Vexing vaccines. Aids is still killing millions in Africa. Tony Barnett reads an account of how the virus may have jumped species

The River: a journey back to the source of HIV and AIDS

Edward Hooper <em>Allen Lane, The Penguin

It has recently emerged that in Gateshead in the mid-1950s about 250,000 children were chosen for a polio vaccine trial. Parents were given minimal information before the children were called for shots of the oral vaccine. It is now clear that new variant CJD has nothing to do with eating beef. It is the result of this trial. A few batches of the vaccine, cultured on bovine tissue, were contaminated with the virus which produces NVCJD.

That paragraph was fiction. But, between 1957 and 1960 an experimental oral polio vaccine was fed to more than 900,000 people in central Africa. Consent was minimal. Edward Hooper presents weighty circumstantial evidence in his new book that here is the origin of the global epidemic of HIV/Aids.

Tens of millions of Africans are infected with HIV. The social and economic impacts are enormous. They will reverberate through African history until the end of time. Only the slave trade has had such dramatic effects. We are seeing hundreds of thousands of orphans, changes in population structure, changes to farming systems, young girls taken out of school to care for ailing parents, the failing elderly burdened by orphan care.

Hooper's book is the work of an obsessive. He has spent nine years pursuing the origin of the Aids epidemic. With enormous energy and imagination - often in the face of extreme obstruction - this non-scientist has discovered as much about the virology and epidemiology of HIV/Aids as most professionals. He combines this with detailed knowledge of events on the ground at particular stages of the epidemic's spread in central Africa.

Each "early" case of "Aids" occurring before the vaccine trials is investigated and dismissed. Hooper examines every conceivable link. Supported by hundreds of interviews and careful reading of a huge and specialised literature, he investigates the coincidence in time and place between early Aids cases and tests of oral polio vaccine developed by the Wistar Institute in Philadelphia. These tests used vaccine stock derived from monkeys and probably also chimpanzees. This resulted in a simian virus, benign in its original host, contaminating the vaccine. That is the origin of HIV.

The idea is not new: it first appeared in the American magazine Rolling Stone in 1992. Then, it was dismissed by the scientific and medical establishment, understandable given the conspiracy theories associated with the epidemic. Hooper is not a conspiracy theorist. He presents clear arguments, elegant and in principle falsifiable. Even so, Hooper does not claim anything more than that this is a hypothesis, one which should be tested. The Swedish Institute for Infectious Disease Control, and possibly the Wistar Institute, hold samples of the original vaccine stock. Tests were done on the Swedish material in 1995 with negative results. But Hooper identifies the specific vaccine batches which are stored and which should now be tested.

Why is this important? Understanding the origin of HIV is important for development of vaccines. Knowing what happened and whether competition between medical researchers led to hurried trials and insufficient care tells us about the risk involved in big science - important in relation to debates about GMOs, and the BSE/CJD saga, and at a time of drug company globalisation. There is also the argument that, if Hooper is right, then people may further shy away from all vaccines - with disastrous consequences for public health. But it is not vaccination itself which is the problem, especially as it saves countless lives. The problem is the conditions of commercial and academic competition under which this research is done.

Multi-drug therapies may incline rich countries to (wrongly) assume that the HIV threat has receded. In poor countries, there is little cause for optimism. Treatments cost about $10,000 per head per year - unthinkable sums where the annual health budgets per head of population may be less than $10.

In the poor world many millions are dying. Decisions and actions taken in the late 1950s may now be having terrible effects. In areas of southern Africa, 25 per cent of women attending ante-natal clinics are HIV+. Epidemics grow geometrically. Globally, these are early days. In addition to associated epidemics of tuberculosis (a common opportunistic infection) there is the "epidemic" of social and economic impact eating into the fabric of African society.

This book does not argue conspiracy. It poses hypotheses in testable form. It does not argue against vaccination but suggests that the context of scientific discovery and development has to be examined. It is not in any way anti-science. It is a serious book underlining the common sense view that science is good but must be controlled and used for the common good.

Tony Barnett is professor of development studies at the University of East Anglia