The Impatient Dr. Lange: One Man's Fight to End the Global HIV Epidemic

1   The End

The plane would crash in six hours, and his face would be on the news. American television anchors would mangle his Dutch name, stretching and shortening the o and the e into swooping ooo’s and snappy a’s as they described him: genius scientist, AIDS fighter, medical diplomat, father of five, humanitarian, mastermind of a potential cure for HIV. Dr. Joseph Marie Albert Lange, better known as Joep—pronounced Yoop—was dead, and the world wondered if the cure for HIV lay singed and scattered across a field in the Ukraine.

The rebels had shot down the wrong plane. Joep, who was known for publicly cursing out fools even when those fools were presidents and Nobel Prize winners, probably muttered stupid and God verdomme in Dutch from seat 3C in flight MH17’s business class as the plane was pierced by shrapnel. A Buk ground-to-air missile fired by pro-Russian separatists had exploded near its nose.

Damn those idiots fighting a bloody war with Russia. Damn the air traffic controllers for flying his plane into a war zone.

Joep didn’t even like Malaysia Airlines. He had racked up millions of miles on his favorite airline, KLM, as he flew around the world chasing a viral epidemic. But Malaysia Airlines flight MH17 offered the cheapest business class tickets from Amsterdam to Melbourne, where he was headed to speak at the twentieth International AIDS Conference.

Sixteen thousand people waited for him in Melbourne, waited to hear the Dutch doctor with the soft voice and the words that cut like knives. Joep spoke his mind. He didn’t hide behind jargon or politics. He had put his neck on the line since the very beginning of the epidemic—which coincided with the beginning of his career—by advocating for the poor and the vulnerable, taking positions his peers called fanciful and absurd. On the highest platforms, at the biggest AIDS conferences, Joep disagreed with the world’s top scientists and refused to settle for the status quo—a status quo that favored the white and the wealthy.

He called scientists and policy makers cowards and imbeciles when they said it was too difficult to get lifesaving AIDS drugs to Africans. If we can get cold Coca-Cola and beer to every remote corner of Africa, surely we can do the same with drugs, was his mantra.

Joep first met AIDS in the summer of 1981. He was twenty-six years old, fresh out of medical school, and about to come face to face with a new and mysterious killer. The men who walked into the emergency room of his Amsterdam hospital, their bodies feverish, their eyes glassy and rimmed with blue-gray circles, were the same age as he, sometimes younger. Walking corpses collapsed onto gurneys, their bodies rattled with an infection so new to humanity that there was no primer for battling it.

The virus floating through their veins, burrowing into their brains, and making its home in their glands had jumped from monkeys to humans, morphing and mutating along the way. It attacked the immune system, the very part of the body designed to keep intruders at bay. Joep’s patients were left wide open to a slew of bizarre infections that grew inside their lungs and crept beneath their skin. The young men with hollowed-out eyes coughed raspy coughs and sat in pools of diarrhea. They died slow, drawn-out deaths.

There was no dignity in AIDS, only bewilderment. Young lovers were left bereft, parents were dazed. Joep rolled up his sleeves and got to work pressing his palms into bellies, asking his young patients questions about sex and desire. He packed his bags with novels and notepads and flew to San Francisco, London, and Sydney to talk to doctors who said their patients were dying of the same plague and there was nothing they could do to save them.

AIDS was a guaranteed death sentence back then—Joep helped to change that. He ran from the ward to the lab clutching vials of his patients’ blood in his long fingers, the tails of his white coat flapping as he hurried along the corridors of the University of Amsterdam’s Academic Medical Center. This new disease couldn’t be battled at the bedside alone. He needed to be at the lab bench, interrogating the virus that caused AIDS.

Switching between stethoscope and microscope, petri dishes and patients, Joep stripped HIV to its bare bones, revealing the virus’s anatomy and deciphering its Achilles’ heel. While working on his PhD in the mid-1980s, he made seminal discoveries about HIV and AIDS. Over the next thirty years, he published close to four hundred articles and saved, by some estimates, millions of lives.

When Joep stepped onto the Malaysia Airlines plane on July 17, 2014, he was beside the love of his life, Jacqueline van Tongeren, a woman who had embraced half a dozen careers before she embraced him. Jacqueline was the picture of elegance, shiny brown hair swept her shoulders, couture frocks swished around her calves. High cheekbones and smooth skin belied her sixty-four—soon to be sixty-five—years. Jacqueline’s birthday was just nine days away. Joep would turn sixty in September.

They had met on the AIDS ward of the University of Amsterdam’s Academic Medical Center in 1990, when she was hired as head nurse. Jacqueline was in a relationship back then, and Joep was married to the mother of his five children. Eventually, their decades-long friendship bloomed into a love affair that they announced to knowing friends and family seven years before their deaths.

Jacqueline sat upright in 3A, the window seat next to Joep, her posture honed from years of dancing ballet. She eyed Malaysia Airlines’ business class menu and texted her friend, Han Nefkens, that she was excited to taste the delicious Asian food that reminded her of Indonesia, where she was born. She had already emailed her brother to share some important news.

The night before she boarded flight MH17, Jacqueline prepared her will. Her younger brother, Philip Flip van Tongeren, was the executor. I meant to call you to tell you, she wrote in an email she sent him at one a.m.

There was another secret to share. After years of living apart, the pair had purchased a new home together—a love nest. They would move in when they got back from Melbourne in ten days. Joep planned to write a novel there, Jacqueline hoped to use it as a base while they traveled around the world spending month-long stints in their dream destinations. Of course, they would never stop battling the HIV epidemic. They had seen up close how a virus could creep into bodies and destroy white blood cells, then jump across borders and crush economies.

Now the air above a Ukrainian village was choked with smoke and regret. Guidebooks to the Australian outback turned to cinder, the faces of koala bears crumpled and burned. Travel toothbrushes melted into plastic puddles among stalks of scorched, yellow grass. The wrecked body of the plane lay strewn across the field, jagged pieces of its belly and tail still smoldering.

Every person on board was dead. Two hundred and ninety-eight Australians, Indonesians, Malaysians, Brits, Dutch, Germans, Belgians, Filipinos, with one American, one Canadian, and one New Zealander. Among the dead: three babies, seventy-seven children, a nun, a helicopter pilot, five AIDS researchers. An Australian couple who lost their son and daughter-in-law on another Malaysia Airlines plane, flight MH370, when it disappeared in March that year, lost their granddaughter on flight MH17. Bodies rained down over houses and fields. Their limbs and lives became bargaining chips for pro-Russian separatists.

But death was still six hours away. It was a cool summer morning in Amsterdam and Jacqueline was crouching on the floor of her apartment, cramming Missoni skirts and Comme des Garcons blouses into a suitcase already stuffed with shoes. She texted her best friend, Peggy van Leeuwen: I’m like the Imelda Marcos of Holland!

Joep was shooting off a sarcastic email to one of his staffers, squeezing medical journals and three novels into a laptop bag to read on the plane, then looping a leash around his diabetic Irish terrier’s neck. He stroked Lizzy’s soft gray fur. They stepped onto Beethovenstraat, the tony street he lived on with his children, for a stroll before the long flight. The air was fresh, Lizzy was weaving in and out of his legs. He waved at a friend driving past them.

2   Origin Stories

It was a breezy morning in August 1961 when a teenaged boy stepped onto a merchant ship in the Oslofjord docks in Norway. Arne Vidar Røed had just turned fifteen and earned a job as a kitchen hand aboard the Hoegh Aronde, a four-thousand-ton cargo ship.

It was Arne’s first day as a sailor. What could be more thrilling to a teenaged boy than leaving behind the frosty waters of Scandinavia and floating toward the warm waves of the Gulf of Guinea?

Ship life bore its own tedium. Restless from months marooned on the metal vessel with only men for companionship, Arne was ready for adventure. He stepped off the ship in Douala, Cameroon’s largest city, and found it heaving with the traffic of hard-working people—fishermen, ship makers, farmers—people who used the strength of their bodies to make a living.

Ramshackle bars wafted sweat and the sounds of bikutsi music through the streets. Arne knocked back beer and stomped his feet with a new friend who taught him how to thrust his hips in time to the beat. When he boarded the ship days later, he carried with him a souvenir from that night. It was gonorrhea, the first of three sexually transmitted infections he acquired on his virgin voyage.

Arne sailed north with his new microbial companion, stepping ashore at ports in Nigeria, Ghana, Côte d’Ivoire, Liberia, Guinea, and Senegal. It would be ten months before he returned home to Norway, another four years before a nameless parasite inside his veins would flow to the surface.

In the meantime, with his infectious memento still buried deep inside him, the merchant seaman sailed to Canada, the Caribbean, Asia, and Europe. Besides a two-day stop in Mombasa, Kenya, in the mid-1960s, Arne never returned to Africa.

In 1965, Arne settled down in Oslo, married, and had a baby girl. By the time his second daughter was born in 1966, the young father’s joints were swollen and hot, his chest was tight and congested, and his muscles ached deeply. The glands beneath Arne’s jaw were tender, throbbing knots. Angry lumps poked out along the creases of his groin and in his armpits. Crops of red blisters dotted his chest and back.

Arne’s doctors were baffled. In an Oslo clinic, they listed the young man’s maladies and scratched their heads. Occam’s razor is a philosophical law applied to medicine. It guides a doctor to link every one of the patient’s problems to a single unifying diagnosis. But what would explain a cough, fever, strange rashes, swollen lymph nodes, and aching joints? Perhaps Hickam’s dictum, the counterargument to Occam’s law of parsimony, was at play. Hickam’s dictum states that patients can have as many different diseases as they please. Yes, that was it.

The doctors gave Arne a vague and useless diagnosis of a connective tissue disorder. They scribbled a prescription instructing the pharmacist to dispense steroid pills. They hoped this would dampen the immune system’s rage.

Then Arne’s wife fell sick. Minor urinary tract infections flared into major diseases of her bladder and kidneys. Her tongue sprouted a furry coat of white fungus, her brain swelled against her skull. She was diagnosed with leukemia.

Arne’s symptoms waxed and waned. Too sick to sail, he took on work as a truck driver delivering cargo across the Netherlands, Austria, Germany, and France. His two eldest children were happy, healthy girls, but when his youngest daughter turned two she fell sick with bizarre infections rarely seen in children. Her lungs bloomed with the same white fungus that coated her mother’s tongue. The spores refused to budge, even though her parents fed her spoonfuls of a gloopy, pink, antifungal syrup.

Bacteria invaded the little girl’s body—her joints, bones, and blood were colonized with Staphylococcus aureus and Haemophilus influenzae. Then a virus attacked. Varicella-zoster, the bug that causes chickenpox and shingles, spread through her organs killing her before her third birthday.

The grieving father groaned beneath the pains in his hips and knees. Swellings and rashes continued to flare up and down his body. At twenty-nine years old, Arne became incontinent, soiling his trousers throughout the day. When he went to visit the doctors again, they watched as he hobbled through the clinic hallways. His legs were becoming paralyzed. Arne babbled like a madman. The doctors scribbled dementia and unknown etiology in his medical notes.

Arne died three months after his youngest daughter’s death. It was April 1976, three months before his thirtieth birthday. His wife died in December, leaving doctors triply perplexed. Dr. Stig Fredrik Frøland, a physician at the National Hospital in Norway, cut open their bodies and pulled out organs riddled with fungi, bacteria, and viruses. Their spinal cords dripped pus, their spleens were withered, their immune systems massacred.

No doctor could name the illness or explain why the trio had suffered fulminant deaths. One Norwegian doctor had an idea. He took it to Italy. At a meeting of the Italian-Scandinavian neuropathological society in Rome in 1977, Dr. Christian Fredrik Lindboe, a colleague of Dr. Frøland, presented the unusual cases.

He clicked through slides of the young girl’s lymphoid tissue, her father’s brain, her mother’s spleen. He showed their nerve cells mangled by an unknown attacker, their T helper cells all but vanished. To the room of neurologists and pathologists, he dared to pose a hypothesis: perhaps an infectious agent—a virus—was responsible for their deaths. Dr. Lindboe was right, but it would be eleven years before he could prove it.

In 1987, he went back to the hospital’s freezers with Dr. Frøland, thawed the family’s archived blood samples, and searched their remains for a peculiar virus making the news. Thousands had died from a plague that was spreading across the globe, and now there was a way to test for the new infection. They tested the samples. Arne, his wife, and their daughter were positive for the human immunodeficiency virus.

But in science as in other aspects of life, timing is important, Dr. Lindboe said. And we were definitely too early this time.

Arne’s aching hands may have steered his cargo truck up and down the flat roads of northern Holland into the hills of southern Holland in 1971, just as a lanky, softly spoken seventeen-year-old boy was hatching his own plans to escape provincial life and embark on an international voyage.

Joseph Marie Albert Lange, known to everyone as Joep, lived in the town of Den Briel, its name derived from the Celtic word brogilo, meaning closed off. The teenager wanted desperately to get out.

His life had been a series of moves to increasingly larger towns. Joep was born in 1954 in Nieuwenhagen, a bucolic coal-mining village in the southern tip of the country, where life revolved around the pair of imposing Catholic churches a few hundred yards from his house.

Nieuwenhagen sat in Limburg, the Netherlands’ southernmost province and the only part of the country that wasn’t flat. Joep’s birthplace was home to some of the best chocolate and beer in Holland, but it was deeply Catholic and claustrophobic.

On a map of the Netherlands, Limburg juts out of the mainland like a polyp on a stalk, burying itself into Germany on the east and Belgium on the west. Brussels and Cologne were closer to Joep’s hometown than the country’s own capital, Amsterdam. Up north, the city folk looked down on their southern neighbors and their singsongy dialect of Limburgish, with its mishmash of German, Dutch, and Flemish.

During the Eighty Years’ War, which began in the mid-sixteenth century, the Netherlands fought for its independence from Spain. Limburg was home to many bloody battles, but Limburgians, most of whom were staunch Catholics, often chose to fight against the Calvinist Hollanders in the north siding instead with the Spaniards, who were Catholic. The province continued sending its young men to fight on the side of the Germans up until the 1860s.

Joseph Marie Albert Lange, known to everyone as Joep

Always the outsiders, many Limburgers considered themselves distinct from their brethren in the north, reluctantly celebrating Queen’s Day and backing their nation in the World Cup. Every other day, they were Limburgians first and Dutch second.

Despite Limburg’s strong Catholic tradition, Joep’s family eschewed the influence of the Church as much as they could. When she was told by a priest to have more children, Joep’s maternal grandmother, Maria, told the man to hush and stop interfering in her business.

Maria married Sjeng Bertram, who also came from a large Catholic family. The couple were self-made entrepreneurs, opening a café in Nieuwenhagen during World War II where American soldiers chugged beer and chatted with Dutch women. Twice a week they converted the annex into a dance hall.

Business was good, and with the help of their daughter—whom they named after the holy mother—and her husband, Sjef Reumkens, they bought one of the largest villas in the village, hoping to hear the pitter patter of tiny feet across the tiled floors. Villa Belvedere was a stunning brick building shaded by oak and spar trees, set back from the road behind a wooden fence.

The younger Maria and her husband, Sjef, had two children in the early years of the war, a son named Jean, and a daughter named Maria, who was known as Marietje and Rietje, or Riet, to avoid confusion in a household filled with three Marias.

When Riet was eight months old her father, Sjef, fell ill and was diagnosed with a brain aneurysm. He remained sickly throughout Riet and Jean’s childhood, suffering paralysis until his death at the age of forty. The children were not yet ten years old.

Maria’s friends stepped in to help the young widow find a new beau. A few years after the loss of her husband, they invited Maria to a party in Nieuwenhagen and introduced her to a dashing man ten years her junior. Joseph Lange, known as Joep, came from a middle-class family in nearby Heerlen and worked as an engineer at the Oranje Nassau coal mine.

It was love at first sight. Their age difference—a scandal in a small, conservative village—was spoken about in hushed tones. The pair courted, married, and had a son within a year. Keeping with the family tradition of passing down names, they christened their son, Joseph Marie Albert Lange. The child was born in the villa on September 25, 1954. Joep’s older siblings, Riet and Jean, cooed over their baby brother while the grandparents fussed around him.

When American soldiers liberated Limburg, Joep’s grandparents converted the annex that was a dance hall into a small movie theater and eventually built a big movie theater in the center of Nieuwenhagen by Joep’s third birthday. But the timing was unfortunate. Television sets were popping up in homes across Holland. The grandparents moved into an apartment above the ill-fated movie theater, and Joep’s mother, seeking independence from her parents and their cooped-up quarters, suggested to her husband that they move to Heerlen, the town three miles away where he worked. She was thrilled when he said yes. Heerlen meant relief from living under the same roof as her parents.

Joep with his older sister, Rietje de Krieger

Joep’s father was an opinionated man who stoked intellectual debates at the dinner table. Joep learned to speak his mind and hold his ground. Still, he couldn’t talk his way out