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Introduction 15  Introduction Excellence is rarely found, more rarely valued. — Johann Wolfgang von Goethe “Cold War Triangle” is about the human face of science, how scientists from three different cultures collaborated to create the complex drugs that saved millions of lives. Who were the mentors that influenced them and their careers? How did they intersect with one another? What traits in their unique backgrounds and disparate journeys led them toward the making of key discoveries in modern medicine? This book recounts an inspiring story of the groundbreaking cooperation between East and West during the darkest days of the Cold War. How did scientists behind the Iron Curtain overcome authoritarian rule, cross hostile borders and ultimately collaborate with colleagues in the West? Who would have thought then that their cooperative spirit would culminate in a vital weapon to inhibit HIV and thwart an epidemic? Preventing the onslaught of infectious disease has been an innate human concern since the dawn of time. The discovery of antibiotics to combat bacteria laid the groundwork for a new medical field, virology, which focused on the tiniest of microbes. The development of vaccines to prevent debilitating diseases and save lives brought relief to mankind. The search for antiviral drugs was initially considered extraneous. Unaware of a looming epidemic, some scientists were already starting to put the tools in place to combat a retrovirus. HIV is a slow-moving retrovirus but contrary to all other viruses-causing infectious disease, it has proven to be one of the deadliest forms that humanityhasever encountered. Ifnot treated, thisviruskillsalmostallwithout fail. When HIV came into the limelight in the 1980s, people became painfully aware that there were hardly any antiviral drugs in existence. None of them could inhibit HIV. Even the entire arsenal of antibiotics, one of the biggest triumphs of medicine, proved useless against viruses. 16 Cold War Triangle AZT, the first drug to treat AIDS, became available in 1987. However, it gave only a short reprieve as it proved too toxic for long-term treatment . Death continued to lurk at the doorstep of those infected with HIV. When science could not produce a real life-saving treatment, disillusion turned into anger. The streets exploded with demonstrations by gay protesters , besieging large pharmaceutical companies. As the AIDS epidemic expanded and more lives were lost, the media and public demanded to know why modern science could not find an effective treatment. It took almost ten more years until a new generation of drugs hit the market. Patients struggled to keep pace with their therapy; the mix of medications involved taking more than twenty pills at six different times of the day and still had plenty of side effects. It kept people alive but in a miserable way.3 Atriangularpartnership,formedduringtheColdWarbetweenBelgian, Czech and American scientific teams, led the way to the most effective treatment in the world today that features a one-a-day pill with few side effects. The protagonists   —   Erik De Clercq, a Belgian scientist from the University of Leuven, and his Czech colleague, Antonín Holý, from the AcademyofSciencesinPrague  —  firstmetinWestGermanyin1976.Their work yielded splendid discoveries that were licensed to an American company before the fall of the Berlin Wall. Holý and De Clercq had single -handedly created a whole class of molecules out of which Tenofovir emerged. The conviction of one man, John Martin, was the driving force behind his team at Gilead Sciences to develop this compound. Tenofovir has since evolved into several drugs that allow HIV-infected people to lead a normal life. One of them, Truvada, has also been approved for the prevention of HIV, which could put an end to the epidemic if enough people could take it. The Gilead drugs became the gold standard for HIV treatment in the West. John Martin played a pivotal role in bringing these twenty-first century drugs to Africa and the rest of the developing world. A brief excursion into the history of virology and vaccines The power of a microbe is a baffling phenomenon. It can unseat empires and shape history. The end of the Roman Empire was connected to a steep demographic decline caused by smallpox epidemics, which Introduction 17  had been spread throughout the Mediterranean by Roman soldiers. The bacteria causing Black Death (Yersinia pestis), which originated in China, was carried on the backs of Mongolian hordes to a major Genoese trading port on the Black Sea. The bacteria travelled on black rats in cargo destined for Europe.4 The Black Death that swept the continent...