As a medical student at the University of Adelaide during the late 1950s, a young Michael Alpers read with fascination about a fatal neurological illness called kuru that was endemic to a small cultural group in the Eastern Highlands of Papua New Guinea.
At the time, it was a completely mysterious disease. The Fore people still lived a deeply traditional life, having only just been contacted to the outside world.
After graduating from medicine, the man who would become Professor Michael Alpers AO travelled to the Okapa patrol post in Papua New Guinea in 1961 to assume a role as research doctor with the Department of Public Health.
The victims of kuru suffered from lack of coordination, body tremors and shaking limbs – symptoms that worsened as the sufferers progressed towards death over a period of 6-18 months. In 1961, scientists had only recently recognised the similarities between kuru and the transmissible disease of sheep called scrapie. Both were degenerative diseases of the nervous system, which should not, by the usual tenets of microbiology, be infectious. But little else was known.
Based in the Waisa community – of which he and his family are still part – Professor Alpers began an international collaboration with Dr Carleton Gajdusek – the eventual winner of the Nobel Prize in Physiology or Medicine in 1976. Professor Alpers conducted post-mortems on kuru patients within hours of their deaths, and then sent the samples to Dr Gajdusek at the National Institutes of Health in the United States.
After three years, he moved to the US to work with Dr Gajdusek in undertaking transmission experiments with these samples. There, with Dr Joseph Gibbs, they showed that kuru, like scrapie, was indeed transmissible: it became the first human transmissible spongiform encephalopathy. At the NIH he also analysed the epidemiology of kuru and discovered that kuru was beginning to disappear in children, starting with the youngest age group.
His unique field studies approached kuru from cultural, behavioural, clinical, epidemiological and biomedical aspects, exactly the way that we want to approach and link bioscience with public health outcomes now. In 1967, despite the continuing scepticism of his colleagues, he wrote a paper linking the transmission of kuru to the mortuary practices of the Fore people.
Until the late 1950s, the Fore had practised what Professor Alpers terms ‘transumption’, collectively consuming the bodies of relatives who had died – an important spiritual practice that helped to free the spirits of the dead.
The authorities had banned ‘transumption’ in the 1950s on the basis of its cannibalistic connotations. Professor Alpers made the vital link between this ban and the epidemiological decline that he had shown. Transumption also explained why kuru occurred far more frequently in women and children, since they, and not the men, ate the internal organs, including the infected brain. It was later realised that the infrequent cases where a man manifested kuru resulted from ingesting the infected tissue as a child, since kuru can have a long incubation period – sometimes more than 50 years.
This once-derided theory is now generally accepted as the basis for the astounding epidemic of kuru among the Fore people, at the peak of which 200 people or one percent of the population, died each year.
After four years at the NIH, Professor Alpers moved to the University of Western Australia as a research fellow within the Department of Microbiology. From there, he made annual field trips to Papua New Guinea, meaning that his 47-year period of studying kuru remains completely uninterrupted.
Kuru is caused by prions, and Professor Alpers’ work provided vital building blocks in the discovery and understanding of these infectious, self-reproducing pathogens comprised of mis-folded proteins. Prions are one of the biggest medical discoveries of the 20th century. For his ground-breaking work on prions (and inventing the name) Dr Stanley Prusiner was awarded the Nobel Prize in 1997.
In 1977, Professor Alpers became Director of the Papua New Guinea Institute of Medical Research, working with five expatriate and five local staff. He continued his work on kuru, but more particularly initiated new studies on the major diseases affecting the people of the newly independent country: pneumonia, malaria, diarrhoeal diseases, typhoid, asthma and filariasis. He also conducted nutritional and genetic studies. In malaria, he worked tirelessly on studies to reduce the sickness and death that malaria inflicted on children, and he initiated a program, in collaboration with colleagues in Australia, to develop a blood-stage malaria vaccine that would protect children growing up in the tropical world.
By the time of his departure 23 years later, the Institute comprised five expatriate and 250 local staff.
Professor Alpers is now John Curtin Distinguished Professor of International Health at Curtin University of Technology in Western Australia.
In 2005, he was appointed an Officer of the Order of Australia for his services to medical science and to health and development in Papua New Guinea. He was appointed a Companion of the Papua New Guinean Order of the Star of Melanesia in 2008 for his contribution to the development of Papua New Guinea.
He is committed to community health and health equity, and is currently a member or fellow of 30 professional societies and associations. He is a Fellow of the Royal Society and of the Third World Academy of Sciences.
His work on kuru has been fundamental to our understanding of one of the most confounding modern prion diseases – bovine spongiform encephalopathy, more commonly known as mad cow disease, which results in variant Creutzfeldt-Jakob disease in humans. His collaborative studies on the incubation period and the genetics of kuru now instruct scientists on how the epidemic of variant CJD may continue to evolve in populations where it is incubating, particularly in the United Kingdom.
The last kuru sufferer died in 2005, but Professor Alpers’ team will continue their active field surveillance in Fore communities until 2010 when - provided that no new case appears - this devastating illness will be considered to have died out and the epidemic will be declared at an end.