We Will Prevail Together

The long war against HIV infection lost one of its great generals when Jonathan M. Mann, the founder of the World Health Organization's AIDS Program, was killed in the crash of Swissair Flight 111 off Nova Scotia last month. And because Dr. Mann's wife, Mary Lou Clements, was seated beside him on that doomed flight, the war against HIV also lost one of its most brilliant field commanders.

At the time of their deaths the Manns were en route to Geneva, Switzerland, the home of W.H.O. and the site of this year's World AIDS Conference, to attend a series of global-strategy sessions on AIDS. Jonathan Mann was the principal architect of the World Health Organization's response to the AIDS pandemic, and his wife was an expert on AIDS vaccines. Because they played such prominent roles in the worldwide mobilization against HIV, the Manns were well known, well respected, and well liked by AIDS researchers everywhere. All of us at HIV Newsline knew the Manns, and some of us knew them very well. For this reason their loss is a personal as well as a professional tragedy for the members of our editorial advisory board and for our staff.

It is almost impossible to calculate the impact that Jonathan Mann had on the worldwide effort to halt the spread of HIV infection. In the early 1980s, when Dr. Mann assumed the directorship of the World Health Organization's AIDS program, this new plague was as terrifying as it was mysterious. We did not know the causative agent, we did not know the mode of transmission, and we did not know how to prevent its spread. All we knew was that the disease killed slowly -- which made it a greater potential threat to public health than, say, influenza, Ebola virus, or bubonic plague, all of which produce acute illness that leads to rapid death. By contrast, individuals infected with whatever caused AIDS could apparently live for years, perhaps even decades -- all the while infecting others.

Jonathan Mann's great contribution to the global effort to contain HIV infection was his refusal to see the war as unwinnable or the enemy as unassailable. As Dr. Daniel Tarantola, a colleague at W.H.O., put it, Dr. Mann defined AIDS "not as a terrible viral disease but as a social problem to be solved." And so, while others focused on identifying and isolating the virus, Dr. Mann devoted himself to developing social programs that would prevent the spread of HIV. He started with a single office and a staff of one, and over the next four years he transformed that office into the largest program ever administered by W.H.O., with a staff of almost 300 and an annual budget of more than $100 million.

Along the way he persuaded 155 countries to join his crusade, a feat that called upon his considerable diplomatic skills, since many of those countries were, at least initially, deeply suspicious of the World Health Organization's motives for collecting information on the spread of AIDS. (In sub-Saharan Africa, for example, W.H.O. representatives encountered outright hostility, from officials who feared that the organization's only purpose in amassing statistics was to "blame" Central Africa for the emerging epidemic.) In the end Dr. Mann prevailed over both indifference and intransigence about HIV infection -- in large measure because he insisted that AIDS be seen as a human-rights issue rather than simply as a public-health issue.

Dr. James Curran, the former director of the Centers for Disease Control, attributes Dr. Mann's singular achievement to the fact that he was "a spiritual leader as well as a scientific leader." No one who knew Jonathan Mann would disagree with that assessment. He was a passionate believer in the necessity of linking health issues and human-rights issues, which he saw as indivisible. This credo was one that Dr. Mann articulated on countless occasions, but never more movingly than in remarks he made at an AIDS Action Committee dinner in Boston in 1989:

In the last few years we have gained confidence that as individuals and all together we are not condemned passively to allow the disease AIDS, or the fears and forces which it can unleash, to dominate us. Against AIDS we will prevail together, for we will refuse to be split, or to cast into the shadows those persons, groups, and nations that are affected.

All those who see the AIDS pandemic as Jonathan Mann saw it -- as a global threat -- recognize that the key to containing HIV worldwide is a safe, effective, and inexpensive vaccine. Dr. Mann's wife, Mary Lou Clements, an epidemiologist who headed the center for immunization research at the School of Hygiene and Public Health at Johns Hopkins University, was at the forefront of the unending -- but so far unavailing -- effort to develop such a vaccine. Dr. Clements was not merely a leading researcher in this demanding and often disappointing field, she was also an expert on the assessment of candidate vaccines. Her loss is one more body blow to an area of AIDS research that has experienced more than its share over the years.

In such sad times it is helpful to remember the Manns in Jonathan's own words: "We will prevail together," he said, because "we will refuse to be split, or to cast into the shadows those persons, groups, and nations that are affected" by AIDS. That passionate conviction, that refusal to succumb to desperation and despair, and that insistence that the social implications of AIDS be acknowledged are as much a part of the Manns' legacy as their remarkable professional achievements.

Those words apply equally well to the Manns' relationship with one another. Their mutual love made each of them feel complete, and it strengthened their resolve to work together to develop an effective AIDS vaccine. They were happy in their devotion to each other, and united in their dedication to defeating HIV infection. Readers who wish to honor the Manns' memory and perpetuate their legacy can do so by sending a contribution in their names to the Johns Hopkins School of Public Health. Checks should be made payable to The Clements-Mann Fellowship Fund in Vaccine Sciences and sent to Dean Alfred Sommer, M.D., Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.