Читать книгу Somebody to Love - Matt Richards - Страница 10

For a decade after the events of 1908 the chain of infection of the virus was kept alive, though confined to the Congo. The disease that would develop from the virus would not explode as a notable outbreak for a number of decades and would require the perfect alignment of circumstances for the virus to spread rapidly.

That alignment started to occur during a series of well-intended but ill-fated medical campaigns in the Belgian Congo between 1921 and 1959. Colonial health authorities, determined to treat certain debilitating and often deadly tropical diseases such as sleeping sickness, were using, for the first time, mass-produced disposable syringes that enabled them to carry out systemic programmes.

Hypodermic syringes had been around since 1848 but even by the end of World War I they were still only handmade, their components of glass and metal shaped by skilled craftsmen, making them extremely rare. During one medical expedition to the upper Sangha river from 1917–19, the French doctor Eugène Jamot treated over 5,300 cases of sleeping sickness using only six syringes.¹

It was in the 1920s that the mass manufacture of hypodermic syringes began and changed all that. This was crucial for medical teams working in Africa, particularly the Belgian Congo and neighbouring Cameroon, although resources were still scant – the syringes were not expendable – and sterilisation of the needles or syringes was virtually impossible.

These injection campaigns to combat sleeping sickness were the ideal circumstances for the spread of the virus that the young hunter had unwittingly brought to Leopoldville. The injections were carried out in the Belgian Congo by mobile teams with no formal education and a minimal amount of technical training, who visited patients in their villages to give them their monthly shots in order to treat the villagers, but also to protect the native workforce and colonial administrators. Such was the number of people they had to inject there was no time for boiling and sterilising each needle after use. They were simply rinsed quickly with water and alcohol before being used on the next patient. Consequently, all too often the syringes retained small quantities of blood. Just the smallest amount of infected blood was all that was required to transmit the disease. Even after 1956, when disposable plastic syringes became available (these were invented by New Zealand pharmacist and veterinarian Colin Murdoch who wanted to develop a method of vaccination that eliminated the risks of infection) they were still likely to have been reused due to cost.

This practice continued unabated and led Jacques Pepin, a Canadian professor of microbiology, to propose in 2011 that the connection between the initial human source and the global pandemic of the virus was the hypodermic syringe.² He worked out that around 3.9m injections were given against sleeping sickness, and 74 per cent of these were administered intravenously – right into the vein, not into muscle. This intravenous method of delivery is not only the most direct way of getting a drug into the body it is also the best way to unintentionally transmit a blood-borne virus.³ Also, before 1950, there were only two colonies in the sub-Sahara region of Africa who had blood transfusion programmes. One was Senegal, which started blood transfusion programmes in 1943, the other was the Belgian Congo, where rudimentary blood transfusion programmes had been in place since 1923 and were used specifically to treat infants with severe anaemia, primarily from malaria. Such was the fear of malaria that it appears the benefits of blood transfusions far outweighed the risk of infection from other diseases or blood-borne viruses such as human immunodeficiency virus (HIV).⁴

There are differing views; some experts doubt that needles were necessary in such a way for HIV to establish itself within humans, suggesting that sexual contact had been enough. But even they agree that injection campaigns, and to a lesser extent blood transfusion programmes, may have played a later role, certainly spreading the virus across Africa once it was established.

According to Pepin, however, it is the injections that might account for the intensification of HIV infections beyond a critical threshold; that is, the moment when the virus had been unintentionally injected into enough people to stop it from burning out naturally, a point whereupon sexual transmission would do the rest. And as travel grew within Africa, thanks to the development of road and rail, so rapid transmission throughout the continent was achieved. From the late 1930s to the early 1950s, the virus spread by rail and river to Mbuji-Mayi and Lubumbashi in the south and Kisangani in the north. At first, it was an infection confined to specific groups of people. But the virus soon broke out into the general population and spread, especially after the Belgian Congo achieved independence on 30th June 1960 and became known as the Democratic Republic of Congo. From here, the virus took hold and formed secondary reservoirs, whereupon it spread to countries in southern and eastern Africa and across the sub-Sahara with an unstoppable momentum.

And, before too long, it had spread to the rest of the world.