Visionaries is a limited series That looks at the figures who are trying to transform the way we live.
Ravindra Gupta was more than a decade old for drug-resistant HIV when he first became known as Adam Castillejo, who would become known as a “London patient,” the second person cured of HIV in the world. Gupta, who goes by Ravi, was a professor at the University College London straddling the clinical and academic worlds when Mr. Castillejo presented as both HIV-positive and with relapsed lymphoma, followed by a previous transplant using healthy stem cells from Mr. Castillejo’s own body had failed.
Work on the building by the German hematologist Gero Hutter and others that went into curing the first person’s HIV – Timothy Ray Brown, known as the “Berlin patient” – Dr. Gupta and his associates using stem cells from a donor with a rare genetic mutation that prevents certain individuals from being infected with HIV. Castillejo agreed and had his transplant in 2016. Seventeen months later, Dr. Gupta and his team took Mr. Castillejo off the antiretroviral drugs that kept his HIV at bay. In 2019, three years after the transplant, Dr. Gupta published the results in Nature, confirming Castillejo was cured of HIV
The news shook the scientific world and revitalized the search for a cure. Dr. Gupta was hired as a professor of clinical microbiology at Cambridge and established his research on the Gupta Lab’s school’s biomedical campus.
A few months later, the coronavirus hit the pandemic – and with nations going into lockdown and medical systems taxed to their breaking point, he found himself drawn into the response.
“Respiratory viruses were never anything I would consider getting into. I didn’t think we had the skills or expertise to be useful, “said Dr. Gupta said recently. But, he added, “The clinical interface of what I do is dragged into working on SARS. Things got bad here in March, and everything shut down. One of the desperate needs was identified as rapid testing. “
Soon his team was completely pivoted and some of the first research validating rapid and antibody tests for coronavirus using techniques honed during HIV research. Over the past two and a half years, Gupta Lab has cranked out cutting-edge research, describing how new variants arise and providing some of the first evidence that breakthrough Covid infections were possible in vaccinated individuals.
At his lab at Cambridge, he discussed both remarkable strides made by scientists over the past three years, as well as the consequences of the public’s diminishing trust in scientific knowledge.
This interview has been condensed and edited.
How has previous research on AIDS / HIV affected the response to the coronavirus?
The response to SARS-CoV-2 has accelerated largely because of HIV advances. There have been huge advances in how we make drugs, target viruses, and a lot of this technology have been honed on HIV
What are the similarities between these two pandemics?
Both have created a huge panic, SARS-CoV-2 more than HIV – for good reason, because it is respiratory. Certain people are more vulnerable than others, and socioeconomics certainly matters. Also, in this age of availability of vaccines, the rich versus poor, global north versus global south – all of those inequalities have been coming through.
Has this global emergency improved your ability to work with your colleagues across various disciplines?
It is definitely galvanized with a load of interactions we otherwise have not done. We got interested in immunology, we did some very cutting-edge work with colleagues downstairs and in different parts of the building. We started using stem cells to make artificial lungs in experiments. All of these things started happening as a result of the emergency. People who we would never have talked to, ideas we would never have had. So it has been really exciting scientifically.
Does fatigue account for the public’s waning response to Covid?
Yeah, I think so. I think the intensity has a burnout of emotional energy. Of course strides have been made in HIV for over 20 years. That happened very quickly for Covid. And in the absence of a vaccine and mRNA technology, we would be in a much darker place.
Across society we are seeing a decline in trust institutions, but in your field there are rather severe consequences to people refusing to get a vaccine, for example. Has that affected the way you think scientists and the medical establishment must communicate with the public?
I think there’s a general lack of trust between the public and the people who provide information. That ‘s driven by sectors of the public spreading misinformation. I think the actual communication was quite good in the beginning – you got clear messages and I think it was quite good. Public health messaging has gotten more complicated because no one wants to wear masks.
For example, after vaccination, people thought we’d be mask-free. We published a paper on the nature of breakthrough infections and the CDC next week cited our work as a reason to mask, even with the vaccine. Which sounds normal now, but back then it drove people crazy. But it was the right thing to do because your responses could wane for a few months, and plenty of people with double-dose vaccinations can end up with re-infections around the second time. So that all contributed to the confusion based on lack of education or nuance of knowledge. And one thing we have to deal with now is that communication takes nuance that even scientists can’t grasp. So expecting the public to grasp this is pretty much impossible. So we’re at a crossroads for how we communicate complex messages.
Are there long-term implications if we can’t persuade a large proportion of the population to be vaccinated?
Circulation may take place in places like China, where the population is relatively naïve when it comes to vaccines, and the vaccines are not necessarily the best ones. And if people do not get their boosters on time, we may end up reaching a period when it becomes another major health problem of the magnitude we have already seen. I can foresee in a few years’ time we may have trouble again. The worrying thing is that we are winding down a lot of the things we have developed to deal with this.