842
16.
17.
18.
19.
20.
21.
22. 23.
Wezel AL, van Steenis G, van der Marel IP, Osterhaus ADME. Inactivated polio virus vaccine: current production methods and new developments. Rev Infect Dis 1984; 6 suppl 2: S335. Ogra PL, Karzon DT, Righthand F, McGillivrancy M. Immunoglobulin response in serum and secretions after immunization with live and inactivated polio vaccine and natural infection. N Engl J Med 1968; 279: 893-900. Nishio O, Ishihara Y, Sakae K, et al. The trend of immunity with live polio virus vaccine and the effect of revaccination: follow up of vaccinees for ten years. J Biol Stand 1984; 12: 1-10. Marine WM, Chin TDY, Gravelle CR. Limitation of fecal and pharyngeal polio virus excretion in Salk vaccinated children. Am J Hyg 1962; 76: 173-95. Henry JL, Jaikaran ES, Davies JR, et al. A study of polio vaccination in infancy: excretion following challenge with live virus by children given killed or living polio vaccine. J Hyg 1966; 64: 105-20. Cossart YE. Evolution of polio virus since the introduction of attenuated vaccine. Br Med J 1977; 1: 1621-23. Kim-Farley RJ, Rutherford G, Lichfield, et al. Outbreak of paralytic poliomyelitis in Taiwan. Lancet 1984; ii: 1322-24. Fox JP, Gelfand HM, Leblanc DR, Rowan DF. The influence of natural and artificially induced immunity on alimentary infections with polio viruses. Am J Public Health 1958; 48: 1181-92. van
24.
Schaap GJ, Bijkerk H, Coutinho RA, et al. The spread of wild polio virus
in the well vaccinated Netherlands in connection with the 1978 epidemic. Prog Med Virol 1984; 29: 124-40. 25. Hovi T, Cantell K, Herovilainen A, et al. Outbreak of paralytic poliomyelitis in Finland: widespread circulation of antigenically altered polio virus type 3 in a vaccinated population. Lancet 1986; i: 1427-32 26. Magrath DI, Evans DMA, Ferguson M, et al. Antigenic and molecular properties of type 3 polio virus responsible for an outbreak of poliomyelitis in a vaccinated population. J Gen Virol 1986; 67: 899-905. 27. Montagnon B, Fauget B, Vincent-Falquet JC. Industrial scale production of inactivated polio virus vaccine prepared by culture of Vero cells on microcarriers. Rev Infect Dis 1984; 6 suppl 2: 341-44. 28. Skinner MA, Racaniello VR, Dunn G, Cooper J, Minor PD, Almond JW. A new model for the secondary structure of the 5’ non coding RNA of polio virus is supported by biochemical and genetical data that also show that RNA secondary structure is important in neurovirulence. J Mol Biol 1989; 207: 379-92. 29. Griffiths AH. Permanent brain damage and pertussis vaccination. Is the end of the saga in sight? Vaccines 1989; 7: 199-210. 30. McBean AH, Thoms ML, Johnson RH, Gadless BR, MacDonald B. A comparison of the serologic responses to oral and injectable trivalent polio virus vaccines. Rev Infect Dis 1984; 6 suppl 2: S552-55.
VIEWPOINT AIDS in Africa:
problems for research and researchers
AIDS continues to spread in Africa and has already claimed many young lives. Much more research into AIDS and human immunodeficiency virus (HIV) infection in Africa is needed, especially into epidemiological and behavioural aspects of HIV transmission, the natural history of HIV infection, and its influence on other infectious diseases. But AIDS researchers in Africa face some difficult problems, several partly self-inflicted or caused by colleagues from overseas. AIDS will only be treatable or preventable-if ever-when HIV infection is more fully understood. It is therefore essential for AIDS researchers and national governments in Africa to recognise and to overcome these
problems by working together; people are more important than pride.
"Origin" of AIDS AID S was first recognised in the USA in 1981,1but was not described in black Africans until 1983.2 Nevertheless, on recognition of these African AIDS patients, some western scientists speculated that HIV may have originated in Africa, and the distribution of Kaposi sarcoma-a malignancy frequently associated with AIDS and which is endemic in east and central Africa-was held to be "strong evidence" for this hypothesis. As a result, there was an influx of scientists to try to prove this theory, and others who had access to African serum decided to analyse it for HIV antibodies.3
This somewhat unscientific approach led to some useful information, including a better understanding of the relation of HIV-1, HIV-2, and simian immunodeficiency virus (SIV), but early emphasis on "discovering the origin of AIDS in Africa" was pejorative and unfortunate. Many African politicians strongly resented this emphasis, and sensationalised reports in the western mass media, with unfortunate results. Some African governments initially denied the presence of AIDS in their countries, which delayed the start of health education programmes and protection against cross-infection in hospitals, and ensured further spread of HIV. Similarly, the motives of foreign researchers were viewed with extreme suspicion-suspicion that was readily transferred to their African coworkers. In several countries, governments insisted on a right to carefully scrutinise information collected by local researchers before it was released, which caused further delays and a further deterioration of relations between African researchers and both their overseas colleagues and home governments. The inaccuracies and misinformation perpetuated by western and, to a certain extent, local media have been
ADDRESS: Department of Medicine, Makerere University Medical School, Mulago Hospital, PO Box 7051, Kampala, Uganda (D Serwadda, MB, E. Katongole-Mbidde, MRCP) Correspondence to Dr D. Serwadda.
843
discussed
at
length, for example by Konotey-Ahulu4
and
Sabatier,5 but inaccuracies persist. HIV seroprevalence
INFORMATION FOR AUTHORS
often quoted as representative of a whole country, and may even be extrapolated to apply to the whole continent. This does not just upset governments: inaccurate and indiscriminate media reports of seroprevalence rates make patients and local populations reluctant to participate in further hospital or community-based studies, especially in areas for which high seroprevalence rates have been described (and in which further studies are most needed).
The Lancet does not refuse to look at papers that fail to the journal’s style requirements, but it much prefers to see submissions meeting the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, prepared by the International Committee of Medical Journal Editors, of which The Lancet is a member (see Br A4ed _7 1988; 296: 401-05 or Ann Intern Med 1988; 108: 258-65). Especially important is the need for double-spaced typing on one side of the paper; for references to carry titles and final page numbers; and for three copies of submitted articles. Submissions by FAX are not welcome and will only be evaluated after prior agreement with the
figures from small local
Research
surveys
goals and
Collaborative studies
can
are
data management
encounter
other
problems,
prominent amongst which may be a divergence between the goals of African and of western researchers. Although perhaps from good intentions, such as a desire to understand the virus and to find novel treatments as soon as possible, it sometimes seems that researchers (and funding agencies) from overseas find it easier than their local colleagues to overlook the suffering caused by AIDS to individuals and communities in Africa. Several western-financed studies have not included a service commitment to the local population, and there is a tendency to address problems more relevant to western populations rather than those felt most appropriate by local workers. As the volume of data from collaborative studies increases, many African researchers have found themselves ill-equipped to analyse such huge quantities of information-and financial constraints often mean that they cannot take the time needed to obtain the necessary training, and often have other time-consuming clinical commitments. In the haste to interpret results, data have been analysed locally by short-contract experts, or even exported for analysis elsewhere (and sometimes presented or published without further consultation with African collaborators, or consideration of its effects on the study population). Such behaviour is at best discourteous; whether, under international law, it amounts to theft of data remains uncertain.
The way ahead On the one hand, Africa needs financial, medical, and scientific support to cope with the clinical effects of HIV infection and for further research. On the other, research into AIDS in Africa may be crucial to our understanding of how best to control HIV infection-of benefit throughout the world. Is it too much to ask for western media to be more responsible, and African governments less sensitive? Or for collaborative research to include a greater financial commitment to the clinical needs of the study population, and towards training of local collaborators?
REFERENCES 1. Pneumocystis
pneumonia—Los Angeles. MMWR 1981; 30: 250-52. N, Mascart-Lemone F, de Maubeuge J, Brenez D, Marcelis L. Acquired immunodeficiency syndrome in black Africans. Lancet 1983;
2. Clumeck
i: 642. 3.
Levine PH, Dean AG, de The G, Sarngadharan MG, Gallo RC. Evidence for exposure to HTLV-III in Uganda prior to 1973. Science 1984; 225: 1473-76. 4. Konotey-Ahulu FID. AIDS in Africa: misinformation and disinformation. Lancet 1987; ii: 206-07. 5. Sabatier R. Blame and counter-blame in blaming others. London: Panos, 1988: 85-101.
Saxinger WC,
meet
journal. Length of contributions. Authors can improve their chances of success if they observe the following word limits: articles, not more than 3000 (roughly twelve pages of typescript on A4); preliminary reports and hypotheses, 1500; letters, 500. To these limits to the body of the text may be added a title page; a summary of not more than 150 words, tables, illustrations, and legends; and references (preferably not more than 30 for articles and 10 for letters). Addresses. Details of addresses of all authors, a single qualification such as MD or PhD, and full professorships are published as a footnote to papers, and this information should be provided on the title page of the manuscript. A full address should be provided for the corresponding author, and the journal will need to know if this author differs from the one for editorial communications, including proofs. Authorship. The journal may ask for justification of authorship (see Lancet 1985; ii: 595). Covering letter. Every reasonable effort should be made for all authors to sign the covering letter. In this letter authors may wish to indicate any concessions they are willing to make, such as the omission of tables, figures, references, or parts of the text. Single copies of work that is unpublished, submitted, or in press, and is important to the argument, should be enclosed. Dual publication. If material in a submitted article has been published before or is to appear in part or whole elsewhere, the Editor must be informed. Acknowledgment of receipt. The receipt of papers (but not letters) is acknowledged immediately, a reference number for future inquiries being provided. Peer review. Every paper submitted is read by two or more of The Lancet’s editorial team of physicians and scientists. All those shortlisted for publication in the section Medical Science are then sent to one or more external advisers. Peer review is used more selectively for other categories of article and for letters. Proofs. Authors should arrange for proofs of articles to be returned within 48 hours. When proofs of letters are sent, the journal needs to have corrections as quickly as possible. Reprints. Within a few days of publication of a paper 100 offprints are despatched free of charge. Reprints must be ordered through The Lancet’s Reprint Department in London or Baltimore (for inquiries from North America). Copyright. Authors are assumed, with exceptions such as certain government employees, to transfer to The Lancet the copyright in their words, and this will be confirmed formally at proof stage for articles. Single copies can be made by individual clinicians or research workers for personal use without permission or payment. Multiple copying can be done only with the agreement of the journal’s Permissions Department in London, to which any requests for republication or translation should be addressed.
16.
17.
18.
19.
20.
21.
22. 23.
Wezel AL, van Steenis G, van der Marel IP, Osterhaus ADME. Inactivated polio virus vaccine: current production methods and new developments. Rev Infect Dis 1984; 6 suppl 2: S335. Ogra PL, Karzon DT, Righthand F, McGillivrancy M. Immunoglobulin response in serum and secretions after immunization with live and inactivated polio vaccine and natural infection. N Engl J Med 1968; 279: 893-900. Nishio O, Ishihara Y, Sakae K, et al. The trend of immunity with live polio virus vaccine and the effect of revaccination: follow up of vaccinees for ten years. J Biol Stand 1984; 12: 1-10. Marine WM, Chin TDY, Gravelle CR. Limitation of fecal and pharyngeal polio virus excretion in Salk vaccinated children. Am J Hyg 1962; 76: 173-95. Henry JL, Jaikaran ES, Davies JR, et al. A study of polio vaccination in infancy: excretion following challenge with live virus by children given killed or living polio vaccine. J Hyg 1966; 64: 105-20. Cossart YE. Evolution of polio virus since the introduction of attenuated vaccine. Br Med J 1977; 1: 1621-23. Kim-Farley RJ, Rutherford G, Lichfield, et al. Outbreak of paralytic poliomyelitis in Taiwan. Lancet 1984; ii: 1322-24. Fox JP, Gelfand HM, Leblanc DR, Rowan DF. The influence of natural and artificially induced immunity on alimentary infections with polio viruses. Am J Public Health 1958; 48: 1181-92. van
24.
Schaap GJ, Bijkerk H, Coutinho RA, et al. The spread of wild polio virus
in the well vaccinated Netherlands in connection with the 1978 epidemic. Prog Med Virol 1984; 29: 124-40. 25. Hovi T, Cantell K, Herovilainen A, et al. Outbreak of paralytic poliomyelitis in Finland: widespread circulation of antigenically altered polio virus type 3 in a vaccinated population. Lancet 1986; i: 1427-32 26. Magrath DI, Evans DMA, Ferguson M, et al. Antigenic and molecular properties of type 3 polio virus responsible for an outbreak of poliomyelitis in a vaccinated population. J Gen Virol 1986; 67: 899-905. 27. Montagnon B, Fauget B, Vincent-Falquet JC. Industrial scale production of inactivated polio virus vaccine prepared by culture of Vero cells on microcarriers. Rev Infect Dis 1984; 6 suppl 2: 341-44. 28. Skinner MA, Racaniello VR, Dunn G, Cooper J, Minor PD, Almond JW. A new model for the secondary structure of the 5’ non coding RNA of polio virus is supported by biochemical and genetical data that also show that RNA secondary structure is important in neurovirulence. J Mol Biol 1989; 207: 379-92. 29. Griffiths AH. Permanent brain damage and pertussis vaccination. Is the end of the saga in sight? Vaccines 1989; 7: 199-210. 30. McBean AH, Thoms ML, Johnson RH, Gadless BR, MacDonald B. A comparison of the serologic responses to oral and injectable trivalent polio virus vaccines. Rev Infect Dis 1984; 6 suppl 2: S552-55.
VIEWPOINT AIDS in Africa:
problems for research and researchers
AIDS continues to spread in Africa and has already claimed many young lives. Much more research into AIDS and human immunodeficiency virus (HIV) infection in Africa is needed, especially into epidemiological and behavioural aspects of HIV transmission, the natural history of HIV infection, and its influence on other infectious diseases. But AIDS researchers in Africa face some difficult problems, several partly self-inflicted or caused by colleagues from overseas. AIDS will only be treatable or preventable-if ever-when HIV infection is more fully understood. It is therefore essential for AIDS researchers and national governments in Africa to recognise and to overcome these
problems by working together; people are more important than pride.
"Origin" of AIDS AID S was first recognised in the USA in 1981,1but was not described in black Africans until 1983.2 Nevertheless, on recognition of these African AIDS patients, some western scientists speculated that HIV may have originated in Africa, and the distribution of Kaposi sarcoma-a malignancy frequently associated with AIDS and which is endemic in east and central Africa-was held to be "strong evidence" for this hypothesis. As a result, there was an influx of scientists to try to prove this theory, and others who had access to African serum decided to analyse it for HIV antibodies.3
This somewhat unscientific approach led to some useful information, including a better understanding of the relation of HIV-1, HIV-2, and simian immunodeficiency virus (SIV), but early emphasis on "discovering the origin of AIDS in Africa" was pejorative and unfortunate. Many African politicians strongly resented this emphasis, and sensationalised reports in the western mass media, with unfortunate results. Some African governments initially denied the presence of AIDS in their countries, which delayed the start of health education programmes and protection against cross-infection in hospitals, and ensured further spread of HIV. Similarly, the motives of foreign researchers were viewed with extreme suspicion-suspicion that was readily transferred to their African coworkers. In several countries, governments insisted on a right to carefully scrutinise information collected by local researchers before it was released, which caused further delays and a further deterioration of relations between African researchers and both their overseas colleagues and home governments. The inaccuracies and misinformation perpetuated by western and, to a certain extent, local media have been
ADDRESS: Department of Medicine, Makerere University Medical School, Mulago Hospital, PO Box 7051, Kampala, Uganda (D Serwadda, MB, E. Katongole-Mbidde, MRCP) Correspondence to Dr D. Serwadda.
843
discussed
at
length, for example by Konotey-Ahulu4
and
Sabatier,5 but inaccuracies persist. HIV seroprevalence
INFORMATION FOR AUTHORS
often quoted as representative of a whole country, and may even be extrapolated to apply to the whole continent. This does not just upset governments: inaccurate and indiscriminate media reports of seroprevalence rates make patients and local populations reluctant to participate in further hospital or community-based studies, especially in areas for which high seroprevalence rates have been described (and in which further studies are most needed).
The Lancet does not refuse to look at papers that fail to the journal’s style requirements, but it much prefers to see submissions meeting the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, prepared by the International Committee of Medical Journal Editors, of which The Lancet is a member (see Br A4ed _7 1988; 296: 401-05 or Ann Intern Med 1988; 108: 258-65). Especially important is the need for double-spaced typing on one side of the paper; for references to carry titles and final page numbers; and for three copies of submitted articles. Submissions by FAX are not welcome and will only be evaluated after prior agreement with the
figures from small local
Research
surveys
goals and
Collaborative studies
can
are
data management
encounter
other
problems,
prominent amongst which may be a divergence between the goals of African and of western researchers. Although perhaps from good intentions, such as a desire to understand the virus and to find novel treatments as soon as possible, it sometimes seems that researchers (and funding agencies) from overseas find it easier than their local colleagues to overlook the suffering caused by AIDS to individuals and communities in Africa. Several western-financed studies have not included a service commitment to the local population, and there is a tendency to address problems more relevant to western populations rather than those felt most appropriate by local workers. As the volume of data from collaborative studies increases, many African researchers have found themselves ill-equipped to analyse such huge quantities of information-and financial constraints often mean that they cannot take the time needed to obtain the necessary training, and often have other time-consuming clinical commitments. In the haste to interpret results, data have been analysed locally by short-contract experts, or even exported for analysis elsewhere (and sometimes presented or published without further consultation with African collaborators, or consideration of its effects on the study population). Such behaviour is at best discourteous; whether, under international law, it amounts to theft of data remains uncertain.
The way ahead On the one hand, Africa needs financial, medical, and scientific support to cope with the clinical effects of HIV infection and for further research. On the other, research into AIDS in Africa may be crucial to our understanding of how best to control HIV infection-of benefit throughout the world. Is it too much to ask for western media to be more responsible, and African governments less sensitive? Or for collaborative research to include a greater financial commitment to the clinical needs of the study population, and towards training of local collaborators?
REFERENCES 1. Pneumocystis
pneumonia—Los Angeles. MMWR 1981; 30: 250-52. N, Mascart-Lemone F, de Maubeuge J, Brenez D, Marcelis L. Acquired immunodeficiency syndrome in black Africans. Lancet 1983;
2. Clumeck
i: 642. 3.
Levine PH, Dean AG, de The G, Sarngadharan MG, Gallo RC. Evidence for exposure to HTLV-III in Uganda prior to 1973. Science 1984; 225: 1473-76. 4. Konotey-Ahulu FID. AIDS in Africa: misinformation and disinformation. Lancet 1987; ii: 206-07. 5. Sabatier R. Blame and counter-blame in blaming others. London: Panos, 1988: 85-101.
Saxinger WC,
meet
journal. Length of contributions. Authors can improve their chances of success if they observe the following word limits: articles, not more than 3000 (roughly twelve pages of typescript on A4); preliminary reports and hypotheses, 1500; letters, 500. To these limits to the body of the text may be added a title page; a summary of not more than 150 words, tables, illustrations, and legends; and references (preferably not more than 30 for articles and 10 for letters). Addresses. Details of addresses of all authors, a single qualification such as MD or PhD, and full professorships are published as a footnote to papers, and this information should be provided on the title page of the manuscript. A full address should be provided for the corresponding author, and the journal will need to know if this author differs from the one for editorial communications, including proofs. Authorship. The journal may ask for justification of authorship (see Lancet 1985; ii: 595). Covering letter. Every reasonable effort should be made for all authors to sign the covering letter. In this letter authors may wish to indicate any concessions they are willing to make, such as the omission of tables, figures, references, or parts of the text. Single copies of work that is unpublished, submitted, or in press, and is important to the argument, should be enclosed. Dual publication. If material in a submitted article has been published before or is to appear in part or whole elsewhere, the Editor must be informed. Acknowledgment of receipt. The receipt of papers (but not letters) is acknowledged immediately, a reference number for future inquiries being provided. Peer review. Every paper submitted is read by two or more of The Lancet’s editorial team of physicians and scientists. All those shortlisted for publication in the section Medical Science are then sent to one or more external advisers. Peer review is used more selectively for other categories of article and for letters. Proofs. Authors should arrange for proofs of articles to be returned within 48 hours. When proofs of letters are sent, the journal needs to have corrections as quickly as possible. Reprints. Within a few days of publication of a paper 100 offprints are despatched free of charge. Reprints must be ordered through The Lancet’s Reprint Department in London or Baltimore (for inquiries from North America). Copyright. Authors are assumed, with exceptions such as certain government employees, to transfer to The Lancet the copyright in their words, and this will be confirmed formally at proof stage for articles. Single copies can be made by individual clinicians or research workers for personal use without permission or payment. Multiple copying can be done only with the agreement of the journal’s Permissions Department in London, to which any requests for republication or translation should be addressed.
