Two months before veteran AIDS researcher Joep Lange perished in the Malaysia Airlines jetliner shot down over Ukraine, he was in Moscow, pressing for Russia to start programs to prevent HIV spread among drug users.
Lange was “advocating harm reduction,” said Michel Kazatchkine, a close friend of Lange and the United Nations envoy on HIV/AIDS in Eastern Europe and Central Asia. “We talked about this. We felt that in times of crisis, you need to remain engaged.”
The 59-year-old Dutch doctor, one of 298 victims on flight MH17, was on his way to the International AIDS Conference in Melbourne, where colleagues and friends expected to see again the passionate brand of advocacy he was known for. Lange reached every corner of the world through his work: pursuing trials that led to new HIV drugs, campaigning for treatment access in poor nations and mentoring the next generation of public health researchers.
“When I think of Joep, I think of the fact that he was a friend and a terrific guy,” said National Institute of Allergy and Infectious Diseases Director Anthony Fauci, an immunologist who has headed NIAID in Bethesda, Maryland, for 30 years. “It was his charismatic, activist personality, to push and do the right thing that, I think, he will be remembered much more for than for any particular experiment.”
Kazatchkine, friends and colleagues gathered at the AIDS conference describe an intellectual and humanitarian who was as caring of those closest to him as of those as far away as Thailand and Nigeria. And, as Fauci described, he was as comfortable showing him how to eat herring Dutch-style as he was corralling world leaders.
Lange, the head of global health at the Academic Medical Center of the University of Amsterdam, and his partner, Jacqueline van Tongeren, were among six delegates on board flight MH17 whose deaths have cast a shadow over the Melbourne meeting.
Lange, a former International AIDS Society president, graduated from University of Amsterdam with a medical degree in 1981. He had been a fixture at almost every major meeting on HIV for decades.
“I expect him to walk in any time,” said David Cooper, director of Australia’s first national center in HIV epidemiology and clinical research which is now part of Sydney's Kirby Institute, opening his tablet computer to show a photograph of himself and Lange taken with their daughters in Bangkok about a decade ago.
Cooper recalled gravitating toward the then 33-year-old infectious diseases physician at a reception in Paris in 1987. Doctors from across the developed world, including HIV discoverer Francoise Barre-Sinoussi, were gathered in the French capital to hear the results of one of the earliest human trials using azidothymidine, or AZT, in AIDS patients.
“There were 20 deaths in the placebo group versus one death in the AZT group,” Cooper said.
Lange and Cooper, a clinical immunologist at St. Vincent’s Hospital in Sydney at the time, were excited by the results. Over drinks on the Left Bank, the two men plotted how they could test AZT on HIV patients with less advanced disease in trials that eventually proved the drug could stave off deadly manifestations of AIDS.
In the early 1990s, Lange became convinced that three antiretroviral medications needed to be used in combination because single-tablet treatments were stoking drug resistance.
He was instrumental in persuading pharmaceutical companies, initially reluctant to testing combination HIV therapies, to pursue the trials, said Cooper. Working in the Netherlands, he joined forces with Cooper in Sydney, Julio Montaner in Vancouver and Stefano Vella in Rome to investigate the combination of drugs nevirapine, didanosine and zidovudine. The researchers called their international collaboration the INCAS group. Montaner presented their findings at the 11th International AIDS Society-USA Conference in July 1996.
The results were stunning. The viral loads of half of the participants fell to undetectable levels after a year of treatment. The research marked a turning point in the battle against AIDS. There was now a way to suppress HIV such that it would be rendered a chronic infection, not certain death.
“If it wasn’t for Joep, that study wouldn’t have been done,” Cooper said. “It wasn’t that he was the only voice, but he was the most persuasive, and that persuasion probably saved millions of lives.”
Lange’s “really transforming contributions were his personality and his passion,” NIAID’s Fauci said. “He was fundamentally a very likable, gentle person who could in a very productive way really get in your face about pushing people, governments and things to do the right thing.”
Fauci and Lange first crossed paths when they were studying the relationship between HIV viral load and disease progression. They met in person at a reception for an AIDS meeting in Amsterdam in the late 1980s, Fauci recalls. Young, fresh out of his fellowship, Lange taught him the proper Dutch way to eat herring, Fauci said
“You grab it and you go,’” Fauci said, tilting his head back and making out to drop something into his wide-opened mouth. “And that’s the way you eat herring: straight down,” he said, laughing.
Lange was one of the earliest proponents of the “test and treat” concept that aimed to initiate antiretroviral therapy as soon as someone tested positive, instead of waiting for the virus to deplete key immune cells, Fauci said. Early treatment made those infected less likely to pass the virus to others.
Kazatchkine’s 25-year friendship with Lange was cemented during preparations for the 2nd IAS Conference on Pathogenesis and Treatment in Paris in 2003. Kazatchkine, then head of the French National Agency for AIDS Research, the event host, was one of the main organizers. Lange, who was then the IAS president, and Van Tongeren would come to Paris regularly for meetings.
Then-presidents Nelson Mandela of South Africa, Fernando Henrique Cardoso of Brazil and Jacques Chirac of France also attended the Paris conference, which was one of the first to push for access to treatment in the developing world.
Lange “became passionate about the fact that 90 percent of the epidemic was in the developing world, and these people were dying without any access,” Cooper said.
Lange pressed Fauci constantly about the need to do more trials in developing countries and improve their access to lifesaving drugs, the American doctor said. “His favorite quote was, ‘If you can get Coca-Cola to the far reaches of Africa, why can’t you get antiretroviral drugs there?’”
Cooper and Lange worked with Praphan Phanuphak, a clinical immunologist with the Thai Red Cross, to establish HIVNAT in 1996, as a vehicle for bringing clinical research to the developing world. To promote better access, he worked on every step, from scientific evidence, to pricing to insurance coverage, including a program in Nigeria, Kazatchkine said.
“People are talking about his brilliant research side, but he mentored so many scientists in Southeast Asia and around the world,” said Deborah Birx, ambassador-at-large and coordinator of the U.S. government’s activities to combat HIV/AIDS globally, who worked in Thailand around the same time as Lange. “A lot of scientists won’t take the time to do that.”