Pretty much everyone involved with HIV/AIDS in the early years crossed swords with the irascible, impolitic—but passionately, unwaveringly committed — Laurence David Kramer. In the 1980s, Kramer wrote The Normal Heart and other landmark works as he saw what the virus was doing to gay men like him — and how little the world seemed to care. He helped to found the Gay Men’s Health Crisis, the model AIDS service organization in New York, and co-founded ACT-UP (AIDS Coalition to Unleash Power), the in-your-face activist network that held the kind of demonstrations to which the genteel NIH and FDA were not accustomed.
In his obituary, the New York Times called Kramer the “Master of Provocation.” In an email to POLITICO, Fauci, whose relationship to Kramer was at first fraught and then close, recalled him as a “transforming figure in the field of public health activism.”
AIDS in the early 1980s was mysterious, frightening, lethal and stigmatic. President Ronald Reagan didn’t even mention it in public for four years; research money for what some in his White House disparagingly called the “gay plague” was not a priority.
Kramer demanded change. His mantra to the public health experts and biomedical researchers who did undertake the work was “FASTER, FASTER, FASTER,” or “NOW, NOW, NOW.” He confronted, he protested, he got in people’s faces — and he stayed there. Looking at the mounting death toll of his friends and community, he would not be mollified.
“I still know his phone number by heart,” says Tim Westmoreland — and he meant Kramer’s 1980s landline. A longtime aide to then-Rep. Henry Waxman, Westmoreland played a pivotal, behind-the-scenes role in finally securing federal research dollars for HIV/AIDS and adding to it over the years.
The public health world today has taken to heart Kramer’s lessons about confronting an epidemic — although the current administration has not always done so. Part of his message was: When an infection begins to spread, “watch the numbers, use the numbers to understand — and with that understanding, go big, and go big soon,” says Westmoreland, who now teaches health law at Georgetown. “If you allow it to smolder, it gets harder.”
Another Kramer message was that the people dying of AIDS in those days — mainly gay men, drug users, sex workers — were not disposable, even if much of society and government treated them as such. The difference with the coronavirus, Gonsalves says with a tinge of Krameresque fury, is that now everyone seems disposable “on a scale that is quite unimaginable.” Communities of color bear the brunt, but with more than 300,000 Americans dead from the virus, and counting, all of the country is affected. “Where is the outrage?” Gonsalves asks, adding that if Kramer were alive now, that’s what he would be shouting.
Yet Kramer’s outrage wasn’t all theatrics. He made scientists — Fauci among them, by his own retellings — think about Kramer’s mantra. How to go faster, faster, faster. How to do things now, now, now — while never compromising the science itself. “He was unabashedly iconoclastic and theatrical as he confronted scientists and health authorities excoriating them for real and perceived deficiencies,” Fauci recalls. “Despite his abrasive style, he was an iconic figure who opened a pathway for productive collaborations between scientists, regulators and the advocacy communities.”
For example, as HIV/AIDS research developed, scientists learned to evaluate potential drugs not just by who and how many people in a clinical trial died, but by looking for “surrogate markers,” other scientifically sound ways of figuring out earlier on in a trial whether a drug would work. “We sped it up,” says Kessler, who was the FDA commissioner under Presidents George H.W. Bush and Bill Clinton and is now advising President-elect Joe Biden on the pandemic. “We found newer scientific methodologies to do drug evaluations safely.”
Researchers haven’t found an analogous “surrogate” — like viral load measurements for HIV/AIDS — for the coronavirus, Kessler says. But in the past 20 or 30 years, there’s been a lot of progress in using both scientific and regulatory tools with roots in the AIDS era to speed drug research, drug access and drug approval for several diseases, including many cancers.
It’s not far-fetched to say that Larry Kramer’s persistence, at least in part, is to thank. All infectious disease experts who focused on AIDS had to deal with Kramer, Kessler says. “You had to endure incredible flak. But you always ended up as close friends,” he continues. “Everyone fell in love with him, eventually.”