Former surgeon general C. Everett Koop died Monday in New Hampshire at age 96. Koop is justly renowned for his role in the tobacco wars of the 1990s. His repeated warnings that tobacco use was deadly and increasing among children anchored a series of famous congressional hearings that led to warning labels, bans on Joe Camel-type advertising and finally, in 2009, the FDA’s regulation of tobacco.
But Koop was also a pivotal figure, and probably saved just as many lives, because he broke a deadlock in the Republican Party that had stopped Congress from addressing the rampaging AIDS epidemic in the 1980s. He did this in two ways: by publicly emphasizing the epidemiological threat the disease posed to all (not just gay) Americans, and by casting himself as a sort of shadow GOP leader at a time when the party’s actual leaders were exacerbating the deadly crisis.
Congress is routinely maligned for being ineffective or worse, but it’s also capable of heroism. AIDS put both tendencies on vivid display. In 1981, when the epidemic struck, Ronald Reagan’s first budget took aim at public health funds. Staffers for the House Subcommittee on Health and the Environment spread out among agencies like the NIH, FDA, and CDC to try and anticipate the fallout. It turned out doctors were bracing for an epidemic they expected would strike among preventable childhood diseases — Reagan’s cuts would halve the immunization budget. During a visit to the CDC in Atlanta, one staffer learned of a strange outbreak of a deadly pneumonia showing up in gay men in Los Angeles. Before AIDS even had a name, Congress had identified the threat and begun plans to direct attention and research funding to the new disease.
Scientists immediately recognized the danger AIDS posed and how it would spread. Democrats led by Rep. Henry Waxman wrote public-health legislation to help contain the outbreak. But prominent Republicans dubbed AIDS a “gay disease” and blocked these efforts. Two were especially damaging. Rep. Bill Dannemeyer proposed rounding up gay men and quarantining them on a South Pacific island, sought to criminalize the transmission of HIV and read graphic descriptions of sexual acts into the Congressional Record. Rep. Dan Burton stopped eating soup for fear that a waiter might give him AIDS and brought his own scissors to the House barber so he couldn’t acquire the disease from an earlier customer. Even more damaging than blocking legislation was the paranoid alarm these members imparted to the public understanding of the AIDS epidemic. And they instilled terror of the government in gay men, whose cooperation health officials desperately needed to contain the outbreak.
Koop was a noted social conservative who disapproved of homosexuality. But as a doctor, he recognized the epidemiological implications of what was happening and fought tirelessly to contain them. Whenever he testified before Congress, he knocked down the conservative talking point that “AIDS is not a no-fault disease.” He labored to disabuse Republicans like Burton and Dannemeyer of their crackpot conviction that AIDS spread through spores and could be transmitted by spoons and scissors. He intentionally highlighted the tragedies of pediatric AIDS and hemophiliacs like Ryan White who contracted the disease through transfusions to shape public consciousness of AIDS as affecting more than gay men and intravenous drug users. Ultimately, this strategy yielded landmark legislation, the Ryan White CARE Act.
But not before Koop overcame the implacable opposition of fellow social conservatives in Congress. Despite fanning AIDS hysteria, Republicans did not all oppose public health efforts, and a number urgently wanted to act. The problem they faced is the obverse of the one the party faces today: They were primarily junior members who were bullied by senior figures like Dannemeyer, the ranking member of the Health and Environment subcommittee. Seniority made these figures uniquely effective in stripping “special rights,” or even basic conditions of equality, for gays from legislation to, for instance, extend health privacy laws so that gay men could cooperate with public health officials without fear of losing insurance, jobs, or custody of their children (the Americans with Disabilities Act did not yet exist). Sen. Jesse Helms stopped the first major AIDS bill because its authors would not strip confidentiality language.
Koop’s prominence, and his integrity both as a doctor and a social conservative, gradually made him the most important Republican in the debate, first in the eyes of the media, then the public, and eventually in Congress as well. At a time when Reagan was silent about the disease, Koop advocated condoms and safe-sex classes in schools and used the power of office to issue reports and educational pamphlets sent to millions of Americans. These efforts helped shift public awareness in a way that made legislation possible. Koop’s campaign to highlight pediatric AIDS finally persuaded Rep. Norman Lent, a Long Island Republican who was ranking member of the full Energy and Commerce Committee and therefore outranked Dannemeyer.
The rapid advances in gay rights over the last few years make it easy to forget the intensity of oppression gays faced from politicians in the very recent past, as well as the extraordinary efforts by members of Congress to overcome that opposition. Koop merits special distinction for having overcome the enmity of both sides. Liberals, including Waxman, initially blocked his nomination for fear he would be an anti-abortion crusader, but later came to admire him. Conservatives expected the same thing and were disappointed. Many bitterly resented Koop’s role in the AIDS crisis and, when he left office, boycotted his farewell dinner.
Koop was a “maverick” in the non-Washington sense of the word, and it cannot have been easy for him. It’s worth pausing to reflect on his many contributions (or even read his underrated memoir, available for a penny).
May he rest in peace.
Joshua Green is a national correspondent at Bloomberg Businessweek and a columnist for the Boston Globe. With Henry Waxman, he co-wrote “The Waxman Report: How Congress Really Works” (Twelve, 2009). Follow him on Twitter @JoshuaGreen.