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Empathy for underdogs inspired epidemiologist

By Jessica Cohen

For the Gazette

MILFORD, Pa. – Infectious disease specialist Doug Manion came to Milford, Pa, and COVID-19 drug research after learning physics in French, designing African water and sanitation systems, treating AIDS patients and researching a drug for them. What prompted these ventures was an empathy for outsiders that was rooted at home, in Canada, he said.

“The French were considered the underclass in Ottawa, so my mother was raised in English and barely spoke French, though her parents were French and spoke English with a thick French accent,” Manion said. “So, my parents thought it would be a good idea if I did my studies in French.”

His father, John L. Manion, was a Canadian civil servant in the immigration department, who eased Hungarian rebels into Canada after their revolt against oppressive Soviets in 1956.

“It was a humanitarian crisis, and my father was central to the relief effort,” Manion said. “He was in his 20s, like me when I encountered HIV. He became secretary of the treasury and assistant deputy of the privy council and ran the cabinet. The prime minister threw a party for him when he retired and named a yearly lecture after him. He was my moral compass.”

Manion thrived in math and physics, which he learned in French. Many of his classmates became doctors, but Manion headed into engineering, inspired by a mentor working on designs for low-cost water supply and sanitation systems for Africa. Manion was working from Ottawa on those designs for sub-Saharan Africa when he first heard about an epidemic there of “slim man’s disease.”

“Young, healthy men were becoming emaciated, but it was considered a disease of them, not us,” he said. “I thought then about going to medical school.”

That was 1981, and the disease soon showed up in America as AIDS. Some people viewed it as “deserved” by gay men, Manion said, but he began doing pre-med classes alongside courses for his last year of engineering school.

As he pursued a medical degree in internal medicine at the University of Ottawa from 1983-90, then did a fellowship in infectious diseases, he treated many AIDS patients.

“Their immune system stops working, and they had a litany of infections, bacterial, viral and fungal. Most died,” he said. “The first cases appeared in 1981, but Ronald Reagan didn’t mention the disease publicly until 1985. Gay men were outed because of their infections, so they were both judged and dying.”

From 1992 to 1997, Manion did postdoctoral research on pharmaceuticals at Massachusetts General Hospital and taught at Harvard Medical School, then went on to Dupont Pharmaceuticals to do trials of a new drug. He led clinical research for Sustiva, which, in 1998, became the first drug to stop the progression of AIDS with one pill a day, as opposed to 20 pills taken multiple times a day.

Sustiva improved compliance and allowed AIDS patients some discretion with their regimens, not having to take big pill boxes to work, Manion said. Meanwhile, he looked for “partner drugs” that could be alternated with Sustiva to prevent resistance.

Along the way, Manion sometimes crossed paths with Robert Redfield, CDC director, and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who were doing important AIDS research.

Manion first encountered Sean Strub, now mayor of Milford, at the World AIDS Conference in Geneva, Switzerland. Strub owned Poz, a magazine that covered AIDS research and related governmental issues.

“They weren’t stopping the spread of AIDS with condom distribution and needle exchanges,” Manion recalled. “There’s a problem with turning a blind eye to a disease and considering it a disease of ‘them,’ not ‘us.’ Any disease of the human race is a disease of us. People thought COVID-19 was a disease of ‘them’ when it appeared in China and around Asia. We feel safer if it’s a disease of ‘them.’ After a few months of complacency about COVID-19, this is the result.”

He noted how residents of a Nebraska town discouraged a local couple on an infected cruise ship from coming home. However, the years of AIDS research were instructive. Manion had been working on a cancer drug, as CEO of Kleo Pharmaceuticals in New Haven, a “spinoff” from Yale, when COVID-19 emerged, and the company pivoted to address the new threat, he said.

“From HIV, we learned how viruses work. Kleo makes a molecule that tricks antibodies we already have into fighting COVID-19,” said Manion, who now lives in Milford part time.

Human trials will begin in the fall. Meanwhile, he commends Strub for advocating masks two weeks before public health officials supported it.

“I wear a mask all the time. It’s destigmatizing,” said Manion. “Hope is not a strategy.”

 

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