The guiding force

It’s not been a banner week for Dr. Allan Ronald, but there he is, sitting in a board room quite comfortably with a cup of coffee and his characteristic smile.

The smile and the signature mirth in his blue eyes exude an undying optimism in the man who has made the University of Manitoba Canada's premier site for infectious disease education, peppering the country with leading epidemiologists, microbiologists and public health officers.

Still, he is not all happy. The Winnipeg International Centre for Infectious Diseases, where he is a scientific adviser, has just seen its bid to establish a vaccine manufacturing plant quashed. He says he played a small role in the two years of hard work to produce a 400-page proposal that had the backing of the world's largest vaccine manufacturer, Canada's largest biotech firm and the New York-based International AIDS Vaccine Initiative, which spurs development of vaccine candidates around the world. Ronald believes the federal Tories have quashed their commitment to build Canada's counterpart to the lab in Bethesda, Md., where promising research is taken onto the lab bench for vaccine production.

"We heard, by rumour, that our proposal had won in every category (assessed)," he says. "We had won."

Poof. Insult to injury: Ronald, 70, professor emeritus in internal medicine and microbiology at the U of M, should not be in Winnipeg this week.

A cadre of top Manitoba HIV scientists -- Frank Plummer, Joanne Embree and Stephen Moses -- and the president of the University of Manitoba, David Barnard, are in Nairobi, Kenya, celebrating, with the vice-chancellor of the University of Nairobi, the accomplishments spawned from a clinic Ronald co-founded there 30 years ago.

The anniversary was marked at the annual meeting of the University of Nairobi's collaborative network of clinical and community research in HIV.

But the man who helped put Canada on the HIV research map has been grounded by lymphoma.

Since his lymphoma was detected last July, he has undergone surgery and chemotherapy and has been ordered to stay put.

"I just got a splenectomy (partial or complete removal of the spleen) and my oncologist says I can't travel till April outside the health care system. There will be 200 people there (Nairobi)."

Initially squeezed into a working clinic in Nairobi's Pumwani slum, the project with the University of Nairobi was launched when the head of microbiology there, Herbert Nsanze, heard of the work in Winnipeg on chancroid, a genital wart, and needed help with Kenya's outbreak.

A young Margaret Fast, then a fellow in infectious diseases, went with Ronald in 1980 to set up the work. Fast, now scientific director of the National Collaborating Centre for Infectious Diseases, had just finished work as a doctor in remote Vietnam.

"I still marvel at her bravery," Ronald says.

And so it goes with Allan Ronald; he recounts accomplishments extolling the remarkable cohort of brilliant scientists he attracts and mentors. The work on chancroid, recognized by the WHO, was published in 1975 "largely due to Dr. (Greg) Hammond," another fellow then under his tutelage.

In 1981, Francis Plummer took over the clinic.

"Right from the get-go Frank was an abnormal person in that he was -- my questions were pretty limited and simplistic," Ronald says. "Frank saw a bigger picture.

"Frank got there and said chancroid is an interesting problem but it doesn't kill anyone. The really important problem is gonorrhea because it was destroying eyes in newborns."

The clinic's research in Nairobi on sexually transmitted diseases attracted infectious diseases experts from around the world -- notably Belgium's Peter Piot and American James Curran. And it would put Manitoba and Nairobi in a unique position when the world was awakened to a devastating new scourge -- AIDS.

Once known as Slim Disease in Africa for its wasting effect on victims, AIDS was circulating for years. The virus, however, would not be named or recognized as a global health threat until the early 1980s when gay men in the U.S. began showing up with a form of fungal pneumonia and Kaposi sarcoma, a rare cancer, that hit those with compromised immune systems.

Ronald first heard of the emerging epidemic one night in January 1981.

"I was having dinner with Nsanze and Curran at the Nairobi Club, a decadent old British institution," Ronald recalls. "Curran says 'I got this interesting phone call today from the CDC. I've got to return home. There's 10 gay people who have died in the last few months in Los Angeles and New York. They've got these crazy diseases.'

"We spent the rest of the evening wondering what in the world could be killing gay men in Los Angeles and New York. We didn't realize it was totally going to change our whole lives."

Curran would lead the battle against AIDS at the Centres for Disease Control in Atlanta for the next 20 years and Peter Piot, co-discoverer in 1976 of Ebola, would do groundbreaking work on HIV in Zaire and then lead UNAIDS.

"I stayed and Frank arrived, and by 1984 we had set up the HIV unit in Nairobi."

Curran doesn't recall the dinner, but he knows well the impact the small clinic in Nairobi had.

"Very entrepreneurial," he says. "They had the foresight, the science and the missionary zeal to get involved ... long before there was any real mandate to do so in Africa."

Curran believes that humanitarian zeal, faith and science led Ronald in his work in Africa.

The joint Nairobi/Manitoba project plunged into the frontier of HIV research and treatment, drawing researchers from around the world, and training infectious diseases specialists in Kenya and beyond.

The work led by Plummer was among the first to open an understanding of HIV, how it works and spreads.

The Nairobi team found evidence early that circumcision protected men from HIV; that some sex workers in the slums had immunity, though they were regularly bombarded by HIV from their clients; that mothers transmitted HIV in breast milk to babies, including to some born HIV-negative.

U of M's Stephen Moses, who worked on the circumcision discovery, says his education project in southern India with 60,000 female sex workers flowed from HIV prevention in Nairobi.

"They're still discovering that some people are exposed and not infected," Ronald adds, recalling the resistance the team faced in proving immunity.

Ronald took his work to Uganda where he and his wife Myrna Ronald, a nurse, educate physicians and nurses on HIV prevention. That project now has trained more than 5,000 people from 27 African countries.

The research goes on. Ronald and 43 other researchers have published a study -- his 255th article -- this month in the New England Journal of Medicine that found immunity among 3,400 African couples, in which one partner was HIV-positive. The study aimed to find whether treating genital herpes -- which greatly increases the chances of contracting HIV -- with the antiviral acyclovir would reduce transmission of HIV. It did not.

But Ronald believes the immunity discovery in 1994 in Kenya will be key to defeating the scourge.

"It isn't chance! That's the whole thing -- people said to Frank it's chance but chance leads you to discoveries. It's a biological basis and we've got to understand what it is and hopefully it'll lead to a vaccine."

Moses believes it, too. But he remains dubious that a vaccine will be here soon. "I think the vaccine is still a very, very long way away."

For Ronald, the disappointment in seeing the vaccine plant bid rejected is another bump to get over, like missing the 30th anniversary in Nairobi: "It's the first one I've missed, so it's hard.

"But I'm alive and I hope I'll be there for the 31st."

catherine.mitchell@freepress.mb.ca

Republished from the Winnipeg Free Press print edition January 30, 2010 H6