Part One 1
Everything has a beginning.
Our beginning is in the Belgian Congo, deep in the heart of Africa. The year is 1908 and the country is attempting to rebuild itself following the brutal regime of King Leopold II.
This was the year the Congo Free State was abolished and annexed as a colony of Belgium, to become known as the Belgian Congo, an area 75 times larger than Belgium itself. King Leopold died a year later, having never once set foot in the Congo region.
Before long the Belgian Congo had become, to many, a âmodel colonyâ and the transfer of responsibility to Brussels had ensured much of the wealth produced in the Congo was reinvested within the region. Missionaries arrived and built hospitals and clinics and the Church ran schools. An infrastructure of railways, ports and roads underwent construction and mining companies provided homes for their staff as well as welfare and technical training.
But while this had great benefits for the citizens of cities and towns such as Boma and Leopoldville1, for those inhabitants deep in the rainforest, the tentacles of progress barely touched them. These tribal people continued to exist as they had done for thousands of years, surviving through hunting and gathering before heading to a nearby village or town to trade bush meat or the prized honey they had collected from the rainforestâs canopy. A number of tribes existed within the vast Congo rainforest. The most famous were the âPygmiesâ, known as the Mbuti of the Ituri Forest in northern Congo, but there were also the Aka, the Twa and the Baka tribes and their taller and more dominant neighbours, the Bantu. And among the Bantu tribe lived a young hunter.
Our hunter lives deep within the Congolese jungle as part of the small ethnic Bantu group that inhabits the upper Sangha river basin. Nomadic in nature, the Bantu survive by hunting bush meat within the forest. Being young, fit and muscular, he is one of the best hunters within the tribe and, not only does he hunt, but he has been entrusted to take the bush meat, carcasses and furs upriver to the city of Leopoldville to trade for the manioc root from which to make cassava bread for the rest of the tribe. However, first he has to catch his prey.
Armed with a long spear, a cast-iron knife and a wire for setting traps, he had crept into the forest the day before to set his snares. He used a twig to pin a lethal loop of wire to the ground, then covered it in leaves. A living sapling bent over by another wire provided the spring that pulls the noose tight. Now, a full night and day since he set his traps, he checks the snares to see what, if anything, he has caught.
Drawing near to his first snare, the hunter hears a disturbance in the undergrowth ahead. He approaches slowly and silently, wary of disturbing the lethal green mamba, bright as blades of grass, who lurk on the rainforest floor and in trees. Finally, he gets close to the snare and, peering through the vine-like tangle of lianas, he sees that he has snared a young male chimpanzee. The animal, once energetic and full of life, now appears exhausted and almost dead.
Moving closer, he notices that it has gnawed off part of its own leg in a struggle to free itself from the snare. He rushes towards the chimp and spears it quickly, but not quick enough. The chimpâs teeth sink into his left hand. He recoils as the sharp pain flows up his arm. With his full force he pushes the spear deep into the chimpâs chest. It is enough: the chimp releases its grip on life.
He examines his wounded hand. The bite is not too deep as the creature was weak from loss of blood. He cleans up the wound as best he can, then cuts open the dead animal and discards its entrails with an iron knife. Once this job is done, he hoists it across his shoulders and heads back to his boat. The warm blood from the chimp mingles and mixes with his own blood from the open wound.
Unbeknown to him, the chimpanzee he has hunted and killed is carrying a virus. It enters the hunterâs bloodstream at the wound, and the virus, in that moment finding his blood to be not so different from the blood of the chimp, takes hold. He is the perfect host, given that chimpanzees and humans share more than 98 per cent sequence identity across their genomes. The virus immediately begins to replicate aggressively. Oblivious to his new infection, the hunter throws the dead chimp into his boat, on top of a pile of carcasses of various animals he has already hunted, species such as pangolins and small antelope, and pushes out from the riverbank. He makes his way on the current towards Leopoldville, a three-day journey down the Sangha river.
Around this time, Leopoldville was a thriving, bustling marketplace with a booming population. While Boma, over 200 miles to the west, was the capital city of the Belgian Congo and residence of the Governor-General, Leopoldville was a sprawling town with single-storey shacks down to the banks of the river Congo, a mighty 3,000-mile expanse of water that curved north and east to Kisangani, more than 600 miles away. Once a fishing village, the recent completion of the Matadi-Leopoldville portage railway meant that it had become a commercial centre. Consequently, it was to Leopoldville that traders, hawkers and hunters from throughout the Belgian Congo would descend to sell their wares. And where there are traders, hawkers and hunters, there are also prostitutes.
After three days on the river, our hunter arrives in Leopoldville. He has made this journey many times before, usually with the same species that he has tracked down and killed in the jungle. This time appears no different. The carcasses he has transported, including the chimpanzee that bit him, are cut up to be sold, cooked or smoked. As a result of this cooking, the chimp meat will likely not infect anyone else. The skins and hides he will exchange with other traders for maize and cassava. But for the bush meat, he manages to make a few Belgian francs â enough money, in fact, to celebrate with a drink and a visit to one of the many prostitutes parading up and down the streets. Either on this, or subsequent visits, the hunter will pass on the virus that lingers unknown within him and thatâs all thatâs needed for the virus to begin its spread throughout mankind.2 The transmission of the virus from chimpanzee to hunter was likely the one and only time this one strain of HIV passed across the species boundary, from chimp to human, and then successfully established itself to become the pandemic we still face today.
In the densely populated Leopoldville, where the ratio of men to women was high and prostitution rife, our hunterâs virus was relatively easy to spread. Even more dangerously, the period from infection to death could be, and often was, some years before it compromised the immune system of its host, allowing it ample time to pass silently from the first human victim to the next. The prostitute the hunter spent the night with in Leopoldville, along with other prostitutes he visited on subsequent trips to the city, passed it on to their clients, who then returned home to their wives, girlfriends and partners, and so the fatal cycle slowly began.
2
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 1917â19, 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 â the syringes were not expendable â 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 â 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.
3
Seek your happiness in the happiness of all.
Zoroaster
On 14th December 1908, the same year that the simian immunodeficiency virus (SIV), which would go on to become HIV, passed from chimp to hunter in the Congo, a woman gave birth to a 6lb 4oz baby boy in a small Indian city to the north of Bombay. The child was named Bomi by his parents and was given the surname of Bulsara after the name of the city of his birth, Bulsar.
Bomi was born into a family of Parsees, a group of religious followers of the Iranian prophet Zoroaster. Meaning âPersiansâ, the Parsees emigrated to India from Iran to avoid brutal religious persecution by the Muslims in the eighth century and settled predominantly in Bombay and towns and villages to the north of the city.
Developing a flair for commerce, the Parsees were receptive of European influence in India and during the 19th century had become a wealthy community, thanks to Bombayâs railway and shipbuilding industries. The Bulsars, however, were not from prosperous Bombay, but lived 120 miles to the north in the state of Gujarat. Here, for many locals, the only realistic source of income was harvesting mangos from the many orchards that dotted the landscape. Consequently, the Parsee community in Gujarat were far from wealthy and many young men from the region were forced to seek work elsewhere, not only in India, but further afield too.
Bomi, one of eight brothers, was no exception. Out of necessity and financial hardship, one by one he and his brothers left India and sailed almost 3,000 miles across the Indian Ocean to the exotically named Zanzibar seeking work.
Upon arrival, Bomi was fortunate and found work almost immediately with the British Government as a high court cashier in Stone Town, settling into life on the island quickly and comfortably, dedicating himself to his work and diligently and slowly building himself a privileged lifestyle. However, he desired a family to share his high standard of living, having arrived in Zanzibar unmarried and alone. Part of Bomiâs job meant that he frequently had to travel throughout Zanzibar as well as returning often to India. During one of those return trips to his homeland he met Jer, a bespectacled and dainty young girl, 14 years his junior. It was love at first sight and they married shortly after in Bombay, whereupon Jer left her own family behind to follow her new husband westwards across the Indian Ocean back to Zanzibar, where they hoped to raise a family of their own.
The newlyweds lived in a two-storey apartment that was accessed by a flight of stairs from the busy Shangani Street in Stone Town on the western side of the island. Compared to other Zanzibaris, the Bulsaras enjoyed a high standard of living, with Bomiâs salary enabling them to employ a domestic servant and even affording a small family car. Almost 60 years later, Jer Bulsara recalled it as being âa comfortable lifeâ.1
It was on Thursday, 5t...