Joep LangeBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4827 (Published 24 July 2014) Cite this as: BMJ 2014;349:g4827
- Ned Stafford, Hamburg
In June this year, three months before turning 60, Joep Lange was on a plane, chatting with a colleague about his work. Lange had spent most of his adult life on HIV/AIDS—as a pioneer researcher helping to understand the basic pathology of the virus, as a caring doctor, and as a determined advocate for HIV/AIDS patients around the world, especially in Africa.
But after three decades of hard work, Lange knew that the battle against HIV/AIDS had not been won—and was not even close to being won. There was still much to be done, still millions and millions of suffering people he wanted to help. Lange would need more time. Lange’s colleague on the flight, Jacques van der Gaag, professor of development economics at the University of Amsterdam, noted that it is now normal to continue working beyond the traditional retirement age of 65. He told Lange: “You still have at least 10 more productive years in you.”
Lange replied: “But that is not enough.”
On 17 July Lange boarded a plane in Amsterdam to travel as a delegate to the 20th International AIDS Conference in Melbourne. With him on board was his partner, Jacqueline van Tongeren, and at least four other delegates to the conference. In an unimaginable horror, the plane—Malaysia Airlines flight MH17—crashed in Ukraine after apparently being shot down. All 283 passengers and 15 crew members died.
“Joep Lange is no more,” says Agnes van Ardenne, former Dutch minister for development cooperation, adding: “But his dream will live on.” She described Lange as “a towering example of humanity” who was on a “quest to establish the right to healthcare for everyone . . . everywhere.”
Known and respected worldwide for his expertise on HIV/AIDS, Lange served from 1992 to 1995 as chief of clinical research and drug development for the World Health Organization’s Global Programme on AIDS, and from 2002 to 2004 as president of the International AIDS Society (IAS). At the time of his death, he was professor of medicine and head of the global health department at the University of Amsterdam’s Academic Medical Centre (AMC) and executive scientific director of the Amsterdam Institute for Global Health and Development (AIGHD). He held seemingly countless other positions and served on editorial boards of several scientific journals. When he spoke, people listened—even those who disagreed.
“Joep was an internationalist, and his ideas were always ahead of the curve,” says his colleague and friend, David Cooper, director of the Kirby Institute in Sydney. “Social justice was his passion, along with literature and art.” Cooper adds: “Joep was fearless, refused to take no for an answer, and loved any challenge that others had deemed impossible.”
Joseph Marie Albert Lange was born 25 September 1954 in Nieuwenhagen, the Netherlands. In the autumn of 1971, he travelled to the USA to spend a school year as a foreign exchange student at a high school in Tampa, Florida. He had long hair and he liked Bob Dylan, according to classmates interviewed by a Tampa newspaper after his death.1 A daughter of a family with whom he stayed remembers receiving a special present from him on her 13th birthday: the White Album by the Beatles. Lange returned to the high school in 2012 for the 40 year reunion of his class. One classmate recalled of his visit: “As an adult, you would have never known, when you met him that he had made that many accomplishments in his lifetime. He was so humble.”
Lange studied medicine at the University of Amsterdam, earning his medical degree in 1981 and a PhD in 1987. Specialising in infectious diseases at AMC, he became interested in HIV/AIDS in 1983, two years after the mysterious disease had first been clinically observed in the US. The next year he was co-author of a paper concerning AIDS published in the Lancet.2 The pace of his research output accelerated dramatically after he earned his PhD in 1987, and at the time of his death he had published nearly 400 papers.
The most important papers he co-authored include a study of 14 men with HIV who did not develop AIDS for at least two years.3 Another, published in 1989, followed the progression and changes of the HIV virus in 20 men from no symptoms until immunodeficiency occurred.4 Perhaps his most important HIV paper was published in 1992 in the Journal of Virology, it indicated that the virus was concealed in certain types of white blood cells.5 The paper has been cited more than 1000 times.
Through his research, Lange became convinced that the most effective treatment of HIV should include use of at least three antiretroviral drugs, known as triple antiretroviral therapy. In 1994 at the European AIDS Clinical Society meeting in Milan, at a time when many leading experts were sceptical of antiretroviral therapy, Lange argued that only an array of drugs with different mechanisms could combat the virus effectively, urging clinicians to start treatment as early as possible. He also was recognised for his work on the prevention of mother-to-child transmission of HIV.
In 1992, in preparation for his job at WHO, Lange travelled to Africa for the first time. He wanted “to see the epicentre of the HIV/AIDS epidemic.” The visit, he wrote in a contribution for an upcoming booklet on HIV/AIDS research in Africa, “turned out to be a life changing event.”
In Uganda, he toured Makerere University’s Mulago Hospital, accompanied by Elly T Katabira, who would become “a close friend and steady collaborator,” and who is now an associate professor at the university. Lange “was shocked to see the internal medicine wards almost entirely occupied by people with AIDS, two in each bed, and many lying on mattresses on the floor. At regular intervals, I saw how people who had just died were being carried away. Besides a lack of running water, there were virtually no diagnostic tools and little to no medicines.” Lange adds: “It . . . became my mission to do something about the terrible global inequality in access to life-saving medicines.”
In 2000 Lange founded PharmAccess to promote affordable healthcare in Africa. Frustrated about the lack of global commitment from policymakers and global organisations to supply adequate HIV/AIDS drugs for Africa, he famously said: “These drugs have saved hundreds of thousands of lives in Europe and the United States. They could do the same for millions more in developing countries. If we can get cold Coca–Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs.”
Contacted by The BMJ, Katabira said that Lange’s most important medical contribution was “his relentless desire to see that everybody had access to quality healthcare and commodities however poor he or she is.”
Lange leaves four daughters, and a son.
Cite this as: BMJ 2014;349:g4827
Joseph “Joep” Lange (b 1954; q 1981 University of Amsterdam), was one of 298 passengers who died on 17 July 2014 when Malaysia Airlines flight MH17 crashed in Ukraine.