Mann, Jonathan (1947–1998)

An article by Ofelia T. Monzon1

Jonathan Mann came to the World Health Organization (WHO) in 1986 after two years of intensive work as the founder and director of Projet SIDA, a collaborative AIDS research project based in Kinshasa, Zaire, and involving the Centers for Disease Control in the United States, national institutes of health, the Institute of Tropical Medicine (Antwerp, Belgium) and the Ministry of Health, Zaire. This was also his meeting point with Peter Pio t, who heads UNAIDS today.

Prior to working in Zaire, Mann was state epidemiologist and assistant director of the health department in New Mexico. From 1975 to 1977, he was an Epidemic Intelligence Service Officer with the Centers for Disease Control.

Jonathan Mann directed WHO’s Global Program on AIDS until 1990. Among the

many innovative advocacy and resource mobilization initiatives during that time, many remember the first ever gathering in London of more than 100 Ministers of Health from around the globe, who had come to discuss one single issue: the AIDS epidemic.

Following his departure from WHO in Geneva, he returned to the United States and was appointed Professor of Epidemiology and International Health at the Harvard School of Public Health. Subsequently, in 1993, he was appointed the first Francois-Xavier Bagnoud Professor of Health and Human Rights and founding Director of the Francois-Xavier Bagnoud Center for Health and Human Rights at Harvard University.

Since 1 January 1998, and until his and his wife’s tragic death in September of that year, Jonathan Mann served as Dean of the School of Public Health of the Allegheny University of the Health Sciences in Philadelphia.

Mann received his B.A. (magna cum laude in history) from Harvard College, his M.D.

from Washington University at St. Louis (1974) and his M.P.H. from the Harvard School of Public Health (1980).

He was a member of the Institute of Medicine (National Academy of Sciences) and a fellow of the American College of Epidemiology. He was also the President of Doctors of the World, the affiliate in the United States of the French medical humanitarian relief 1

organization, Medecins du Monde. He was the Chairman of the Global AIDS Policy Coalition, an independent research and advocacy organization.

Dr. Jonathan Mann and his wife, Dr Mary-Lou Clements-Mann, were among the 229

passengers of Swissair Flight 111 which went down off the coast of Nova Scotia in eastern Canada on 3 September 1998. There were no survivors of the crash. His three children reside in the United States of America.

A vocal and tireless advocate of the need for everybody to join hands and fight AIDS

before a plane crash silenced him foreverhis influence will continue to linger on. Writing about a person who was a giant in his field during his brief can be a formidable challenge.

Jonathan Mann was a young American doctor at the time I first met him. At a donors meeting organized by WHO in 1986, he told me that it was his first month in a new position created by WHO that was tasked to deal with AIDS. Faced with this huge responsibility, he had only a single assistant, Dr. Hiko Tamashiro. Coming from a country where only a single person had been reported with AIDS, most of discussions were country representatives where AIDS had already been presenting problems, i.e. Africa.

In a private discussion with Mann during that meeting, I presented the difficulties of AIDS prevention in a country with very limited resources and with a then unstable political situation. This was a task, which would encounter many obstacles. Mann advised me to express this sentiment to policy making groups in the Philippines. At the time, I was impressed with the vigor with which he verbalized his concerns to the gathering.

I returned to the Philippines imbued with the determination to stimulate the health authorities to initiate AIDS activities.Over the next few years, I continued to hear about Mann from the many articles that were being written about him. The need for education and public awareness were cited repeatedly from the WHO Global Program on AIDS as well as statistics showing a grim increase in numbers of people affected by AIDS.

In 1988, he visited Manila and requested that I show him around. At that time, I was conducting an intervention program for sex workers in Manila and two adjoining cities.

Political unrest was the climate in which the intervention was being conducted and as a matter of fact, a coup d’etat occurred during the 2 year program. Prostitution was illegal, and possession of condoms was evidence of such. In as much as the field workers were distributing condoms and demonstrating its appropriate use, the city police had to be treated to a lecture on AIDS prevention and the need for field workers to carry around condoms.

Those were exciting times. 2

As I took Mann around clubs and bars in the cities, the zeal with which he approached his mission was very apparent. Mann interviewed both male and female sex workers, delving into the plight of these young workers with sensitivity and incisiveness. Some of the male sex workers were college students working their way through college whereas most of the female workers were helping support their families who were in their home provinces. These workers did not inform their families as to the nature of the employment that brought in money needed for survival.

In succeeding International AIDS Conferences, I would encounter Jonathan Mann, listen to his increasing fervor and zeal as he would expound on the challenges that beset the control of AIDS. He recognized that AIDS was not simply a medical condition. Where most of the people involved in AIDS at that time were dealing with this disease through traditional medical methods and public health approaches, Mann warned the world that the control of AIDS required facing the problems that underlie human behavior. Gradually, countries were awakened to the need of society getting together and tackling the many complex issues that led to vulnerability to AIDS.

As time went on, increasingly Mann raised his voice, warning the world that AIDS was spreading fast, especially in the countries that could least afford it. Poverty, gender inequality, marginalization of people with HIV infection, and human rights violations were issues stressed by Mann as he continually called on many disciplines to join the fight against this disease.

Long after he left WHO, his voice was heard from the Harvard School of Public Health where he had relocated and media continued to quote him. His two-volume AIDS in the World (Mann, Tarantola, Netter, 1992; Mann, Tarantola, 1996) have been used by local AIDS workers for reference, as have countless people all over the world. The second edition “ offered perspectives from which individuals, communities, nations, and international organizations could redefine their responses to the pandemic”.

How does one measure the impact of such a vibrant personality on the development and effect of control of AIDS in a country? The answer of course is it is impossible. During the early years of the Global Program on AIDS, only a few AIDS patients had been reported from the Philippines. Almost at the same time, the AIDS control program of the Philippines was being developed. I was privileged to be part of those early beginnings.

During those early years (1988-1990), communications were being released from the Global Program on AIDS regarding the spread of the disease, the impact on issues far reaching into all parts of society, and the need to address these issues as part of the response 3 to AIDS. WHO also provided a consultant for the development of the first Medium Term Program of the Philippines in 1987. Most if not all countries in this region depend on WHO for information and advice regarding diseases of public health importance. Under the aegis of the Department of Health, the initial prevention activities of AIDS information and education were undertaken. Mann was a tireless advocate during this period. Reports were emanating from his WHO office and these were being reported by the media in this country, as was happening all over the world. The public was being energized by his warnings.

The Philippines is now into its third medium term plan for HIV/AIDS control. Its first plan which established the basic directions for prevention and control were written during the period when Mann was quite active in issuing messages of caution and action. In the case of AIDS, the Global Program for AIDS during Mann’s leadership played a very important role in providing AIDS information, and the components for country action against AIDS. Interest and involvement of non-governmental organizations now working in AIDS in this country were observed to have started in the early 1990s.

This country at the present time appears to have a low HIV prevalence. As of November 2001, an aggregated total of 1,589 have been reported by the passive and active surveillance methods since 1986. There are both governmental, i.e. the Philippine National AIDS Council, and many non-governmental organizations with various AIDS prevention activities. AIDS education is required in schools at all levels, although implementation in some areas are not optimal. Involving media in AIDS has been an ongoing activity by the AIDS Society of the Philippines since 1997. There are counseling programs, and other intervention approaches that are being conducted in many parts of this country of 75 million people. Legal and ethical aspects of AIDS have been looked at and the Philippines has the distinction of being the only country in Asia with an “AIDS law” (Republic Act No 8504, 1998). Ethical guidelines (Philippine National AIDS Council, 2000) have been disseminated throughout the country and monitoring of these various undertakings have been initiated.

Care and support programs are at an early stage of implementation.

The influence of Mann on government and nongovernment AIDS responses in this country cannot be downplayed. How much of that influence translated into an apparent low number of reported HIV/AIDS cases in this country is difficult to estimate since there are other factors which may have played pivotal roles: commitment by various agencies, cultural differences, political advocacy, circumcision, and the absence of borders contiguous with other countries are some of the disparate factors speculated on. Suffice it to say that at an important and critical point in the crafting of this country’s AIDS control program, Mann’s voice was a 4 ceaseless reminder to begin preventive measures. A vocal and tireless advocate of the need for everybody to join hands and fight AIDS before a plane crash silenced him forever, his influence will continue to linger on.

Note

Ofelia T. Monzon (Philippines) . M.D. Graduate of the College of Medicine, University of Santo Tomas, Manila. Trained at Baylor University and at UCLA School of Medicine, United States. She initiated many AIDS activities among sex workers in the Philippines and established the first laboratory for AIDS testing. From 1988–90, she conducted an AIDS intervention programme in three Metro Manila cities and helped design a strategy for HIV testing. Helped design the first Medium-Term AIDS Plan for the Philippines. Currently, President of the AIDS Society of the Philippines. Author or co-author of more than 100 published and poster presentations.

References

See particularly: http://www.hsph.harvard.edu/fxbcenter/inmem.htm

Mann, J.; Tarantola D; Netter T. 1992. AIDS in the world. Cambridge, MA, Harvard University Press.

Mann, J.; Tarantola, D.J.M. 1996. AIDS in the World II. Oxford, UK; New York, NY, Oxford University Press.

Philippines. Republic Act No 8504. 1998. The Philippine AIDS Prevention and Control Act of 1998. Manila.

Philippines. The Philippine National AIDS Council. The AIDS Society of the Philippines. 2000. Ethical guidelines in AIDS investigations in the Philippines. Manila.

Copyright notice

The following text was originally published in PROSPECTS: the quarterly review of education (Paris, UNESCO: International Bureau of Education), vol. 24, no. 1/2, 1994, p. 61–76.

This document may be reproduced free of charge as long as acknowledgement is made of the source.