Life stories from Paul Farmer, Drew Faust, Howard Gardner, Annette Gordon-Reed, Martin Karplus, Toshiko Mori, Steven Pinker, E.O. Wilson, and many more, in the Experience series.
During an earlier pandemic that even today is only slowly relaxing its grip on the globe, pioneering AIDS researcher Myron “Max” Essex was one of the first to propose that a retrovirus was the cause of AIDS. The Harvard T.H. Chan School of Public Health virologist’s work shed light on the nature of HIV, led to development of an HIV blood test, and later focused on fighting the global pandemic at its heart — in southern Africa. As the head of the Harvard AIDS Institute, now the Harvard T.H. Chan School of Public Health AIDS Initiative (HAI), Essex established the Botswana Harvard Partnership, a collaboration between the University’s AIDS scientists and the government of Botswana. Though HIV/AIDS has become a chronic condition for many — 23.3 million were on antiretroviral drugs at the end of 2018 — work remains to be done. Some 770,000 died from HIV-related causes in 2018, and nearly 15 million of the 38 million infected worldwide are not receiving drug treatment, according to the World Health Organization (WHO). Essex, who in February 2019 became the Mary Woodard Lasker Professor of Health Sciences, Emeritus, sat down with the Gazette to talk about his career, share his thoughts about the challenges ahead in the fight against HIV, and offer lessons learned to a new generation of students.
Q: What are your thoughts on COVID-19 in light of your experience with HIV? Is there a major lesson to be learned?
A: I think there are quite a few lessons to be learned. One is we’re never fully prepared for these things because they emerge from nowhere as zoonotic infections and we don’t study the natural environment of viruses enough in lower species or do sentinel surveys of people that have more frequent contact with these feral, wild species. HIV/AIDS came from subhuman primates — multiple times — and was amplified rapidly via air travel. COVID presumably came from animals in the market in Wuhan [China]. It amplified with people and air travel. It’s just amazing how little we know about the breadth of these viruses in animals that could interact with people. We totally ignore those issues.
The second lesson is the importance of international cooperation for understanding and surveillance. The entire world structure breaks down if you don’t have good cooperation.
There are lessons at every level. With HIV/AIDS, we learned an awful lot about how to make good drugs. We learned that mixing different drugs will compensate for the mutation rate of RNA viruses, and COVID is an RNA virus. Eventually, we had drugs that were so well designed that it was hard for the virus to mutate around them. This is probably a bias from HIV, but my own feeling is that it’s going to be easier to make drugs against COVID-19 than to make a vaccine that’s highly efficacious. It might even be easier to take drugs prophylactically for high-exposure people.
Q: The COVID-19 vaccine development target seems very aggressive. Are you concerned at all that a vaccine can be developed in a year or year and a half?
A: I think with all the effort that’s going into it, I would say there probably will be something, perhaps with 30 percent to 60 percent efficacy. It could be generally available, at least in the West, for high-risk groups, within two years. That’s my best guess. But they’re not going to have long-term safety [data]. It’s possible a lot of people will get injected with something that hasn’t really been proven for efficacy.
Q: Why don’t we look more closely at HIV and AIDS, which you spent much of your career fighting. How do you view the pandemic now? Do you feel your work has had an effect?
A: I would say that I’m absolutely amazed that we — speaking for all AIDS researchers in the world over the last 30, 40 years — have been as successful as we have in preventing new infections, recognizing the total lack of any success whatsoever in making a vaccine. If you had asked me — and I’d venture to say most other AIDS researchers in the 1980s would agree — if we would have been able to control this epidemic without a vaccine, I would have said, “No.” We have succeeded, for the most part, in controlling it without a vaccine.
Q: What has made a vaccine against HIV so difficult? You personally have tried a couple of approaches and others — well-funded pharma companies included — have as well. There’s been a lot of work on this.
A: Absolutely. I got in in the first wave with quite a few others, to do vaccine research, try to make a vaccine, and we tested a couple. I would say, though, to give myself a little credit, that we also got out sooner than many others because we recognized it wasn’t going anywhere. The reason is that the virus is prone to mutations that can evade immune responses. It was a never-ending challenge because the virus was always a step or two ahead and able to overcome [any vaccine] through selection and successful replication — evolution, if you will. What we didn’t remotely appreciate at the time was that drugs [used for treatment] would be able to overcome that evolution, overcome the mutations HIV was evolving toward drug resistance. The utilization of multiple drugs to target the virus all at once meant it couldn’t mutate fast enough to survive. That made us appreciate that it was easier to beat the virus by drugs than by vaccines.
Q: You have had an interesting path, from veterinary school to heading a Harvard AIDS lab, to work in southern Africa. How did you get interested in science/biology/virology/veterinary medicine to begin with? I’ve read that you were born in Rhode Island. Did you grow up there?
A: Yes. I’m not sure there’s much that’s remarkable. Neither of my parents went to college. My father didn’t even go to high school. He was, I guess you’d say, a lower-level businessperson — a sporting-goods salesman and such. And my mother was mostly stay-at-home, though I think she worked a little as a secretary when I was younger.
Q: Brothers and sisters?
A: One sister, Cynthia, three years older. She did go to college and worked most of her life at Perkins School for the Blind in Watertown. She ended up as head of the lower school there, a position she retired from five or so years ago.
Q: Did your parents emphasize education, since both of you went to college?
A: They encouraged it. I think part of my motivation was I liked sports. I played basketball in high school, thought I was better than I really was and thought I could play basketball in college — at the University of Rhode Island — but wasn’t good enough to do that. Then I found that science was interesting.