Public healthauthorities established more than a century ago a scientific rule that is also a moral precept: don't try to protect some people from a contagious disease and leave others unprotected.

Don't protect only the rich and the middle classes, or only the law abiding: for the infection will sooner or later spread from the unprotected to the protected. Even those who detest prostitution, for example, must realize that protecting prostitutes from syphilis is a necessary step toward protecting the public at large.

But the United States has tolerated one distressing exception to this principle- and we are currently paying a catastrophic price for our scientific and moral lapse. Here's the story:

One subzero winter night half a century ago, while a blizzard raged, two interns at the University of Nebraska College of Medicine puzzled over a very sick patient who suffered at times from very high fever, alternating with bone-shaking chills.

"Malaria"said one intern

"You're crazy"said the other

"There isn't a live mosquito within a thousand miles."

That winter and the next, mid-winter malaria was similarly reported in Chicago, St. Paul, San Francisco and New York City—where the mystery was solved in 1940. Some addicts were sharing the needles and syringes they used to inject heroin. If one of them was infected with malaria parasites, others who subsequently used the same needle without sterilizing it might acquire the infection, summer or winter. Thus, as early as 1940, the country was put on notice that infectious diseases can be spread via needle-sharing.

I retold the story in the February 1941 issue ofReaders' Digest. I called it "The Case of the Missing Mosquitoes," and I warned in particular that in the summer of 1941, when mosquitoes re-turned, we could expect some of them to bite malaria-infected needle-shar-ers and then transmit the malaria parasites to other women, men and children.

I failed to add, however, what should have been obvious to every-body—that far worse diseases than malaria might spread in the same way among needle-sharers, and from them to the rest of us.

The U.S. heroin industry, not public health officials, saved us from a needle-borne malaria epidemic. Her-oin dealers don't like their customers to fall ill; it gives their product a bad reputation. And if a customer dies, it is a loss to the heroin trade. So dealers added quinine to the heroin "bag" to kill the malaria parasites. Indeed they used up so much quinine that they exacer-bated a world shortage.

But the quinine protected only against malaria. Other blood-borne disease organisms remained free to spread among U.S. needle-sharers, and from them to others. Ever since 1940, needle-sharing has been a disaster waiting to happen.

Instead of seeking to avert such a disaster, U.S. drug law enforcement officials lobbied for measures that ac-tually encouraged needle-sharing. They persuaded 33 state legislatures to pass "needle laws" making it a crime to possess syringes and needles unless prescribed by a physician; and some states also made it a crime for a physi-cian to prescribe sterile injection para-phernalia for addicts.

These needle laws failed to dis-courage needle injecting; for anyone enterprising enough to secure a heroin "fix" can also borrow the paraphernalia needed to inject it. What the needle laws did accomplish was to teach drug injectors not to risk arrest by walking around with syringes and needles in their possession. Instead, they shared needles, and still do.

Heroin dealers also fear arrest under the needle laws. They may want to protect the reputation of their product and the lives of their customers by supplying sterile, disposable needles free or at a low cost, just as they add quinine to the heroine bag. Syringe-and-needle combinations desig-ned for one-time use cost only 20 cents or so at the corner drug store if you have a prescription; no doubt the heroin industry could buy them much cheaper at wholesale. But the law stands in the way.

After quinine in the heroin bag had aborted the midwinter malaria epidemic, U.S. needle-sharers began to fall ill with other needle-borne infec-tions. One was bacterial endocarditis, a devastating, often fatal infection of the heart valves that can be transmit-ted both by needle-sharing andby blood transfusion. By rare good luck, penicil-lin was discovered just in time to pre-vent bacterial endocarditis from kill-ing countless blood transfusion recipi-ents as well as needle-sharers.

Syphilis is another infectious disease that can be transmitted through needle-sharing—and through blood transfusion. No one knows how much syphilis has been spread along this route.

Hepatitis B is a debilitating, sometimes fatal blood-borne infec-tion of the liver, and is thought to be a precursor of liver cancer. Following World War II, it was primarily a dis-ease of needle-sharing heroin addicts. But after a while the hepatitis B virus got into the U.S. blood supply, and hepatitis became a frequent sequel to blood transfusions. Many died, needle-shaiers and others alike. Then, at long last, the U.S. public health establish-ment took notice and adopted emer-gency safeguards.

Common sources ofinfected blood for transfusions in those days were the commercial blood donor centers occu-pying store fronts along our urban skid rows and tenderloins. The easiest way for an addict down on his luck to raise money for his next fix was to sell a pint or two of blood at one of those drop-in centers. The centers were closed down when their role in the spread of hepati-tis was discovered—but that was lock-ing the barn after the horse was stolen. The hepatitis B virus had already been spread by blood transfusions far be-yond the boundaries of the drug-inject-ing community. It remains endemic in this country today.

In the beginning, no test was available to screen blood for hepatitis B viruses; so a crash program was launched to develop a screening test. The American Red Cross and other non-profit organizations established today's nationwide system blood banks through which blood screened forhepa-titis viruses and for syphilis bacilli is made available for transfusion.

But that basic public health principle was violated. The precautions taken were desig-ned to protect blood transfusion recipients without protect-ing heroin addicts. No state legislature adopted the most obvious public health safeguard: repeal of the needle laws. As a result, our country remained vulner-able to the possibility that some addi-tional blood-borne infectious disease, more terrible even than hepatitis B, might spread like wildfire among needle-sharers, and then on to the rest of us.

Having thus sown the wind, the United States is today reaping the whirlwind. The AIDS epidemic among needle-sharers has spread on schedule, just like hepatitis B, from them to the outside community.

Once again, we have hurriedly taken emergency measures. A crash research program has developed effec-tive screening tests to safeguard our blood supply against the AIDS virus.

But, once again, lobbyingby drug law enforcement officials has blocked repeal of the state needle laws. As a result, we remain in peril that some future devastating infection—perhaps one as incurable as AIDS, perhaps one even more disastrous—will spread like malaria, bacterial endocarditis, syphi-lis, hepatitis B and AIDS.

Would repeal of the needle laws safeguard the public's health? Decisive evidence comes from Minnesota, where the state legislature has stubbornly refused to be stampeded by drug law enforcement officials into mandating that proof of a prescription is required in order to purchase syringes. The re-sults ofthis stubbornness were reported recently by two University of Minne-sota Medical School professors, Dr. James A. Halikas and Dr. Joseph Westermeyer.

In Minnesota, they point out, intravenous drug users "have always been able to buy clean needles and syringes over the counter." (Pharma-cists are not actually allowed to sell syringes for illicit use, but the law does not require them to ask for proof of a prescription, and the state rarely prose-cutes addicts for possessing clean needles and syringes.) Blood tests of heterosexual Minnesota drug injectors have turned up very few AIDS-virus infections; and most of those infected, Drs. Halikas andWestermeyer explain, "lived for significant periods outside the Twin Cities region, in New York City or other major cities, and are thought to have become infected through sharing drug paraphernalia there.

"We have treated hundreds of other patients at high risk (for AIDS]...and have yet to find a hetero-sexual drug user who is positive for the AIDS virus as a result of intravenous drug use." The doctors attributed this to the unwritten Minnesota policy of not criminalizing people who buy syringes without a prescription.

The data from the state of Oregon, Canada, Britain and Holland point in the same direction.

Repeal of the needle laws by all 33 states thathave them would achieve only a modest effect on the AIDS epi-demic; it is already several years too late. But repeal may profoundly affect the next blood-borne infection to threaten the public's health. If we wait until the next needle-borne health dis-aster surfaces, however, it will once again be too late.

Repeal of the needle laws will also be an act of conscience, a recogni-tion that addicts are human beings. Defying that moral precept has already cost us dearly.

References
Alcohol and Drug Problems Association of North America (ADPA), 444 N . Capitol St., N.W., Washington, D.C. 20001. (202) 737- 4340. Karst Besteman, Executive Director.
Chemical Dependency Program Division 3823, Minnesota Department of Human Services, 444 Lafayette Road, St. Paul, Minn. 55155. (612) 296-4610. Carol Salkow-ski, AIDS Coordinator.
Mersey Regional Training Centre, 10 Mary-land St., Liverpool, England Ll 9BX. (051) 709-3511. Pat O'Hare, Director.
National Research Council, AIDS, Sexual Behavior and Drug Use, (Feb. 8, 1989), National Academy of Sciences, 2101 Constitution Ave., N.W., Washington, D.C. 20418. Sales: (202) 334-3313. Information: (202) 334-2138.

Edward M. Brecher, "Needles and the Conscience of a Nation," The Drug Policy Letter, March/April 1989, p.5.