The 1970s were times of upheaval and revolution, particularly in terms of Mideast and post-colonial African peace. A one-sided Israeli victory in the Six Day War increased the fervor of Palestinian separatists, encouraging splits even within the most extreme terrorist groups such as the Popular Front for the Liberation of Palestine (PFLP). A splinter group, the PFLP External Operations Group (PFLP-EOG) was founded by Wadie Haddad, a Palestinian nationalist whose expertise was in the hijacking of commercial airliners.1 Haddad had masterminded many hijackings, most notoriously, the Dawson’s Field hijackings of September 1970, where five airliners were hijacked and diverted to a remote desert airstrip in Zarka, Jordan. Upon landing, the passengers were separated between Jewish (and some high-profile Americans) and others, with the latter captives being released almost immediately. The remaining hostages were dispersed on the planes and sites throughout Jordan, thereby demonstrating the impotence of the Jordanian government to reign in the Palestinian terrorists that had become embedded throughout the Hashemite Kingdom. Because of increasing threats of military retaliation sprinkled with diplomacy, the hostages were all eventually released (as were high-profile PFLP members serving jail time in Britain), though the five airliners were destroyed with explosives in spectacular images filmed and viewed throughout the world. Because of this terrorist event, the Jordanian government cracked down on Palestinian extremists in a series of raids memorialized as Black September, causing Waddad to seek sanctuary and patrons elsewhere. Waddad soon found an ally on the shores of Lake Victoria.
Idi Amin, at six foot four inches, was an imposing figure, not least because his large frame combined with erratic behavior to make him brutal, merciless, and surprisingly charismatic.2 After rising to power in a military coup, Amin inaugurated a campaign of violence that earned him the moniker “The Butcher of Uganda.” In June 1976, Amin sympathized and colluded with Haddad to support the hijacking of Air France flight 139, an Airbus A300 commercial airliner carrying 246 passengers, mostly Israelis. While flying over Greek airspace, the plane was hijacked by two PFLP-EOG and two German Revolutionäre Zellen terrorists and diverted first to Benghazi, Libya, and then to Entebbe airport.3 This final destination placed the passengers and crew under control of Amin, who held all under guard in the terminal. The dictator then began negotiations for the release of other terrorists imprisoned in Israel and Europe (though on the behalf of the terrorists, not the hostages). As occurred at Dawson’s field, the Jewish hostages were separated from the non-Jewish, with the latter being released. With threats the Jewish hostages would be executed if terrorists’ demands for the release of Palestinian inmates were not met, the IDF mobilized, and, on the fly, developed an intricate plan for rescuing the hostages despite the fact that Uganda was over 2,500 miles away. In a daring assault, code-named Operation Thunderbolt and led by Yonatan Netanyahu (Yoni, brother of future Prime Minister Benjamin Netanyahu), IDF forces stealthily traversed halfway across a continent by air, rescued all hostages (except four who had been murdered by the terrorists), neutralized the terrorists, and immobilized the entire Ugandan air force with the loss of only one Israeli, Lt. Col. Netanyahu, who was struck down by a sniper lurking at the edge of the jungle surrounding the airport.
The neighborhood surrounding the famous airport is quite heavily wooded and dotted with forests teeming with verdant hills, which afford an occasional glimpse of a powerful mountain gorilla. Such greenery is due to a tropical climate, with temperatures in Entebbe rarely dropping below 60˚F at night or exceeding 80˚F during the day. Steady temperatures that vary day to day by less than 3˚F, combined with abundant rainfall exceeding 60 inches per year, provide the perfect climate for mosquitoes.4 Not just any mosquitoes but Aedes aegypti mosquitoes, a species that has bred and continues to breed terror far worse and more expansive than the PFLP-EOG or Idi Amin himself.
The cause of the suffering is not from the Aedes mosquito itself but from the viruses that teem within. The apes living in this jungle, not to mention their many human neighbors surrounding the region, have provided an opportunity for the mosquitoes, their passenger viruses, and hominids to coevolve, which has created a witches’ brew of killer pathogens. Because of this threat, Entebbe has again entered the modern lexicon, this time as home to a microbial terrorist named for where it was discovered—a small, twenty-five-acre park just to the north of the airport known as the Ziika forest.
Zika is one member of a family of killers known as flaviviruses (flavi being a Greek term for ‘yellow’). Indeed, the best-known flavivirus is the cause of a notorious disease known as yellow fever, named for the pallor that its victims frequently exhibit prior to a painful death.5 The disease is endemic in Africa, and the Ziika forest is host to both the virus and the insect that spreads the virus, Aedes aegypti. Consequently, the Uganda Virus Research Institute (UVRI) was founded in Entebbe’s Ziika forest in 1936 by investigators at the Rockefeller Foundation. Eleven years later, a caged rhesus money at the UVRI began displaying a fever, and the virus was isolated and identified as the modern-day Zika virus.6 Like a bad movie script, it was not until 1952 that Zika was known to have spread to humans. Just as this knowledge was being processed, investigators found themselves in the midst of a growing pandemic. In the years following the end of the Second World War, the virus had already been spreading rapidly to the west, where it had already gained a foothold in the coastal regions and small nations of west Africa. This region was particularly susceptible, as the public health infrastructures were stretched, broken, or never created. Additionally, this was a time when these newly independent or aspirational countries were throwing off the yoke of colonial rule, thereby severing ties that might have helped quash the emerging virus.
The Zika virus made a fateful trip, either by plane or ship, to Malaysia in the 1960s, where it percolated for decades. Much more recently, the virus crossed the Pacific Ocean to South America and then even more quickly north to Central and North America.7 The earliest signs of a problem in the Western Hemisphere were revealed in Brazil, coincident with that country’s hosting the 2014 FIFA World Cup. This fact has triggered persistent speculation that a participant or fan, possibly there for an international rowing event (which included athletes and fans from many Pacific island nations), might have brought Zika to South America. Such causation was particularly troubling, as the rise of Zika coincided with Brazil’s preparations to host the 2016 Summer Olympic Games.
Although Zika infection generally manifests itself with flulike symptoms, its most notorious effect is the potential to infect the nervous system of growing fetuses, thereby imparting a horrific and debilitating condition known as microcephaly (which literally translates into ‘small heads’). As such, the 2015–16 outbreak was the source of dramatic headlines throughout the world, accompanied by heartbreaking photographs of babies born with abnormally small heads and profound nervous system defects.
These concerns raised apocalyptic thoughts that the virus might spread further, causing some athletes and fans, particularly women of childbearing years, to cancel their plans to attend the 2016 Olympics. However, these acute concerns quickly abated in the months following the conclusion of the Olympics as the rate of virus spread slowed. Nonetheless, the rate of Zika virus spread has remained at a dangerous level for those concerned about the disease over the long term.
Yellow Fever
While Zika clearly remains a prominent threat to public health, its impact has not yet come close to equaling two of its relatives. Historically, yellow fever virus has killed millions, particularly following its spread to North America as part of the Columbian Exchange in the late 15th century.8 In a tragic irony, one group of repressed peoples likely created a tragedy for another. Specifically, yellow fever is conjectured to have been imported into the New World by enslaved Africans. This hypothesis is based on epidemiological evidence that the disease was most prominently associated with 17th-century outbreaks in the slave-holding Caribbean Islands of Barbados and Guadalupe.
> The slave-holding Caribbean island of Hispaniola was the likely source of a yellow fever pandemic in the United States.9 On September 20, 1697, the first true world war was concluded with the Treaty of Ryswick. A conflict known as the Nine Years’ War or the War of the Grand Alliance pitted the Sun King, Louis XIV of France, against a coalition of major European powers.10 The war was fought throughout Europe and in Asia (India), the Caribbean (Hispaniola), and the North American colonies (where it was known as King William’s War). Despite being outnumbered, the French nearly carried the day. In the resulting treaty at William of Orange’s palace of Ryswick, various concessions were awarded, including French hegemony of part of Hispaniola, which was renamed Saint Domingue and is known today as Haiti. In 1791, the slaves and free people of color rose in rebellion against their French overlords, and large number of French refugees began an exodus by sail from Saint Domingue to coastal towns throughout the United States.11 Many settled in Philadelphia, which was serving as a temporary capital of the newly formed United States of America as a new capital was being constructed on the Potomac River.
The abrupt surge in immigration was accompanied by equally unexpected guests in the form of mosquitoes infected with yellow fever.12, 13 The disease spread throughout the City of Brotherly Love, creating the greatest levels of devastation in the environs near the Delaware River, which provided ample breeding grounds for mosquitoes. Fear grew as the epidemic killed one in ten Philadelphians, and the city was evacuated by President George Washington and his newly formed government. The spread threatened the new republic in the days following the start of Washington’s second term and was worsened by the dispersion of people (and mosquitoes) to other major American towns, most of which were similarly positioned on or near major bodies of water (and thus harboring the mosquitoes that often accompanied the refugees).
This is not the only time Philadelphia enters the story of yellow fever, as this city later contributed to the eradication of the disease in the United States. In 1855, Philadelphia served as the temporary home for Cuban-born Carlos Juan Finlay.14 Finlay’s father was a physician working for the Venezuelan freedom fighter Simon Bolivar. Juan sought to emulate his father by becoming a doctor as well.15 Infectious diseases almost cut down Finlay’s aspirations on two different occasions, when his travels to France were stymied by local eruptions of cholera (1844) and typhoid fever (1848). Both outbreaks forced Carlos Finlay to return to his native Cuba. However, a third attempt went according to plan, and Finlay completed training as a physician at Jefferson Medical College in Philadelphia, where he demonstrated particular aptitude and interest in infectious diseases. Finlay trained under John Kearsley Mitchell, an early advocate of the germ theory. This was fortunate for our story, since the “miasma” theory of disease still held sway at the time and Mitchell was bucking a belief that was still predominant in most medical schools of the day.
Finally gaining an opportunity to train in France, Finlay moved from Philadelphia to Paris to study under Armand Trousseau, an internal medicine specialist who seemed to have a particular penchant for Caribbean trainees. Specifically, Trousseau had also served as preceptor for the nationalist Ramon Emeterio Betances, the “Father of the Puerto Rican nation.”16, 17 Upon Finlay’s return to Cuba, he specialized in ophthalmology but remained devoted to understanding how and why yellow fever spread throughout the population.
In 1879, Finlay was tasked by the Cuban government with identifying the means by which yellow fever spread throughout the population. Contemporary research into the disease revealed that the infectious agent was within the bloodstream, which caused Finlay to postulate, “It occurred to me that to inoculate yellow fever it would be necessary to pick out the inoculable material from within the blood vessels of a yellow fever patient and to carry it likewise into the interior of a blood vessel of a person who was to be inoculated. All of which conditions the mosquito satisfied most admirably through its bite.”18 In 1881, Finlay appeared at the 5th International Sanity Conference in Washington, D.C., where he presented evidence that the disease was primarily spread by mosquitoes. To Finlay’s amazement and considerable disappointment, his ideas were largely ignored, though not entirely.
In the same year Finlay was investigating how yellow fever spreads in Cuba, a young assistant surgeon by the name of Walter Reed was in his fourth year in the US Army Medical Corps, serving as a physician in Ft. Apache, where his wife Emilie gave birth to their first daughter (also named Emilie).19, 20 Over the next decade and a half, Reed shuffled between various Indian reservations in the western United States. His Native American patients included none other than the great Apache leader Geronimo. In 1893, Reed returned east, joining the faculty of the George Washington University School of Medicine. He was stationed at the new Army Medical School (whose medical institute would later be adorned with his name). Whereas the popular assumption had been that yellow fever was spread through contaminated drinking water, Reed contrasted the habits of those with and without the disease. A major insight occurred as Reed realized infected soldiers tended to spend time walking in the swampy areas of Washington, whereas uninfected soldiers tended to avoid those areas.21, 22
Expanding upon this finding with yellow fever, Reed traveled to Finlay’s native Cuba in the days following the 1898 Spanish-American War to study typhoid fever, a scourge of the troops serving in the newly conquered territory. This first Cuban trip was a rousing success as Reed revealed the disease was spread by flies that contaminated food and water with human waste materials.23
Two years later, Reed returned to Cuba, this time tasked with finding the cause of the pervasiveness of yellow fever in the country. The disease was a particularly high priority for the US military, given the fact that incidence of the disease had delayed and fundamentally threatened the completion of a strategic canal being carved through nearby Panama (outbreaks had frustrated and then ended construction of a 48-mile canal due to extraordinary mortality on construction teams). Based on Finlay’s breakthrough ideas, Reed worked with another army officer, William Crawford Gorgas, to implement a campaign of layered defenses against mosquitoes by purging sources of stagnant water, purifying public sources of water, and promoting the use of insecticides and insect netting. Though Walter Reed appropriately credited the Cuban physician with the breakthrough discovery, history has tended to forget this exchange and instead attributes the finding primarily, if not exclusively, to Walter Reed.24
By targeting mosquitoes rather than the virus itself, yellow fever was largely eradicated from many tropical climates throughout the Western Hemisphere, including Panama. The public health miracle facilitated the final construction of the canal and more fully opened the United States as a blue-water power on both the Atlantic and Pacific Oceans. Likewise, the incidence of yellow fever and other mosquito-borne diseases began to disappear in the United States and throughout the world following the widespread dissemination of Finlay and Reed’s breakthrough.
The disease of yellow fever had been largely eliminated, but not entirely. The eradication of the disease could be achieved through public health measures in some affluent countries, such as the United States. However, the eradication or durable suppression of mosquitoes has proven particularly challenging in countries and regions with fewer resources and more challenging climates (such as Entebbe, which serves as the perfect breeding ground for mosquitoes). In these locations, the disease could only be eliminated by the production and widespread adoption of a safe and effective vaccine.
The disease that arose in Africa was fittingly conquered by an African. Max Theiler was born in Pretoria in 1899. He completed training as a physician in South Africa and received additional training in tropical medicine in London prior to moving to Harvard University for a time. He later left Cambridge to settle down at the Rockefeller Institute, which had a strong interest in yellow fever and would create the Uganda Virus Research Institute in 1930.
In 1918, the Rockefeller Institute dedicated itself to identif
ying and eliminating the source of yellow fever. However, the program suffered from a rather inauspicious start.25 A Rockefeller bacteriologist, Hideyo Noguchi, had traveled to Ecuador to obtain samples from infected patients. After many days and weeks of analyzing the samples under a microscope, Noguchi reported that the disease was caused by a type of spiral-shaped bacterium, appropriately named a spirochete. Based on this finding, Rockefeller Institute researchers developed an antiserum and vaccine against the bacterium and tested the vaccine on thousands of volunteers.26 Unexpectedly, the vaccine proved ineffective. Moreover, the evidence linking yellow fever with the spirochete could not be duplicated by his colleagues. The conclusive evidence refuting the bacterial origin of yellow fever was delivered by another Rockefeller scientist, Max Theiler.
In 1927, Rockefeller moved its yellow fever operations to Africa, and Noguchi joined the team seeking the cause of the disease, maintaining until the end that the spirochete was responsible despite negative results from studies of more than one thousand different animals. Sadly, Noguchi’s end came soon, as he perished from yellow fever in May 1928. Just as the fever was claiming this high-profile victim, a study was being conducted that revealed the disease was caused by a filterable virus. The evidence implicating the virus had been collected in Dakar, capital of the French colony of Senegal. The sample had been taken from a patient, Francois Mayali, who had been infected with a relatively mild case of the disease. This sample was subjected to the Chamberland filter technique, which isolated a transmissible virus and not a spirochete (though spirochetes were later found to contribute to a variety of other diseases that occur in the same patients that have yellow fever).
Between Hope and Fear Page 33
