ber 1984 Jaffe would instruct employees within the Epidemiology Section of the CDC’s
AIDS Branch on the importance of keeping identifi able records in locked fi ling cabinets
and allowing only authorized CDC employees to have access to them. See Jaffe, “Records
Security Procedures [/] AIDS Epidemiology Records,” memo, November 19, 1984, folder:
AIDS Task Force 1983– 85, Darrow Papers.
82. Lorna Weir and Eric Mykhalovskiy, “The Geopolitics of Global Public Health
280
chapter 5
The emergence of HIV had shattered any perceptions of declining
infectious disease risk, and many observers viewed the existing slow-
moving communications channels as inadequate. Dawna Ring, a lawyer
representing an HIV- infected Nova Scotia woman, advanced the view of
a global “infectious disease crisis.” “We are no more than 16 hours away
from any part of the world,” Ring noted in her fi nal oral submissions to
the inquiry. Highlighting the risks of global travel, she reminded those
assembled “that patient zero, the most noteworthy person with AIDS
in North America,” lived in Nova Scotia “between 1978 and 1982, at the
beginning of AIDS entering into our blood systems.” His importance,
she suggested, in an argument based more on correlation that causation,
was “to show to us that we truly are a global community, and that we
cannot look at the epicentres of where a disease is currently occurring
and thinking that that is the only place where the disease is present.” In
her warning that “every small and rural community is at risk of expo-
sure,” the fl ight attendant’s example was emblematic of the dangers of a
more closely and quickly interconnected world.83
Defi ning the Importance of “Patient Zero”
During his testimony as an expert witness at the national hearings in
Toronto in March 1995, Dr. Donald Francis of the US CDC was called
on by the commissioner to offer a defi nition of the term “Patient Zero.”
Krever asked, “Is that simply the person who is common to a lot of peo-
Surveillance in the Twenty- First Century,” in Medicine at the Border: Disease, Global-
ization and Security, 1850 to the Present, ed. Alison Bashford (Basingstoke, UK: Palgrave
Macmillan, 2006), 240– 63; David P. Fidler, “From International Sanitary Conventions
to Global Health Security: The New International Health Regulations,” Chinese Jour-
nal of International Law 4, no. 2 (2005): 325– 92. These World Health Organization reg-
ulations, fi rst named the “International Sanitary Regulations” in 1951 and later “Interna-
tional Health Regulations” in 1969, originally included the three aforementioned diseases,
as well as smallpox, typhus, and relapsing fever. The latter two were removed from the reg-
ulations in 1969, and smallpox was removed in 1981, following its global eradication; see
Gian Luca Burci and Claude- Henri Vignes, World Health Organization (The Hague: Klu-
wer Law International, 2004), 135.
83. Oral submission of Dawna Ring, December 10, 1996, Verbatim Transcripts of Com-
mission, 242:49486– 87; see also Tomes, “Germ Panic,” 195. Ring’s client, Janet Conners,
had contracted the virus through sexual contact with her husband, a hemophiliac who had
received HIV- infected blood products.
Ghosts and Blood 281
ple or is it the fi rst identifi able case?” Not having been directly involved
in the cluster study carried out by his colleagues, Francis ventured his
own defi nition: “This was the individual who really served as the— at
least presumed movement in this cluster of cases, and only— they were
numbering cases 1, 2, 3, 4, 5, and then fi nally, there was this one per-
son who was the fi rst case in all of this that joined it together.”84 Fran-
cis smoothed over the process by which the fl ight attendant received his
eventual designation: “Not having any number, I think they just called
him Patient Zero.”
The scientist later attempted to coin a back- formation for the term,
relating it to the earliest spread of HIV and taking it even further from
its original use as a referent for the “Out- of- California Patient”:
As far as I know, Patient Zero had no— presumably, the fi rst case had sexual
activity in Africa, and I do not know that this individual did. I— we also know
that AIDS was introduced into these countries periodically and so there were
other Patient Zeros that never had Patient One come from them. It was just—
and we’ve never known the individual that brought it into— presumably into
the gay bath houses in this part of the world that really allowed for the ampli-
fi cation of it. Then I would presume that this Patient Zero picked it up from
Patient Zero Zero, and then moved it on to the subsequent ones.85
It seems doubtful that Francis’s attempt— to link the CDC’s 1982 term
“Patient 0” to what had in the years since become the consensus view
on the spread of HIV— clarifi ed matters for the commission. The scien-
tist did, however, offer a clear corrective to the media’s focus on Dugas,
which helped support Greyson’s and Elliott’s reformulated portrayals of
the fl ight attendant: “You should make it very clear, by the way, for the
Canadians, that it was his cooperation and his notebook and the coop-
eration with the investigators that allowed us to do the investigation. It
wasn’t that one Canadian spread AIDS all the way across the United
States. There were lots of people doing this, a lot of them Americans.
84. Testimony of Dr. Donald Francis, March 7, 1995, Verbatim Transcripts of Commis-
sion, 100:21597. In a later interview, another epidemiologist ventured a more succinct defi -
nition, which indicated how the term’s meaning had evolved since the 1980s: “the fi rst per-
son who was infected from an animal source who then transmitted it to another human.”
Mathias, recording C1491/16, tape 1, side A.
85. Testimony of Dr. Donald Francis, March 7, 1995, Verbatim Transcripts of Commis-
sion, 100:21598.
282
chapter 5
This guy just happened to be cooperative and kept a date book, and so
he had people’s names and so a— the investigation was possible thanks
to him, not that he started AIDS in the world or the United States.”86
Francis also told the inquiry that he believed that the CDC would have
complied if Canadian authorities at LCDC had requested specifi c infor-
mation about Canadian cases of AIDS.87
This disclosure set the scene for Elliott’s encounter with Alastair
Clayton, the former head of LCDC, seven months later. Elliott had de-
clared in a newspaper interview that “the key to unlocking the tragedy
was a Canadian,” who had shared his information with American au-
thorities. “Yet Canada got no advantage in having that advance informa-
tion.” Clayton, Elliott later explained, was his “most important target,”
and he would interrogate him as to why there had not been closer com-
munication with the Americans about Dugas and the cluster study.88
On October 13, 1995, on the twentieth fl oor of the Maclean Hunter
Building, Dr. Alastair Clayton sat before
a microphone at the witness
stand at the front of the large room, near the desk of stoic- faced Com-
missioner Krever. Clayton faced fi ve rows of lawyers and a small audi-
ence in the public seating area, as well as a TV camera capturing the pro-
ceedings for live broadcast.89 Elliott, his inquisitor, sat at the table closest
to the witness. As it turned out, Clayton proved to be a self- assured wit-
ness, seemingly thriving on the adversarial position in which— after a
decade— he once again found himself with Elliott. “It would have been
very diffi cult without a name to identify this person and to institute con-
tact tracing unless he had come forward or unless he had been treated in
Canada by a physician who would be doing these things,” he explained
to Elliott. “But we would not at the federal level, or even at the provin-
cial ministerial level, know his name, nor should we have done. Your
86. Ibid.
87. Ibid., 102:21928.
88. See two articles by Ellie Tesher, “Blood Inquiry a Sorry Litany of Errors,” Toronto
Star, September 8, 1995, A2, ProQuest (1355573880); and “Blood Drama Unmasks Bland
‘Stars,’” Toronto Star, October 13, 1995, A2, ProQuest (1357140608).
89. Timothy M. Paterson provides a rich ethnographic description of the national hear-
ings and their physical location in the fi rst chapter of his thesis: “Tainted Blood, Tainted
Knowledge: Contesting Scientifi c Evidence at the Krever Inquiry” (PhD thesis, University
of British Columbia, 1999), 36– 37, doi: 10.14288/1.0089863. Elliott’s interviews are also a
useful source for the inquiry’s inner workings.
Ghosts and Blood 283
organization, Mr. Elliott,” he added— in a baiting manner, perhaps—
referring to ACT’s early activities, “was instrumental in making sure
that confi dentiality was paramount in this situation, a movement which I
applaud greatly.”90
Presented with a witness who was skillfully defl ecting his questions,
Elliott continued nonetheless: “And I am not suggesting that confi -
dentiality ought to have been breached, Dr. Clayton, but the evidence
of Dr. Francis and I think it is borne out by the evidence from Randy
Shilts’ book and from others who have known Mr. Dugas is that he was
very cooperative with public health authorities, that he was quite pre-
pared to open up his extensive records of sexual contacts to scientifi c in-
vestigators in an effort to assist them in understanding this disease and
helping control its spread.”91 Clayton, meanwhile, stated that he had as-
sumed that confi dentiality reasons would have precluded such a request
and as a result did not place one.92 As we have seen, information was dif-
fi cult enough to share between provinces within a nation in the absence
of a legal framework, so the prospect of sharing specifi c details interna-
tionally would have appeared even more daunting and unlikely. As Clay-
ton testifi ed, “Those circumstances could easily be repeated again, be-
cause of the lack of names, as I have mentioned, the importance of lack
of names. Whether or not CDC should have come to us and said, ‘We
have this person, this is his name, this is what he is doing[,]’ I think could
be very diffi cult for us— for them to do and us to accept.” He concluded,
“Had we been informed, we would have been very happy to try to co-
ordinate, but it is diffi cult to imagine how the U.S. government would
have come to us and said, ‘You have one patient whose name is so and
so, he is a fl ight attendant who is doing this that and the next thing.’”93
With his time running down, and his “most important target” main-
taining his ground, Elliott relinquished his focus on “Patient Zero” and
switched to another line of questioning.
90. Testimony of Dr. Alastair Clayton, October 13, 1995, Verbatim Transcripts of Com-
mission, 198:41790.
91. Elliott’s cross- examination of Dr. Alastair Clayton, October 13, 1995, Verbatim
Transcripts of Commission, 198:41790.
92. Ibid., 41787– 89.
93. Ibid., 41793.
284
chapter 5
The Effi cacy of Ghosts and Blood
The Krever commission’s 1,138- page fi nal report was tabled in Can-
ada’s House of Commons on November 26, 1997. The report was deeply
critical of the dysfunctional system, or, as Krever himself articulated in
an interview, “the so- called ‘system,’ which I found was not a system at
all.”94 Described by journalists as an “exhaustive chronicling of the ‘un-
precedented disaster,’” the report’s initial section represented the fi rst
concerted effort to construct a comprehensive outline of the history of
the AIDS epidemic in Canada.95
Chapter 10 of the Final Report outlined key events in the early re-
sponse to AIDS in Canada. At one point it noted that Jessamine, the
chief of LCDC’s Field Epidemiology Division, stated in a February 1982
interview that it was “only a matter of time” before AIDS would appear
in Canada. The report immediately went on to remark that Jessamine,
in saying this, was unaware that “the Centers for Disease Control had
recently linked a Canadian fl ight attendant to several cases of AIDS in
New York and California. The fl ight attendant had travelled extensively
to the gay urban centres of Canada and the United States between 1979
and 1983.”96
Ultimately, this passage was the sole oblique reference to Dugas and
the idea of “Patient Zero” in the entire report, apart from a discussion of
the perceived signifi cance of the cluster study in the United States.97 Yet
this brief mention masked a series of encounters that took place in the
inquiry’s hearings across the country, during which the powerful image
of “Patient Zero” was brought back into public debate. More than ten
years after his death, the fl ight attendant, dressed fi rst by John Greyson
94. Horace Krever, interview with author, Toronto, September 10, 2008, recording
C1491/ 46, tape 1, side A, BLSA.
95. André Picard and Anne McIlroy, “Tainted Blood Tragedy: Never Again,” Globe
and Mail [Toronto], November 27, 1997, A1.
96. Krever, Commission of Inquiry, 1:196. This statement, however, is inaccurate; as
outlined in chapter 2, the CDC’s Darrow and Auerbach did not link Dugas with other
AIDS cases until later in spring 1982.
97. The Final Report presented the 1982 cluster study as an “important milestone” to
support the theory that an infectious agent caused AIDS: Krever, Commission of Inquiry,
1:xxi, 185; 2:592.
Ghosts and Blood 285
and then by Douglas Elliott in a different uniform, had touched down
once more in cities across Canada.
Later, when asked about Elliott’s general strategy, Justice Krever sug-
gested that “I don’t think there’s any question that I heard a lot about
the background of gay ‘communities’ in Canada, Toronto and Montreal,
some of which was relevant for contextual reasons, but as I said any-
body with standing had a particular— I don’t like the word— agenda that
wasn’t necessari
ly mine. That’s inevitable. And the task is to see that it
doesn’t interfere with the Commissioner’s agenda.”98 Regarding the re-
port’s brief mention of “a Canadian fl ight attendant,” the commissioner
refl ected:
It was put in because that was part of the background. That was part of the
context, but it was never signifi cant. In my mind, it didn’t matter. The nature
of the problem that I was inquiring didn’t in any way turn on who the fi rst
person was. It was just something that was in the material, in the literature,
but of no great signifi cance. So I don’t think I said, “I’m going to reduce this
because of it,” it was just in passing, “This is a bit of information.” . . . And
even if that was wrong, it didn’t affect anything in the Inquiry. And the fact
that even if it was right it didn’t affect anything— it was just there.99
Though Krever’s Final Report contained scarcely a reference to Du-
gas, Elliott’s broader strategy—
of gaining a foothold in the “offi cial
history” of AIDS in Canada— was more visibly successful. Krever de-
voted several pages of the Final Report to outline the history of gay ac-
tivism in Canada, with accounts of discrimination and the com mu nity’s
fears of being scapegoated. He also provided a detailed description of
community- based efforts to protect the blood system, “despite the lack of
communication with, direction from, or assistance by the Red Cross.”100
Taken together, John Greyson’s Zero Patience and Douglas Elliott’s
work at the Krever inquiry demonstrate the continuing infl uence of
Randy Shilts’s construction of Gaétan Dugas as “Patient Zero” in Can-
ada through the fi nal pre- HAART years of the HIV/AIDS epidemic. In
highly contrasting ways that point to the diversity of AIDS work dur-
98. Krever, recording C1491/46, tape 1, side B.
99. Ibid.; emphasis on recording.
100. Krever, Commission of Inquiry, 1:234– 37 and 252– 57.
286
chapter 5
ing this period, these two theatrical productions from Toronto investi-
gated the transnational history of the epidemic, the production of histor-
ical truth, and the creation of scientifi c “facts.” One defi ed classifi cation
and standardization; its postmodern delight in building then decon-
structing stories and mashing ideas and genres served to challenge tidy
Patient Zero and the Making of the AIDS Epidemic Page 48
