By Rose Hoban
About 15 years ago, Myron Cohen helped change the course of a pandemic.
Cohen, who’s has been an infectious disease researcher and administrator at UNC Chapel Hill for more than four decades, was lauded worldwide in 2011 for leading a seminal study showing a stunning result: Treating people with HIV with antiretroviral drugs could keep them from passing along human immunodeficiency virus, the pathogen that causes AIDS.
The study, which came out of the HIV Prevention Trials Network, had carefully followed some 1,300 couples in the African country of Malawi. In each couple, one person was diagnosed with HIV and the other was uninfected. The study showed that treating the infected partner was almost completely effective at stopping transmission.
That study changed the course of the HIV pandemic, which has raged since the early 1980s and taken the lives of some 44 million people — and continues to infect tens of millions more. Those study results also changed how the medical community approached HIV, which had initially been considered a death sentence. HIV instead became a chronic disease that could be managed and now even prevented.
The finding was the culmination of decades of work that’s taken Cohen around the world all in his quest to arrest infectious diseases — in a career that has spanned the entire HIV pandemic.
Now Cohen, 75, is giving up some of his half-dozen local and national leadership positions in favor of passing the baton to the next generation, and seeing patients.
NC Health News had a wide-ranging interview with Cohen to look back at his career and look forward at what he’s hoping to do next. Note: This interview has been edited for length and clarity.
NC Health News: Take me back to the beginning of your career.
Cohen: I started at UNC in 1980. I had come from China with my wife (Gail Henderson). We were living in China.
Cohen started out in the lab, looking at the pathophysiology of gonorrhea, a sexually transmitted disease, which is what initially brought him to UNC in 1980 — and to seeing infectious disease patients.
Within a few years, scores of patients started showing up at UNC Hospital with opportunistic infections. It was the beginning of the AIDS crisis, and at the time, the cause of AIDS was still unknown.
By 1984, 25 percent of all the admissions to UNC were for HIV. This very small group of four infectious disease specialists at UNC … the university or the hospital could not manage all these HIV patients.
These HIV patients surfaced because we had so many hemophiliacs living in and around Chapel Hill. UNC and Duke became kind of huge leaders in HIV, not because of gay men, but because the blood supply became contaminated and infected so many hemophiliacs. At that time, the UNC Hemophilia Clinic, which was world-renowned under the direction of Harold Roberts, they were managing about 600 patients in the clinic. Virtually all the patients were getting transfused factors, and those factors worldwide were contaminated with HIV.
A critical part of what happened was that the general internists had a lot of trouble managing patients with HIV. So the infectious disease group expanded very, very quickly, from like four or five people … it expanded in order to manage all these patients.
The hospital gave us our own ward called Med K, and the Med K Ward had its own nurses who were considered brave, and were brave because no one really knew so much about HIV. They lovingly managed these patients on Med K, and we had about 30 or 40 beds. And then we didn’t have a clinic, so we had to start a big clinic.
When the first drugs to treat HIV were developed in 1988, Cohen expanded the infectious disease department, allowing UNC to become one of the leading research and clinical enterprises for the prevention and management of HIV.
Then Cohen was tapped to work with a group of researchers and clinicians to do research and treat people in 16 countries around the world.
Cohen: We picked countries out of a hat. So when I put my hand in the hat, the country that I picked out was Malawi. The reason UNC became so committed to Malawi was because of that hat. The other country we got was Jamaica. And so I went back and forth and back and forth to Jamaica, many times, because that was our easy country. Malawi was our hard country.
NC Health News: Malawi became an important place for you and for UNC. But you didn’t do that work alone.
Cohen: It’s fun to think of your career, but my career is all about hiring and cheerleading super talented people. It was almost never about me. In all candor, it was always about the opportunity to serve, to work with people like Irving Hoffman. Really, Irving built our program in Malawi, unequivocally.
NC Health News: Your work there on HIV is probably the thing that you’re known for most widely as a result, right?
Cohen: I’ve probably written 600, 700, 800 articles. I don’t know how many, but if you can do one or two things, either change public health or medical practice, it’s, like, an incredibly successful career. It’s a rare blessing.
One discovery was the one we worked on for 20 years: From ’88 till 2011, we tried to understand the magnitude and durability of [HIV] treatment as prevention. So we were treating people with drugs, and we wanted to know which drugs to use and could we prevent the transmission of HIV. And then in 2011 we reported that you virtually eliminate transmission of HIV with successful treatment. That became the Science breakthrough of the year. But that was 20 years of work. It wasn’t like overnight.
If you do clinical research really, really carefully, you answer a lot of questions. We had to know which drugs were going to concentrate in genital secretions, we weren’t just going to give any drug. So, we spent years doing that.
We also had to do this ethically. We had a whole health behavior team working on scripts of what do you do when you’re managing a couple — because every transmission event is like your failure, you allowed somebody to get HIV. So we had incredible detail in that study.
The actual most important part of the study were the drugs. And [the National Institutes of Health] wasn’t going to buy the drugs. The drugs were provided by six pharmaceutical companies, and the most important company was Glaxo, which had a drug called Combivir. And they gave us 80 percent of the world’s philanthropic supply. The free drugs are estimated to have cost about $40 million.
I spent a lot of time with pharmaceutical executives convincing them to give me their drugs. The last drug we needed was held by Bristol Myers Squibb, and a woman who worked there at that time named Sally Hodder — I begged her and I begged her for her drug. Finally, she got the company to agree to give the drug, and I sent her, like, two dozen roses. That was how we got that study off the ground.
After the publication of the 2011 study, providing HIV drugs to prevent transmission became worldwide policy.
Cohen: Until then, HIV drugs were being rationed, but realizing that you could prevent transmission by treatment, the rationing died very quickly.
Cohen was a contributing author recognizing limited progress against HIV transmission and that a coordinated, evidence-based national strategy was needed to prevent new HIV infections. Then in 2011, he had the breakthrough discovery that antiretroviral therapy would prevent transmission, allowing people to live long and health lives. Credit: provided by Myron Cohen
NC Health News: It sounds like so much of the success you had in your career and in clinical trials was based on relationships.
Cohen: It was all about treating people in different cultures and different countries, as well as all my collaborators in the United States, in a way that could keep a big group together and moving forward.
In my whole time working here, I never had a conflict with anybody on our faculty, collaborators, and likewise, all my collaborators all over the world. It all worked because of these personal relationships, because people develop trust. They know you respect them, you’re working towards a common goal, and you get to work with people much smarter than me, generally speaking.
Cohen noted some of his friends and collaborators: Barton Haynes at the Duke Human Vaccine Institute, Ward Catesat Family Health International, former UNC Eshelman School of Pharmacy Dean Angela Kashuba.
Really, I wish it was about me, you know? I’d like to have this conversation, ‘Can you believe how smart I am?’ But that’s not the truth. It’s the people I’ve worked with.
Cohen was also instrumental during the COVID-19 pandemic, working on the development of monoclonal antibodies for treatment of the disease.
NC Health News: Do you have any thoughts about the current state of international health funding?
Cohen: You have to be blind to not understand that we now have this unusual situation where the stable infrastructure at the CDC, the NIH, the FDA and USAID and PEPFAR, which was the wind behind the career that I got to live, they’re all disrupted … the infrastructure has been disrupted and destabilized, and the objective of people, I think, in my position is to be prepared to rebuild and stabilize.
This is an unbelievably difficult and painful time to continue down the road that we’ve been on for my whole career. So it’s my belief, however, that we’ll get back on that road.
NC Health News: What do you hear currently from your partners in places like Malawi and China?
Cohen: Our collaborators everywhere know that these decisions that are disruptive are not coming from their U.S. collaborators. In almost every case, we’ve maintained all our relationships. And we then look for every possible avenue towards survival, anticipating rebuilding.
What’s important in that sense is to be sensitive to how difficult it is. You know, we are dismayed here, but imagine if you’re on the end where the drugs aren’t available and the vaccines aren’t available. The stress at the far end is much greater than the stress here.
What are we going to do? What is our work-around? What is possible? What philanthropic possibilities are there? And actually it forces the countries and our European and Asian collaborators to step up as well. There’s still PEPFAR, but it’s not functioning the way that it traditionally functioned, but that allows Europeans, Chinese and other countries to step in.
The U.S. has been a critical player over the last 80 years in advancing the species forward, and that’s manifested in medications, lifespan, vaccines and every other thing we’ve kind of for a variety of reasons, not a single reason we’ve run off the road. And the road might have not been a perfect road, but the road has changed the world unequivocally.
The great irony of this is that Operation Warp Speed, which was President Trump’s idea, was probably one of the greatest scientific contributions in the 20th century, but it also fed a contrarian set of messages, which have really confused the American people.
Maybe the politicians aren’t so confused, because they insist on keeping the funding at the current level, but it certainly confused the American people about what benefits they’ve had from science and medicine and public health over all these years.
We have to create an environment where we get back on the road that allows us to make more contributions and to be leaders.
From my point of view, traveling all over the world, the Chinese are in a very different position, because for them, this is like a great opportunity. They’re very smart, and they’re global just like we were global — or should be global. So we’ve created an opportunity for them to be more competitive and successful than existed a few years ago.
NC Health News: Look into the future for us. You’re not retiring, right?
Cohen: No. But I’m shedding all my titles because I really think younger leadership is very appropriate. You know, for me to hang on with my fingernails to all these jobs is wrong for everybody. It’s wrong for me because my energy level cannot be what it was 25 years ago. All the younger people need an opportunity to bring forth their ideas.
I’ve seen patients for 45 years, and I saw patients in January. Question is, am I going to continue to do patient care? That’s a complex question for older physicians: Do you know enough? Are you useful? And we have such a big group now, I’m kind of superfluous in terms of need.
The second issue is about research and leadership. I’m pretty bound to writing a couple of grants in collaboration with my younger colleagues.
The third thing that I’m really spending a lot of time on right now is philanthropy. Is it possible for me to help raise money in ways that I never did before?
My whole career was raising NIH and CDC and other dollars. I’ve raised almost no money through philanthropy. But that doesn’t mean I can’t do it. And now, because the government is unstable at some level, this is a really good time for philanthropists to consider how big we are and all the discoveries we can make. Can I put together a narrative that would be compelling to some people who would understand the importance of keeping the group together? Anticipating that regardless of whatever, the problems we face are not going to go away.
In other words, if we don’t have an infrastructure, it just makes it harder to deal with the next problem.
NC Health News: And what do you think is the next problem?
Cohen: The shot across our bow is the measles epidemic.
We’re obviously seeing more whooping cough. That’s another big shot across our bow. The question is, are we going to see diphtheria and polio? And many infectious disease specialists feel that the return of either diphtheria or polio will be like a kind of an incredible shock to the American public.
The idea that we’re going to let these devils out of their bottles is just unacceptable to organized medicine and public health. Most experts are very afraid of this.
NC Health News: One last question: Where are you from?
Cohen: From the south side of Chicago. I haven’t lived there since I was 18, but, you know, it’s important where you’re from in terms of expectations. We were very poor. We lived in an 800-square-foot house.
The two things from that upbringing that are for sure, are tenacity and candor. Candor, like, I’m not very duplicitous. I don’t have some big shell game going on. It’s like, ‘Here’s what I’m trying to accomplish. How do we get to yes?’ In fact, when I was raising the pharmaceutical drugs for that study, every conversation was, ‘How do we get to yes?’
And then tenacity. If you’re growing up in a fairly poor household and you’d like to do something with your life, you just really require tenacity. Tenacity is more important than brains.
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