Joep Lange

IT IS not true martyrdom to be killed in the crossfire of someone else’s war. But Joep Lange should still be seen as a martyr, for he would not have died when he did had he not been pursuing a war of his own—a war far deadlier than the skirmishing in eastern Ukraine which brought down the aircraft in which he was flying.

His enemy, which has taken more lives than any armed conflict since the second world war, was the human immunodeficiency virus, HIV. The disease it causes, acquired immunodeficiency syndrome, or AIDS, has killed 39m people since it was recognised in 1981, and continues to kill about 1.5m people a year. But that grim toll has fallen sharply from a peak of 2.4m a decade ago. No soldier wins a war by himself. But Dr Lange’s contribution was bigger than most.

He died en route to Melbourne, where the International AIDS Society’s biennial meeting was about to be held. A former president of the IAS, he had been in the fight almost since the start. He qualified as a doctor in 1981, just before AIDS transformed infectious diseases from a backwater eschewed by ambitious researchers into a crucial and urgent field. He and his team published vital papers on the way HIV infection progresses in people’s bodies. These helped show the importance of reservoirs of the virus that linger in cells other than the T-lymphocytes that are its chief target. That led him to suggest, in the 1990s, that treatment should start early, before a patient showed any symptoms.

These days that is the conventional wisdom. Then, it was controversial. And Dr Lange was also the first to recognise the importance of another now-conventional approach: triple-combination drug therapy, which prescribes medicines that attack HIV in three different ways, denying the virus the opportunity to evolve resistance.

That was controversial, too. In the mid-1990s, when triple-drug therapy was developed, it required the willpower to take up to 20 pills a day according to a precise regimen. It was, moreover, available only to the wealthy. But what once cost $15,000 a year can now be had for $100, and as a single pill to boot. The therapy is the mainstay of the programmes that have helped turn the tide against AIDS.

He also organised a crucial study, published in 2003, which showed that giving drugs to babies usually stops those infants picking up the virus from their mothers’ milk. Such treatment reduced the rate of infection passed on this way from 15% to 1%.

In many ways he was the stereotypical scientist. A confirmed agnostic, he enjoyed the life of the mind, and would plough through English, Dutch and French literature with equal enthusiasm. Friends spoke of a warm sense of humour, but also of professorial absent-mindedness, with books, research notes and papers left haphazardly in offices or at colleagues’ houses.

But those cerebral interests never shaded into professional detachment. Instead of closeting themselves away in laboratories, he insisted that researchers like him should talk to the people whom their work was intended to benefit. He recognised what medical researchers often miss: that patients, even those participating in experiments, are not “subjects”, but partners.

That concern could make him a sharp critic of those he thought foolish. In 2005 he tore into activists who had derailed trials in poor countries of pre-exposure prophylaxis—giving drugs to people who were not yet infected but who were at significant risk of becoming so, such as prostitutes. Dr Lange argued that, in the end, wearing a condom is a man’s decision over which women may not always have much influence. But the pills would give women a way to protect themselves. In a letter in PLOS Medicine, Dr Lange accused the protesters of anarchy:

The methods of these specific activist groups are uninformed demagoguery, intimidation, and “ AIDS exceptionalism”, the last in the sense that they exploit their HIV-positive status to get away with behaviour that would not be accepted from others.

Yet he was, in his own way, as much of an activist as any protester, determined to help get drugs to those who needed them most. You could usually get a cold Coke in a sub-Saharan village, he observed. So there was no reason why you shouldn’t be able to get anti-AIDS drugs to the same place.

The parts others cannot reach

Since the turn of the century he had chaired the PharmAccess Foundation, a Dutch organisation that began by distributing drugs in African countries, working with firms such as Heineken, a Dutch brewery with extensive African interests. Then when PEPFAR, America’s anti-AIDS operation, and the Global Fund, an international body based in Geneva, took over drug distribution, the foundation began supporting medical-insurance schemes and arranging loans to firms trying to fill gaps in the patchy public health care that exists in many parts of Africa.

Despite his prestige, Dr Lange never abandoned research. He was, when he died, setting up a trial to see if giving drugs straight after infection can stop HIV getting a grip in the first place. As he boarded his doomed flight, he sent a text message to a colleague. He might struggle to sleep, he wrote. But at least that would give him precious time to work on his latest project.