JOEP LANGE'S LONG REACH
Along with his partner Jacqueline van Tongeren, the globe-trotting researcher built an impressive body of work. They leave it far too soon.
By Michael Dumiak
Geert Haverkamp sits looking at a screen at his third-floor desk in a nondescript concrete building on a corner off the harbor in Dar es Salaam. Maps of Tanzania in various detail stand pinned to a cluttered corkboard behind him. They plot 100 or so police, military, and prison clinics that form the foundation of HIV/AIDS treatment in the southern African nation. Haverkamp first toured clinics like these years ago with his friend and longtime collaborator Joep Lange.
No more. As the global health, and now much of the broader world knows, Lange, 59, father of five daughters and a leading HIV researcher and former president of the International AIDS Society (IAS), died this summer aboard Malaysia Airlines flight 17 (MH17) while traveling to Australia to attend the annual IAS conference.
“Joep sent me here in 1995 to work on a trial,” says Havercamp, who never left Tanzania. He’s now a program director for PharmAccess, a non-profit founded by Lange aimed at speeding the availability of antiretrovirals in Africa. He recalls what it was like in Tanzania then. “It was quite shocking to come to the big academic centers in Tanzania or Uganda and see … patients lying everywhere. You hear in the corner a few women crying and you know someone has died again. To see that this is completely not necessary, completely unacceptable.”
Lange set out to do something about it. And that he did. Some 500,000 Tanzanians are now on HIV treatment. The trial Lange sent Havercamp to Tanzania for was the Petra Study, part of the landmark research showing that HIV drugs could reduce the risk of breastfeeding mothers transmitting the virus to their babies.
Lange planted many seeds which continue to flourish. He was responsible for nurturing more than 40 doctoral candidates; founding the Amsterdam Institute of Global Health and Development (AIGHD) in the same medical center where he began as a young clinician at the start of the AIDS crisis years; exploring nascent health insurance schemes in sub-Saharan Africa; starting the INTEREST workshops to give young African researchers a place to start presenting their work; and pressing industry and pharmaceutical companies for access to HIV treatment.
David Ho, director of the Aaron Diamond AIDS Research Center in New York City, recalls Lange sticking by him in the first experimental days of what would become antiretroviral combination therapy. “The more controversial part at the time was whether that strategy could ultimately be the cornerstone of a cure,” Ho says. “We were barely beginning to treat in those days, so whenever you mentioned cure, there was a lot of hostility directed toward him and me. People who talk about cancer don’t get criticized like that. We may be as far from a cure today as we were in 1996, but now the mindset is totally different. Joep was brave.”
Catherine Hankins, former chief scientific adviser at the Joint United Nations Programme on HIV/AIDS, got to know Joep in the early 1990s after speaking about women living with HIV at the Montreal international AIDS conference in 1989. Hankins knows what it’s like to be on the other side of Lange in an argument. The two clashed publicly over the design of the initial Petra trial, and later at length over his run-ins with activists trying to disrupt trials on pre-exposure prophylaxis. “He was a kind and gentle guy, but he did not suffer differences of opinion quietly,” she says. “He sent me a harsh e-mail. I probably didn’t talk to him for a few years. It’s a hoot that he pushed really hard for me to come here.” Here is the AIGHD, where Hankins is now deputy science director.
Hankins shared an office with Jacqueline van Tongeren, the AIGHD’s communications director, former research nurse, and Lange’s longtime partner, who also died aboard MH 17. “She was my neighbor and best friend in Amsterdam,” says Hankins. “She helped me find my apartment. I still find myself asking her for advice.” Van Tongeren had a deep interest in art, while Lange had eclectic tastes in music and was always handing out books. Friends recall that there was hardly a place to sit down in his Beethovenstraat apartment. He recommended the American writer Paul Auster to Hankins; the last opera they attended together was La Bohème.
In Kampala, Uganda, not far from where he started the first African AIDS clinic in 1987 seeing 350 patients a day, Elly Katabira also remembers Lange and his books. “He said he’d bring something back for me. I figured no way he’d remember,” says Katabira, also a former IAS president and medical professor at Makerere University. “But he did. Very influential. About why you should never underrate the poor.”
Katabira hosted Lange during his first trip to Africa. Together they helped debunk a fake AIDS remedy, which Lange recalls in a moving essay called Africa on the Rise. What he would have seen there at the time is also captured in a piece by Kathleen Hunt in the New York Times Magazine called Scenes from a Nightmare.
When current Duke Global Health Institute director Michael Merson was at the World Health Organization in the early 1990s, he recruited Lange to run drug development for the Global AIDS Program. From there Lange would soon meet Katabira, and then go on to get PharmAccess up and running in Dar es Salaam and sub-Saharan Africa. Now Merson is once again linked to Lange—the Duke director recently spent a week with Hankins planning a new joint health and technology institute in development with the city of Amsterdam. One of Hankins’ next tasks, meanwhile, is to start arranging the next INTEREST workshop, planned for next spring in Harare. Lange’s long reach is lengthening. “If you have a vision for something, you take advantage of every venue you have,” Hankins says. “And he did.”
Michael Dumiak reports on global science, technology, and public health and is based in Berlin.