingway 12 00:00:45.640 --> 00:00:48.500 and Huxley and thought he should be a man of action and achieve something, and I think 13 00:00:48.500 --> 00:00:49.740 we can safely say he's done that. 14 00:00:51.700 --> 00:00:54.180 He was struck by this desire to do something useful. 15 00:00:54.260 --> 00:00:54.720 And he's done it. 16 00:00:54.740 --> 00:01:01.220 He was interested in his cousin's work in epidemiology and viruses, and he maintained 17 00:01:01.220 --> 00:01:08.440 that interest and completed a veterinary degree, and in fact I think he's still the only Nobel 18 00:01:08.440 --> 00:01:09.940 laureate with such a qualification. 19 00:01:10.840 --> 00:01:18.880 He met Rolf Zinchenagel, and together they did a lot of work, and I believe he was able 20 00:01:19.780 --> 00:01:23.780 to form a friendship and relationship with Rolf, primarily because he was the only one 21 00:01:23.780 --> 00:01:24.720 in the industry. 22 00:01:24.740 --> 00:01:27.540 And I think he was the only institution who could bear to listen to Rolf's opera singing. 23 00:01:28.380 --> 00:01:33.960 They shared the Nobel Prize in 1996 for their work on how the immune system recognises virus 24 00:01:33.960 --> 00:01:34.680 infected cells. 25 00:01:34.900 --> 00:01:37.500 It's a most profound accomplishment. 26 00:01:38.180 --> 00:01:42.400 And he's one of the few living Australian Nobel laureates, but of course, as Adelaide 27 00:01:42.400 --> 00:01:45.540 would well know, not the only Nobel laureate living in Australia. 28 00:01:45.920 --> 00:01:48.360 We have the South African J.M. 29 00:01:48.380 --> 00:01:50.780 Kuretsaya in residence in Adelaide. 30 00:01:52.040 --> 00:01:54.220 Peter was named Australian of the Year. 31 00:01:54.220 --> 00:01:55.580 The following year in 1997. 32 00:01:56.080 --> 00:02:00.520 And so he's had a busy time, and his life's changed dramatically since plugging along 33 00:02:00.520 --> 00:02:01.780 and doing profound research. 34 00:02:02.160 --> 00:02:06.440 He now finds himself in attendance at thinking conferences in Melbourne in the last couple 35 00:02:06.440 --> 00:02:12.460 of days, and he'll be enjoying expounding his ideas on what can be done to Adelaide's 36 00:02:12.460 --> 00:02:13.240 Festival of Ideas. 37 00:02:13.940 --> 00:02:19.020 He now contributes regularly to scientific debate in Australia and across the globe, 38 00:02:19.020 --> 00:02:21.780 really, in radio, television, and in the press. 39 00:02:22.140 --> 00:02:23.780 And he moves between Memphis. 40 00:02:23.780 --> 00:02:27.800 He spends a few months of the year in Memphis at St Jude's and the University of Melbourne. 41 00:02:28.560 --> 00:02:34.660 And he's going to discuss what there is to be done on influenza, AIDS, SARS, and other 42 00:02:34.660 --> 00:02:35.260 scary monsters. 43 00:02:35.680 --> 00:02:38.220 Ladies and gentlemen, please welcome Professor Peter Dowdy. 44 00:02:42.100 --> 00:02:50.340 PETER DOWDY, UNIVERSITY OF MELBOURNE, SA, Thank you very much, John, and thank you for 45 00:02:50.340 --> 00:02:50.540 coming. 46 00:02:50.540 --> 00:02:53.700 Are you getting an echo in the audience, or is it okay? 47 00:02:54.160 --> 00:02:55.240 Yeah, I guess. 48 00:02:55.600 --> 00:02:56.960 Is it better if I move away? 49 00:02:58.020 --> 00:02:58.480 No. 50 00:02:59.200 --> 00:02:59.860 Better here? 51 00:03:01.060 --> 00:03:01.520 Okay. 52 00:03:01.880 --> 00:03:02.340 Okay. 53 00:03:02.420 --> 00:03:03.120 I'll stay here. 54 00:03:03.200 --> 00:03:04.240 I'll be disciplined, right? 55 00:03:04.380 --> 00:03:04.760 Okay. 56 00:03:05.120 --> 00:03:05.580 Yeah. 57 00:03:05.760 --> 00:03:12.220 So I'm going to talk about some infectious diseases, and some infectious diseases that 58 00:03:12.220 --> 00:03:18.180 really hit the headlines and are really quite scary monsters, and we'll all be aware of 59 00:03:18.180 --> 00:03:19.200 them at some level or another. 60 00:03:19.500 --> 00:03:19.960 Okay. 61 00:03:20.540 --> 00:03:24.720 So to say that, I think I need to say something about the interaction between infection and 62 00:03:24.720 --> 00:03:25.560 human beings. 63 00:03:25.860 --> 00:03:32.160 And we are, of course, large, complex, multicellular, multi-organ systems. 64 00:03:32.560 --> 00:03:35.660 We are very complex organisms in the world of biology. 65 00:03:36.200 --> 00:03:41.540 And in or on us live many simpler life forms. 66 00:03:41.660 --> 00:03:47.940 Each of us, as we walk the streets, is a type of walking ecosystem with lots of little organisms 67 00:03:48.600 --> 00:03:50.520 living on our surface. 68 00:03:50.520 --> 00:03:54.120 Surface membranes in our intestine and all the rest of it. 69 00:03:54.420 --> 00:04:02.120 And to keep those organisms from invading us, from going further than the surface of 70 00:04:02.120 --> 00:04:06.560 the lung or the surface of the gut, we have a well-developed immune system. 71 00:04:07.180 --> 00:04:14.320 The immune system is there basically so that we can respond if organisms invade, and we 72 00:04:14.320 --> 00:04:15.180 can get rid of them. 73 00:04:15.440 --> 00:04:19.800 And mostly, the organisms that live with us all the time, the ones that walk around with 74 00:04:19.800 --> 00:04:24.100 us, sit quite happily there and don't attempt to go any further. 75 00:04:24.420 --> 00:04:28.300 And we have the immune system damping them down. 76 00:04:28.480 --> 00:04:30.180 Now that can go wrong. 77 00:04:30.280 --> 00:04:32.440 It can go wrong if our immune system is destroyed. 78 00:04:32.480 --> 00:04:37.240 And some of the things that normally live happily with us will invade and cause disease. 79 00:04:37.740 --> 00:04:41.940 And of course, though, that's not the normal mode of infection that most of us suffer. 80 00:04:42.080 --> 00:04:49.340 And that is when something comes in from outside and we get influenza or we get the croup or 81 00:04:49.340 --> 00:04:51.140 something like that, depending on how old we are. 82 00:04:51.200 --> 00:04:54.500 And then our immune system again turns on and deals with that. 83 00:04:54.900 --> 00:05:00.240 And the great protection that we have against infection is, of course, the vaccine, where 84 00:05:00.240 --> 00:05:04.340 we give our immune system, and the immune system is capable of learning, we give the 85 00:05:04.340 --> 00:05:11.900 immune system an experience of, say, poliovirus by infecting the baby or the young child with 86 00:05:11.900 --> 00:05:14.800 a dumbed-down version of poliovirus, which is not very dangerous. 87 00:05:15.020 --> 00:05:17.300 And then the immune system gets primed up. 88 00:05:17.340 --> 00:05:19.180 It makes the antibodies and the T cells. 89 00:05:19.180 --> 00:05:21.960 And all the rest of it that handle poliovirus infection. 90 00:05:22.340 --> 00:05:27.440 And so if polio comes back again in its fully virulent form, we handle it and get rid of 91 00:05:27.440 --> 00:05:27.560 it. 92 00:05:27.800 --> 00:05:31.540 So our great weapon against infectious disease is vaccination. 93 00:05:31.940 --> 00:05:38.820 And what I want to tell you about, really, is the threat posed by three major infectious 94 00:05:38.820 --> 00:05:46.220 diseases, the SARS epidemic, the AIDS epidemic or the AIDS pandemic, and the influenza viruses. 95 00:05:46.540 --> 00:05:49.160 What I want to tell you about is how the flu is a very important part of the immune system. 96 00:05:49.160 --> 00:06:07.300 What it does is it starts off 97 00:06:08.160 --> 00:06:12.200 Now, the first I'll talk about is the AIDS epidemic. 98 00:06:13.240 --> 00:06:17.720 AIDS came to human consciousness in the early 1980s 99 00:06:17.720 --> 00:06:19.800 when, in the United States, 100 00:06:19.820 --> 00:06:22.160 we started to see gay men developing 101 00:06:22.160 --> 00:06:25.060 a very serious and fatal wasting disease. 102 00:06:25.860 --> 00:06:28.660 People couldn't work out what was causing it. 103 00:06:28.820 --> 00:06:32.840 There were all sorts of speculations about what was happening. 104 00:06:33.020 --> 00:06:34.720 There were speculations about toxins, 105 00:06:34.720 --> 00:06:36.580 toxins, various other things, 106 00:06:36.660 --> 00:06:38.820 about what actually was causing AIDS. 107 00:06:39.980 --> 00:06:44.300 It was only when we actually isolated the virus 108 00:06:44.300 --> 00:06:47.120 that we started to understand what was really going on. 109 00:06:47.280 --> 00:06:50.700 And the isolation of that virus was quite a demanding exercise. 110 00:06:51.200 --> 00:06:54.300 It required a fairly high technology for the time, 111 00:06:55.020 --> 00:06:56.920 and the fact that we were able to do it 112 00:06:56.920 --> 00:07:01.260 really reflected the stage to which science had developed at that time. 113 00:07:01.400 --> 00:07:04.700 If AIDS had come along 50 or 60 years, 114 00:07:04.720 --> 00:07:08.620 we would not have been able to isolate that virus, 115 00:07:08.700 --> 00:07:10.740 and we would not have known how to handle it. 116 00:07:10.820 --> 00:07:13.800 And as a result of that, we would not have been able to put in place 117 00:07:13.800 --> 00:07:17.480 as effectively the control mechanisms that were put in place. 118 00:07:18.200 --> 00:07:20.480 The actual science that was done 119 00:07:20.480 --> 00:07:22.820 that led to the detection of the AIDS virus 120 00:07:22.820 --> 00:07:26.460 really found its home in the development of molecular biology 121 00:07:26.460 --> 00:07:27.740 after the Second World War, 122 00:07:27.860 --> 00:07:31.360 the work that went on at places like Cold Spring Harbour, 123 00:07:31.400 --> 00:07:34.700 and it very much found its home in the type of technology that was done, 124 00:07:34.720 --> 00:07:38.440 developed at the National Cancer Institute in Washington, DC, 125 00:07:38.620 --> 00:07:43.040 under the funding of Richard Nixon's War Against Cancer. 126 00:07:43.280 --> 00:07:46.720 The War Against Cancer has had various successes, 127 00:07:46.900 --> 00:07:50.480 but one of its successes really was to bring us to the stage in science 128 00:07:50.480 --> 00:07:51.900 where we could handle AIDS. 129 00:07:52.520 --> 00:07:53.440 Now, AIDS. 130 00:07:53.640 --> 00:07:56.980 Where did it come from, what happened, and where is it going? 131 00:07:57.280 --> 00:08:02.560 Well, we now know from studies that have been done extensively in Africa 132 00:08:02.560 --> 00:08:04.700 that the AIDS virus is a subject of research, 133 00:08:04.700 --> 00:08:07.960 and it is essentially a chimpanzee virus which has come across into humans. 134 00:08:08.640 --> 00:08:11.220 It is the case that viruses... 135 00:08:11.220 --> 00:08:13.920 Let me just say what a virus is for a start. 136 00:08:13.980 --> 00:08:15.280 I'm talking about virus diseases. 137 00:08:15.760 --> 00:08:18.200 A virus is a very simple organism 138 00:08:18.200 --> 00:08:22.560 that cannot replicate itself outside living cells. 139 00:08:22.840 --> 00:08:25.940 It can't, like a bacterium, grow independently in the soil 140 00:08:25.940 --> 00:08:27.500 or outside the body. 141 00:08:27.720 --> 00:08:29.280 It has to get within a cell, 142 00:08:29.440 --> 00:08:32.520 and it uses the cellular mechanisms of, say, a lung cell 143 00:08:32.520 --> 00:08:33.820 if it's an influenza virus, 144 00:08:34.020 --> 00:08:34.680 or a lymph cell 145 00:08:34.700 --> 00:08:35.020 or a lymphocyte, 146 00:08:35.020 --> 00:08:36.760 a white blood cell if it's the AIDS virus, 147 00:08:36.940 --> 00:08:38.300 to actually replicate itself 148 00:08:38.300 --> 00:08:40.420 and then produce more virus particles 149 00:08:40.420 --> 00:08:42.400 and then go on and infect more individuals. 150 00:08:42.720 --> 00:08:45.280 So these are very simple parasites we're talking about, 151 00:08:45.460 --> 00:08:49.300 and SARS, AIDS, influenza are all caused by viruses. 152 00:08:49.680 --> 00:08:50.240 OK. 153 00:08:50.400 --> 00:08:55.860 So the AIDS virus is a virus that's lived for a very long time in chimpanzees. 154 00:08:55.920 --> 00:09:00.840 And what happens when a virus lives with a particular population 155 00:09:00.840 --> 00:09:02.420 over a very long time 156 00:09:02.420 --> 00:09:05.380 is that the two co-evolve 157 00:09:05.380 --> 00:09:07.380 so that they live with each other. 158 00:09:07.720 --> 00:09:11.880 The classic case in human beings is the virus Epstein-Barr virus. 159 00:09:12.160 --> 00:09:16.580 This is the virus that causes infectious mononucleosis in adolescents. 160 00:09:17.300 --> 00:09:21.740 99% of the people in the room here will be infected with Epstein-Barr virus. 161 00:09:21.940 --> 00:09:24.240 If our immune systems were destroyed, 162 00:09:24.480 --> 00:09:26.980 Epstein-Barr virus could cause cancer, 163 00:09:27.060 --> 00:09:28.200 it could cause lymphoma, 164 00:09:28.360 --> 00:09:30.740 but that's not what normally happens. 165 00:09:30.740 --> 00:09:33.940 Normally we don't die from Epstein-Barr virus infection. 166 00:09:34.320 --> 00:09:35.380 We outlive it. 167 00:09:35.380 --> 00:09:37.060 That means we die from something else. 168 00:09:37.200 --> 00:09:39.180 You realise, of course, that survival in medicine 169 00:09:39.180 --> 00:09:41.460 or long-term survival means you die from something else. 170 00:09:41.860 --> 00:09:42.320 So... 171 00:09:43.780 --> 00:09:47.440 So that's a virus which has very much evolved to live with us, 172 00:09:47.560 --> 00:09:50.160 and if you actually look at that virus, Epstein-Barr virus, 173 00:09:50.320 --> 00:09:53.400 you can see that it's taken in bits of our immune systems 174 00:09:53.400 --> 00:09:55.160 to sort of fool the immune system, 175 00:09:55.220 --> 00:09:57.480 but not fool the immune system to the extent 176 00:09:57.480 --> 00:09:59.760 where the virus would actually go along and destroy us, 177 00:09:59.800 --> 00:10:00.720 because if it did that, it would destroy us. 178 00:10:00.740 --> 00:10:02.000 It would actually destroy itself as well. 179 00:10:02.160 --> 00:10:05.880 So that's what we call a stable ecosystem, if you like, 180 00:10:05.940 --> 00:10:08.520 if you're thinking in terms of the environment. 181 00:10:08.940 --> 00:10:12.020 So the AIDS virus is like that in chimpanzees. 182 00:10:12.060 --> 00:10:15.260 The chimpanzees are infected, they produce the virus, 183 00:10:15.420 --> 00:10:17.020 but it doesn't do them much damage 184 00:10:17.020 --> 00:10:18.460 and they live quite happily with it. 185 00:10:18.900 --> 00:10:21.640 How was it found that it was in chimpanzees? 186 00:10:21.680 --> 00:10:25.580 A young German scientist working in the United States 187 00:10:26.240 --> 00:10:29.440 started to look in primate populations in Africa 188 00:10:29.440 --> 00:10:30.720 to try and find chimpanzees. 189 00:10:30.740 --> 00:10:31.980 She was studying the correlates of the AIDS virus, 190 00:10:32.220 --> 00:10:35.580 and she was studying chimpanzee populations. 191 00:10:37.860 --> 00:10:39.740 Her job really was to... 192 00:10:40.740 --> 00:10:44.020 Chimpanzees tend to sort of get into a sort of a nest in trees, 193 00:10:44.140 --> 00:10:45.140 as I understand it, 194 00:10:45.220 --> 00:10:47.320 and when they're all together in the evening, 195 00:10:47.340 --> 00:10:49.000 they sort of pee out of the nest. 196 00:10:49.180 --> 00:10:53.800 I mean, that's the big tent of the American Republican Party. 197 00:10:54.000 --> 00:10:56.740 It's better to have them inside and pissing out 198 00:10:56.740 --> 00:10:58.120 than outside and pissing in. 199 00:10:59.740 --> 00:11:00.600 George Bush. 200 00:11:00.740 --> 00:11:01.940 George is familiar with that. 201 00:11:03.780 --> 00:11:06.020 And so she was actually standing outside 202 00:11:06.020 --> 00:11:07.440 and had a stick on the end of a tin. 203 00:11:07.580 --> 00:11:08.760 This is research for you. 204 00:11:08.800 --> 00:11:11.680 This is high-quality, top-level biomedical research. 205 00:11:11.860 --> 00:11:14.300 She had a stick on the end of a tin collecting the urine, 206 00:11:14.420 --> 00:11:17.520 and then they were able from that to isolate the chimpanzee viruses 207 00:11:17.520 --> 00:11:19.600 and to show that the chimpanzee virus 208 00:11:19.600 --> 00:11:21.920 is pretty much identical to the human virus. 209 00:11:22.180 --> 00:11:25.100 So it came across, we think, into the human population 210 00:11:25.560 --> 00:11:28.360 because of the practice of killing bushmeat. 211 00:11:28.820 --> 00:11:30.580 What's been happening through the world 212 00:11:30.740 --> 00:11:32.560 over the last 100 years or so 213 00:11:32.560 --> 00:11:34.200 is an enormous increase in population. 214 00:11:34.660 --> 00:11:37.600 You realise, of course, that the human population 215 00:11:37.600 --> 00:11:41.960 between 1900 and 2000 increased fourfold. 216 00:11:42.720 --> 00:11:46.080 That is, at 1900, if we'd been looking in this room, 217 00:11:46.200 --> 00:11:47.860 only that quarter would have been full, 218 00:11:48.000 --> 00:11:49.520 and now the whole room is full. 219 00:11:49.680 --> 00:11:52.320 So fourfold increase in the human population. 220 00:11:52.460 --> 00:11:55.500 As a result of that, because much of that increase in population 221 00:11:55.500 --> 00:11:57.580 has been going on in the developing world, 222 00:11:58.100 --> 00:12:00.720 the people have been pushing more and more into doing this, 223 00:12:00.740 --> 00:12:01.180 and we've been seeing more and more of this in the jungle areas, 224 00:12:01.540 --> 00:12:04.180 and the food supplies have become more and more stretched, 225 00:12:04.440 --> 00:12:06.580 and we've had more and more incursion. 226 00:12:06.640 --> 00:12:10.580 And we've seen that incursion with numerous infections 227 00:12:10.580 --> 00:12:14.740 actually coming across from the animal population into humans. 228 00:12:14.960 --> 00:12:16.220 This has always happened, 229 00:12:16.240 --> 00:12:18.180 but it's been happening with increasing frequency. 230 00:12:18.540 --> 00:12:20.580 Another case is Ebola virus infection, 231 00:12:20.820 --> 00:12:21.840 which I won't talk about today, 232 00:12:22.060 --> 00:12:24.540 but again comes in from a wilder, 233 00:12:24.540 --> 00:12:28.240 savatic reservoir into human populations sporadically, 234 00:12:28.240 --> 00:12:28.900 as it happens. 235 00:12:29.360 --> 00:12:31.080 What probably happened with AIDS 236 00:12:31.080 --> 00:12:33.420 was that someone was killing bushmeat. 237 00:12:33.540 --> 00:12:36.100 There's a practice of killing primates for food, 238 00:12:36.260 --> 00:12:39.260 and they probably, when they were killing the chimp, 239 00:12:39.320 --> 00:12:40.380 they probably cut their hand, 240 00:12:40.460 --> 00:12:42.220 and it probably got into their circulation. 241 00:12:42.640 --> 00:12:45.220 Then it was spread, and it was spread very rapidly, 242 00:12:45.260 --> 00:12:49.160 and of course it spread through international air travel, 243 00:12:49.780 --> 00:12:51.880 and it spread in Africa. 244 00:12:52.020 --> 00:12:54.860 The spread of AIDS, as the epidemic developed, 245 00:12:54.960 --> 00:12:57.420 could be traced very clearly to the truck routes. 246 00:12:57.740 --> 00:12:58.220 So, 247 00:12:58.240 --> 00:12:59.480 goods come into Africa, 248 00:12:59.600 --> 00:13:01.120 they come into ports like Mombasa, 249 00:13:01.260 --> 00:13:03.280 and then if you're getting stuff into Uganda, 250 00:13:03.520 --> 00:13:04.760 most of that would go by truck. 251 00:13:04.860 --> 00:13:08.400 And you could see the AIDS virus developing along those truck routes, 252 00:13:08.480 --> 00:13:09.900 being spread by the truck drivers, 253 00:13:10.940 --> 00:13:13.080 low-level prostitution and all the rest of it. 254 00:13:13.260 --> 00:13:14.800 Now, dealing with AIDS. 255 00:13:15.380 --> 00:13:16.820 What do we have to deal with AIDS? 256 00:13:16.940 --> 00:13:18.080 Well, we have very good drugs. 257 00:13:18.140 --> 00:13:21.100 Science has given us excellent antiviral drugs, 258 00:13:21.280 --> 00:13:24.540 and we have AIDS drugs that target three different pathways, 259 00:13:25.240 --> 00:13:26.940 and someone in our communities 260 00:13:26.940 --> 00:13:29.240 who is suffering, who is unfortunate enough 261 00:13:29.240 --> 00:13:31.720 to have got a blood transfusion with the AIDS virus in, 262 00:13:31.760 --> 00:13:34.140 of course, those people died early on. 263 00:13:34.340 --> 00:13:35.880 Of course, it doesn't happen now, 264 00:13:35.940 --> 00:13:37.260 because we can test the blood supply, 265 00:13:37.340 --> 00:13:39.840 and the blood supply is safe in our type of community. 266 00:13:40.760 --> 00:13:43.260 Or if they are indulging in risky activity, 267 00:13:43.300 --> 00:13:44.420 and they contract AIDS, 268 00:13:44.600 --> 00:13:46.260 then they will be treated with drugs, 269 00:13:46.360 --> 00:13:47.680 and if they can tolerate the drugs, 270 00:13:47.760 --> 00:13:48.600 and not everyone does, 271 00:13:48.820 --> 00:13:51.420 most will have reasonably normal lives. 272 00:13:51.660 --> 00:13:53.120 It's not a good disease to have. 273 00:13:53.280 --> 00:13:55.080 It still, in the end, can kill you. 274 00:13:55.220 --> 00:13:56.920 But many people can be treated with drugs, 275 00:13:56.920 --> 00:13:59.120 and live reasonably normally with the AIDS virus. 276 00:13:59.480 --> 00:14:03.800 So that's one line where science has actually triumphed over AIDS, 277 00:14:03.840 --> 00:14:04.600 in one sense. 278 00:14:05.260 --> 00:14:07.580 The other thing we'd like to have, though, is a vaccine. 279 00:14:07.680 --> 00:14:09.900 The problem, of course, with AIDS drugs 280 00:14:09.900 --> 00:14:12.700 is that we can afford them in our types of societies, 281 00:14:13.760 --> 00:14:15.560 but if you're looking at Africa, 282 00:14:15.680 --> 00:14:16.920 where it's a major problem, 283 00:14:17.020 --> 00:14:19.700 and you've got incidence rates up around 30 to 40% 284 00:14:19.700 --> 00:14:20.620 in some communities, 285 00:14:21.280 --> 00:14:23.280 the AIDS drugs are simply unaffordable. 286 00:14:23.440 --> 00:14:26.740 As you know, there's a big push to get AIDS drugs into Africa, 287 00:14:26.920 --> 00:14:28.420 the trouble is, though, 288 00:14:28.460 --> 00:14:30.700 you really need to monitor people who are on AIDS drugs, 289 00:14:30.860 --> 00:14:33.040 and if you're going to be just treated with one drug 290 00:14:33.040 --> 00:14:34.360 rather than the three drugs, 291 00:14:34.500 --> 00:14:38.060 because the three drugs target three different types of mechanisms 292 00:14:38.060 --> 00:14:39.600 that the virus uses to multiply, 293 00:14:39.940 --> 00:14:41.620 if you just target one of those, 294 00:14:41.660 --> 00:14:43.160 it's easy for the virus to mutate, 295 00:14:43.180 --> 00:14:45.660 because these viruses mutate very quickly, 296 00:14:45.700 --> 00:14:46.860 and you'll get drug resistance. 297 00:14:47.280 --> 00:14:49.400 So you've got to target the three different things, 298 00:14:49.500 --> 00:14:52.820 because then the virus can't be tricky enough to get past it. 299 00:14:53.240 --> 00:14:56.100 What we really need for Africa and the developing world 300 00:14:56.100 --> 00:14:56.720 is a vaccine. 301 00:14:57.320 --> 00:15:00.160 And I've been involved in vaccine research on this. 302 00:15:00.200 --> 00:15:01.400 It's not my major interest. 303 00:15:01.420 --> 00:15:03.020 My major interest is influenza immunity. 304 00:15:03.400 --> 00:15:05.700 I've been involved in vaccine research too, though. 305 00:15:05.800 --> 00:15:07.980 I've just, in fact, two weeks ago, 306 00:15:08.000 --> 00:15:09.340 I was in Washington DC, 307 00:15:10.560 --> 00:15:12.020 chairing a final session 308 00:15:12.020 --> 00:15:16.120 to hand out $300 million for an AIDS vaccine project. 309 00:15:16.460 --> 00:15:19.340 There are a number of projects at that level, 310 00:15:19.440 --> 00:15:21.020 funded by the Gates Foundation, 311 00:15:21.500 --> 00:15:22.920 funded by various other organisations, 312 00:15:23.240 --> 00:15:25.480 and so a lot of money is being spent, 313 00:15:25.560 --> 00:15:26.900 but we're not getting to that level. 314 00:15:26.920 --> 00:15:28.240 We're terribly far with an AIDS vaccine, 315 00:15:28.420 --> 00:15:30.080 and it's not really clear we can make one, 316 00:15:30.140 --> 00:15:31.940 because the virus is so tricky and so forth. 317 00:15:32.080 --> 00:15:34.080 That's what we would like to have for Africa. 318 00:15:34.220 --> 00:15:35.180 We don't have it. 319 00:15:35.360 --> 00:15:37.660 So how do you deal with AIDS if you don't have a vaccine? 320 00:15:37.940 --> 00:15:40.480 Well, the way we deal with it in our society, of course, 321 00:15:40.620 --> 00:15:42.800 is that we've warned people about it, 322 00:15:42.860 --> 00:15:44.800 we've told people what the risks are, 323 00:15:44.960 --> 00:15:47.580 and people have modified their behaviour accordingly. 324 00:15:47.880 --> 00:15:50.080 And so we don't have a massive AIDS problem. 325 00:15:50.380 --> 00:15:52.960 It's been very hard to get that message across 326 00:15:52.960 --> 00:15:54.360 in some of the developing countries. 327 00:15:55.140 --> 00:15:56.900 Thailand had an enormous problem 328 00:15:56.920 --> 00:15:57.600 with AIDS. 329 00:15:57.820 --> 00:15:59.660 They thought they wouldn't, but they did. 330 00:15:59.860 --> 00:16:01.620 But the Thais are very well organised 331 00:16:01.620 --> 00:16:02.820 and very smart people. 332 00:16:03.160 --> 00:16:05.820 They got the king, who's a major maker of opinion, 333 00:16:06.020 --> 00:16:08.040 they got the army, they got the religious groups 334 00:16:08.040 --> 00:16:09.600 and the priests and schoolteachers, 335 00:16:09.620 --> 00:16:11.760 and everyone organised to get out the message 336 00:16:11.760 --> 00:16:14.160 that risky behaviour are at risk of getting AIDS. 337 00:16:14.480 --> 00:16:16.200 Conlums were made freely available, 338 00:16:16.380 --> 00:16:18.640 and they dropped off their AIDS epidemic like that. 339 00:16:19.140 --> 00:16:22.260 Senegal and Uganda were also very, very public 340 00:16:22.260 --> 00:16:24.380 about how to deal with the AIDS epidemic. 341 00:16:24.620 --> 00:16:26.900 Public, the Islamic Republic, 342 00:16:26.920 --> 00:16:29.860 imams in Senegal read the Quran 343 00:16:29.860 --> 00:16:33.180 and interpreted it as saying that it's quite OK to use condoms 344 00:16:33.180 --> 00:16:34.800 and therefore they didn't preach against them, 345 00:16:34.860 --> 00:16:35.660 which was very valuable. 346 00:16:35.880 --> 00:16:39.220 And so those countries have done relatively well in Africa. 347 00:16:39.540 --> 00:16:41.580 On the other hand, you've got other countries 348 00:16:41.580 --> 00:16:42.840 that have refused to acknowledge. 349 00:16:43.360 --> 00:16:46.080 We had a big problem in South Africa for a long time. 350 00:16:46.440 --> 00:16:48.340 One of the really unfortunate things 351 00:16:48.340 --> 00:16:49.740 that happened early on with AIDS 352 00:16:49.740 --> 00:16:51.840 is that even some of the scientific community 353 00:16:51.840 --> 00:16:53.700 were rushing around saying 354 00:16:53.700 --> 00:16:55.960 that the AIDS virus doesn't cause AIDS. 355 00:16:55.960 --> 00:16:57.620 This became a sort of crazy thing. 356 00:16:57.740 --> 00:17:00.420 In a sense, the AIDS virus doesn't cause AIDS. 357 00:17:00.560 --> 00:17:03.960 What it does is the AIDS virus destroys a key component 358 00:17:03.960 --> 00:17:06.400 of the immune system called the CD4 T cell. 359 00:17:06.660 --> 00:17:08.960 If you destroy the CD4 T cell, 360 00:17:09.120 --> 00:17:11.800 you decrease your level of resistance 361 00:17:11.800 --> 00:17:13.500 to all sorts of other infections, 362 00:17:13.680 --> 00:17:15.880 like tuberculosis, like some of the things 363 00:17:15.880 --> 00:17:18.420 that normally live in our gut and in our lungs, 364 00:17:18.520 --> 00:17:19.760 and they kill you. 365 00:17:20.080 --> 00:17:22.200 So it's like, you know, saying, 366 00:17:22.400 --> 00:17:25.400 well, guns don't kill people, bullets do. 367 00:17:26.020 --> 00:17:28.080 And it makes just about as much sense. 368 00:17:29.420 --> 00:17:31.700 But then that led to a lot of confusion, 369 00:17:32.240 --> 00:17:34.680 led to confusion in getting out the message 370 00:17:34.680 --> 00:17:37.300 that the sort of behavioural changes that need to be made. 371 00:17:37.440 --> 00:17:39.700 And it continues to be a major problem. 372 00:17:40.740 --> 00:17:43.040 So while the advanced world says, 373 00:17:43.260 --> 00:17:45.960 well, another problem that's happened, 374 00:17:46.100 --> 00:17:47.620 and this is again a cultural problem, 375 00:17:47.700 --> 00:17:49.840 and this is not a cultural problem that comes from Africa, 376 00:17:50.040 --> 00:17:52.840 this is a cultural problem that comes from the advanced world. 377 00:17:53.200 --> 00:17:55.940 Because of the extreme sensitivities in the American political system, 378 00:17:55.960 --> 00:17:59.380 at the moment, to the values of the religious right, 379 00:18:00.560 --> 00:18:04.300 funding for women's health has dropped massively 380 00:18:04.300 --> 00:18:05.500 in the developing world. 381 00:18:05.840 --> 00:18:09.880 Because women's health clinics are identified as providing abortion. 382 00:18:10.280 --> 00:18:14.700 And so the type of funding that would have gone to women's health clinics, 383 00:18:14.820 --> 00:18:17.060 and it's women who can control these issues 384 00:18:17.060 --> 00:18:18.820 much better than anyone else, of course, 385 00:18:18.920 --> 00:18:20.660 and it's the women that you have to educate, 386 00:18:20.920 --> 00:18:22.760 that type of money has fallen off dramatically. 387 00:18:23.080 --> 00:18:25.560 So while on the one hand President Bush 388 00:18:25.560 --> 00:18:26.840 is putting $300 million, 389 00:18:27.440 --> 00:18:30.840 this grant that I was helping to adjudicate 390 00:18:30.840 --> 00:18:32.860 was at a direct initiative of the President, 391 00:18:33.100 --> 00:18:36.600 he's putting $300 million more into AIDS vaccine, 392 00:18:36.820 --> 00:18:38.340 and it's putting more into AIDS treatment, 393 00:18:38.580 --> 00:18:40.340 their administration at the same time 394 00:18:40.340 --> 00:18:42.720 is cutting the sort of very practical programs 395 00:18:43.560 --> 00:18:46.900 that would help to curtail the outbreak. 396 00:18:47.320 --> 00:18:51.000 In fact, one of the recent things I heard from one of my colleagues 397 00:18:51.000 --> 00:18:53.480 who'd been in Africa, she'd come to the conclusion 398 00:18:53.480 --> 00:18:55.540 that actually the best way 399 00:18:55.560 --> 00:18:58.420 to stop the AIDS academic would be to bribe the witch doctors. 400 00:18:59.060 --> 00:19:00.640 Because they have a lot of influence, 401 00:19:00.940 --> 00:19:02.560