And the Band Played On

Randy Shilts

3 ideas

1. Epidemics grow on the victims' political standing

   A pathogen sets how fast a disease can spread, but whether that spread is checked depends on how much the first people it kills are valued. Because early AIDS cases were gay men, drug users and Haitians, funding requests were delayed or cut, research went unfunded, and public warnings were held back while the case count doubled every few months. The years lost this way let the virus become far more widespread than prompt action would have allowed.

2. Each institution guards its interest, public loses

   Read the failure as many institutions each acting sensibly within their own incentives. Federal officials protected budgets, researchers fought over credit for finding the virus, blood banks protected costs and donor supply, gay community leaders defended bathhouses as sexual liberation, and newspapers waited for a 'general population' angle. No single actor caused the disaster. It came from the gaps between them, where no one was responsible for the whole threat.

3. Blood industry resisted surrogate screening after 1983

   By late 1982 the CDC had documented AIDS in hemophiliacs and transfusion recipients, and at a January 1983 meeting in Atlanta it urged blood banks to screen donors with the hepatitis B core antibody test. Blood industry representatives rejected it, citing cost, uncertain evidence and the risk of alienating donors. Most of the industry held off until the HIV antibody test arrived in 1985, while a few exceptions such as Stanford in 1983 and Irwin Memorial in 1984 screened earlier, and recipients kept being infected in the meantime.

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