The Great Harvard Drug Scandal
It was a distinguished group that gathered one night early last year
at Evoo, the hip Somerville restaurant with modern art on the walls and
organic ingredients in the entrées. The respected AIDS researcher
Phyllis Kanki was there, along with a lot of other Ph.D.s from the
Harvard School of Public Health. And they were celebrating.
It had been a tough stretch leading up to that night. Rumors were
circulating that Harvard president Lawrence Summers had it in for the
School of Public Health, known on campus as the SPH. The school's dean,
Barry Bloom, had confided to some faculty members that Summers planned
to fire him. A few gossipers even believed Summers wanted to close the
school altogether, reallocate its assets, and reassign its staff. This
was all said to be part of the president's master plan to consolidate
power and shift resources to his pet project: the dramatic development
of the university's Allston campus. Summers made no effort, in fact, to
conceal his desire to split the SPH and relocate some of it to Allston.
Just how much truth there was to the rest of the rumors was difficult
to say, but important people at the school were believers. Then Kanki,
the SPH professor who's been doing remarkable things for two decades,
went and did her latest remarkable thing: She pulled down the biggest
grant in Harvard history.
So it was an air of relief as much as jubilation that hung over the
dinner at Evoo. Kanki's grant, after all, was going to do a lot more
than just allow for the expansion of her successful AIDS work in
Africa; at $107 million over five years, it was pretty much going to
save the school. Not even Summers, hardly one to shy away from a fight,
would dare tamper with the SPH while it controlled such a massive
grant. “It was a celebration,” says someone who attended the dinner.
“Everyone was congratulating each other.” Then, this person says, “all
of a sudden—boom! The shit hits the fan.” And as usual when the real
shit starts to fly, it was some of the poorest and most vulnerable
people in the world who ended up covered in it.
The exact sequence of events that followed that dinner in
Somerville, and the precise motivations that led to them, get a bit
hazy in their various recollections and interpretations. What seems
certain, however, is that Harvard's central office tried to take
control of Kanki's grant, convinced that her team lacked the
administrative experience necessary to manage it. That set up a
struggle that stretched over the first half of 2004, delaying crucial
AIDS work for five months. Though this battle would get far less
publicity than other Summers skirmishes—the odd fight he picked with
the Afro-American studies professor Cornel West, for example, or the
controversy he ignited with comments suggesting that genetics might
explain the paucity of women in science—its ramifications would be
infinitely more severe. The casualties would not be limited to the ego
of a star academic or the march of social progress. The university
denies it adamantly, but well-informed critics say the victims this
time would be hundreds of impoverished, AIDS-stricken Africans who died
waiting for Harvard to deliver the life-extending treatment it had been
given public money to provide.
In December 2003 , just weeks before the calendar turned to an
election year, the Bush administration formally commenced an ambitious
program to combat the AIDS pandemic devastating much of the developing
world. The President's Emergency Plan for AIDS Relief, or PEPFAR,
committed $15 billion over five years to that task. Two grant
applications came from Harvard—one from the SPH and the other from the
medical school. Multiple applications for the same grant are a fairly
common occurrence at Harvard, where a culture often described as
ruthless fosters competition and, at times, conflict. “No prisoners,”
says an SPH professor, one of a handful who agreed to be interviewed
for this story provided their names not be used. “If you want to eat
your children, this is the place.” Harvard's individual schools can be
understood as loosely affiliated fiefdoms, each with its own endowment,
and agenda. They compete for nearly everything, and in these
hostilities, money is ammunition. A school's financial status, says one
professor, determines even how many parking spaces it gets.
In February 2004, Harvard learned that the SPH had been awarded one
of four initial PEPFAR grants, and that the medical school's
application had been rejected. (Columbia University, the Elizabeth
Glaser Pediatric AIDS Foundation, and Catholic Relief Services were the
other recipients.) The SPH grant was to be used to treat AIDS patients
in Nigeria and Tanzania with life-prolonging drugs, and to train health
workers in Botswana. The leader of the SPH team was Phyllis Kanki, who
in 20 years of AIDS work has helped identify a new form of HIV,
received broad acclaim for her AIDS efforts in Senegal, and, in 2000,
won a $25 million Gates Foundation grant to do AIDS work in Nigeria.
“She discovered HIV-2!” one of her fellow SPH professors says with a
hoot of admiration. For good measure, Kanki's team eventually included
expert doctors supervising the fieldwork in each country. Dean Barry
Bloom was elated. Seemingly on the ropes for months, his school had
just been handed a potent weapon in the fight for its survival.
It was at this point, according to several people, that Harvard's
president exploded. Some believe it was the absence of Lawrence
Summers's name from a news release announcing the grant that set him
off. Others say it was that he wasn't aware of the grant until he read
about it in the newspapers. Still another explanation has nothing
whatsoever to do with pride. “Larry Summers had this grand scheme to
get rid of the School of Public Health. That's the whole thing, don't
you get it?” says one SPH professor. It's a fairly common belief on
campus, in fact, that Summers was hired with a mandate to rein in the
individual schools and consolidate power in the president's office, the
better to present a unified Harvard brand . Controlling the
SPH would have been a step toward that goal, but then the school won
the PEPFAR grant. “They got the biggest grant in the history of
Harvard,” the professor says. “Now he can't get rid of the School of
Public Health.” Another professor stops short of saying Summers wanted
to close the school, believing it's more likely that the president
simply wanted it under his thumb. Summers did not respond to requests
for comment. Harvard spokesman B. D. Colen calls the notion that the
university ever considered shutting down the SPH “utterly absurd.” The
school, Colen says, “is one of the university's crown jewels.”
Whatever the cause, Summers was so enraged by the SPH grant he could
barely stand the sight of Barry Bloom. At a subsequent dinner,
according to the book Harvard Rules by Richard Bradley, Summers insisted on being seated somewhere that made it impossible for Bloom to enter his field of vision.
None of the School of Public Health professors will talk on the
record. No one wants to risk the administration's wrath, or to
jeopardize the grant now that it's running smoothly. Assured that his
identity would be protected, however, one professor agreed to lay out
the details of what happened in the aftermath of Summers's meltdown.
This professor claims Summers was concerned about potential
risks—lawsuits and the possibility of AIDS drugs hitting the black
market—especially since he wasn't controlling the grant. So, the
professor says, the Harvard president decided to simply take control.
To do that, the professor says, word was spread that despite all her
accomplishments, Phyllis Kanki was unfit to lead the mammoth grant
because she is a veterinarian, not a medical doctor.
The next part of the plan was to create a new position for the
grant, a co-leader to share authority with Kanki. Summers wanted to
fill this position with a respected Harvard AIDS researcher named Bruce
Walker, who happens to be a close friend of Summers's personal
physician. Walker is also the man who led the medical school's losing
application for the PEPFAR grant. According to several SPH faculty
members, both the SPH team and the government interpreted this move as
an attempt to steer the grant to the medical school. The SPH team
eventually agreed to the power-sharing provision so long as it wasn't
Walker who filled the new post. Another medical school doctor was
chosen instead.
This process took precious time, of course—time the other PEPFAR
grant winners were using to ramp up their programs. They had all begun
work by March 2004, immediately after the government released the
funds. As the months passed, however, Harvard delayed “drawing down”
its grant money. The university insists that the delay did not hold up
the project, writing in a statement that “Harvard began funding PEPFAR
activities with its own funds—within less than 90 days, not
five months, of the program's approval in February 2004.” SPH
professors dispute this, and note that even by the administration's
reckoning, the funding came three months late.
Rather than get moving in Africa, in fact, the administration came up with another way to take control of the grant.
There's a reason it's called the President's Emergency
Plan for AIDS Relief. Three million people die from AIDS each year, and
another two million die from tuberculosis, many of those from
HIV-related complications. “To my mind it's an emergency that requires
major attention,” says Allan Rosenfield, dean of Columbia's Mailman
School of Public Health, which received an initial $125 million PEPFAR
grant for work in five African countries, and has recently added four
others. “I consider it an urgent mission. Universities, as well as
nongovernmental organizations, as well as governments, have a role to
play if we're a humanitarian society.” Rosenfield shared those very
thoughts during a call he placed to Bloom as news of the university's
delay spread within academic circles. Whatever Harvard's concerns, he
told his fellow dean, get going. “While I think the president of
Harvard now is totally supportive of PEPFAR, obviously he was raising
questions at the beginning,” Rosenfield recalls. “We did not have the
degree of questions of that type here.”
The holdup had the potential to jeopardize not only the lives of
patients, but also the grant itself. The SPH had a first-year
enrollment target of 8,000 patients in Nigeria. Each day that passed
put that goal farther out of reach. There was also the fact that
Nigerian contractors had been working on the SPH grant for months
without pay. SPH professors claim these doctors and nurses were put to
work after Harvard said it would begin drawing down the funds, only to
then change its mind. “We were behind in our target numbers,” one SPH
professor says. “People that should have been treated right away were
put on a list. Some of them died waiting.” Nigerian doctor John Idoko
told the Harvard Crimson that as many as 400 died.
Harvard disputes that its actions contributed to any deaths at all.
But the explanation offered by university spokesman Colen leaves SPH
faculty members shaking their heads.
Harvard administrators eventually came up with another idea to take
control of the PEPFAR grant. They created a powerful executive-director
position to oversee it. They gave this job on an interim basis to a New
York City lawyer named Mark Barnes, who is well schooled in the
administration of domestic AIDS-relief programs. Barnes says he was
hired for his management and legal abilities. “I could fill the gaps in
the faculty's expertise and skill sets,” he says, “while relying on the
faculty's knowledge of local conditions and professionals in Nigeria
and Tanzania.” But SPH faculty members say Barnes functioned as more
than simply a gap filler. One professor recalls a meeting Barnes called
in Washington, D.C., soon after he was hired. He made it clear at the
meeting that no one was to talk to anyone about the grant without his
clearing it first. That meant Kanki couldn't even communicate with her
government funders unless Barnes gave his permission. Barnes was now
unequivocally Kanki's boss, and he reported to Summers. Kanki was
outraged, but there was little she could do. The administration was now
firmly in control, and on July 28, 2004, Harvard finally began
accepting the government's money.
A month later, Kanki and others received a letter that made the new
rules official. The letter went into great detail about what Kanki, the
grant's principal investigator, could and could not do. The very first
bullet point said it all: “The Executive Director reports to the
President, Provost, and Dean. The Principal Investigators report to the
Executive Director.” As she had been told in person, Kanki was to keep
quiet unless cleared to speak. The missive ended with a stern warning:
“Failure to observe the terms of this letter may have serious
consequences, not only for your individual roles within the program but
also for the program itself.”
The letter carried the signature of Barry Bloom, the SPH dean, but
no one at the school believes he actually wrote it. Sources close to
Bloom say the dean was pressured into putting his name on it. “This is
not Barry's writing,” one of the professors says with a dismissive wave
of his hand. Faculty members say Bloom, in fact, told them that the
university had threatened to kill the grant altogether if he refused to
sign the letter. Bloom wouldn't respond to requests for comment. Colen,
the Harvard spokesman, says the university does not comment on
communication between deans and faculty.
The SPH faculty was aghast that the administration would try to
dictate the terms of a grant, that a researcher could be muzzled. No
longer about control of government funding, the issue now was one of
academic freedom. “The degree of arrogance is amazing,” says one of the
professors. “To think you can get away with a letter like this to a
member of the faculty is incredible.” SPH professors began speaking
out, and as the news spread, the American Association of University
Professors voiced its displeasure. With the pressure building, Bloom
finally did what many of his professors had expected him to do from the
beginning. At an SPH faculty retreat in March, he said the letter
should be rescinded. Six weeks later—nearly a year after it had been
issued—it was.
The first sign that Harvard may have sensed a coming controversy was an October 2004 story in the Boston Herald.
The article cited a source “close to the Harvard president” who claimed
Summers was furious that Kanki's team was far behind in its treatment
goal. “Summers is apoplectic,” the source told the newspaper. “He sees
a major scandal brewing here.” Absent from the piece was any mention
that the university had delayed accepting the grant. “Summers is
reportedly disappointed with Kanki's performance,” the article
continued, “and has apparently also questioned her qualifications for
the Africa assignment.” At the end of the story, a spokeswoman for
Summers disputed he ever said any such thing.
Kanki-as-unqualified never took, however, and Harvard eventually
acknowledged that it had, in fact, delayed accepting the PEPFAR funds.
It offered differing explanations. The administration said it proceeded
slowly to minimize legal risk. It also raised the question of whether
the project was in keeping with Harvard's mission: education. And
finally, the university said it needed to ensure that the
administrative side of the grant was as proficient as the medical one.
If it hadn't, Barnes says, “I expect that the media could and would be
writing about Harvard's failure to assure oversight and accountability
in such a critical program, involving perhaps $200 million of U.S.
taxpayer money over five years and the lives and welfare of so many
people.”
SPH professors scoff at the idea of legal danger. Allan Rosenfield
at Columbia says PEPFAR actually does carry some risk, but probably no
more than campus maintenance. “If Columbia is renovating an old
building and has scaffolding up on Broadway, there's a risk that the
scaffolding will give way,” he says. “There's a risk with everything
you do.” As to whether Harvard should be involved in this sort of work
at all, Summers himself has made several public statements supporting
an international presence for the university. In 2001, for instance, he
said, “We need to demonstrate that humanity is capable of enormous
progress, to demonstrate that the human condition can be made better by
strengthening the forces of hope—better not just in rich countries like
this one, but better in every country in the world.”
Parsing Harvard's reservations about the administration of the grant
is more difficult, because it happens to be true that the university
had never before received a financial award so big. Whatever the merits
of the university's apprehension, people were dying, and Harvard was
looking reckless. Worse, it looked foolish.
In May of this year , Phyllis Kanki received a new letter, this one
from Harvard provost Steven Hyman. From now on, the letter stated,
Kanki and the executive director, now a man named Richard Skolnik,
would share control of the grant. The new terms are seen as a victory
at the SPH, an admission from Harvard that it overstepped its bounds
with the original letter. (Harvard officials say Hyman was unavailable
for comment.) Despite the initial five-month delay, Kanki's team in
Nigeria fell just 700 patients short of its first-year goal of 8,000.
Today, about 10,000 people are being treated in Nigeria, along with
another 3,000 in Tanzania. Skolnik trumpets these accomplishments.
“[I]t would be very difficult to find any health project in any
resource-poor country that has saved as many lives as fast as the
Harvard PEPFAR project has,” he says. On this, many SPH professors
concur. They just wonder how many more lives could have been saved had
the university acted faster.
None, says Harvard spokesman B. D. Colen. “Like our PEPFAR partners,
Harvard has a set amount of money for medication, an amount of money
that will only allow us to treat a woefully small proportion of the
HIV/AIDS-infected individuals in the countries in which we are [in]
operation,” he says. “For example, in Nigeria, the program as it is now
constituted will eventually provide treatment for only 40,000 of the
500,000 infected individuals. So whether the program began treating
people in month one, month two, or month three, the program will treat
the same number of people.”
I could point out the stunned reaction this response elicited from
AIDS doctors, such as the one who says, “If you are faced with a
drowning child and have one life preserver, would you rationalize
letting the child drown because you wanted to save the life preserver
for other potential drowning victims?” I could tell you that doctors
and researchers believe early intervention is the key not only to
saving the life of a sick patient, but also to ensuring the patient
doesn't infect others, including her own unborn child. I could even
tell you about the Elizabeth Glaser PEPFAR project, which had been
slated to treat only 6,900 patients in its first year, yet managed to
enroll 12,400. The government happily paid for the extra care. I could
tell you all this, but what would be the point? Harvard delayed. The
sick people? Well, what did they have to do with anything?