Individual exchanges in medicine and science have been under way since the early 1960s. But it was not until May 23, 1972, that broader cooperation in health was initiated between the Soviet and U.S. governments. In the spirit of de'tente under President Richard Nixon and Soviet leader Leonid Brezhnev, an agreement between the two countries was signed.

It promised joint efforts, including the study of heart disease, cancer, environmental health, mental health, arthritis, and viral infections. In 1974, an agreement for cooperative research on developing the artificial heart was also signed.

Exchanges grew throughout the 1970s until the Soviet Union's 1979 invasion of Afghanistan. President Carter put a stop to all high-level visits by American health officials to the U.S.S.R. In the Reagan administration in the early 1980s, the chill continued -- reinforced by political events, such as the Soviet downing of the KAL jet in 1983 and the initial Soviet handling of the medical treatment of famed dissident Andrei Sakharov and his wife Yelena Bonner.

Even with the freeze on high-level contacts, many of the exchange efforts continued at the working scientist level. Nonetheless, "a lot of the American scientists for their own personal and political reasons did not want to collaborate," noted Alexandra Stepanian, Soviet program officer at NIH's Fogarty International Center.

The 1985 Geneva summit again put a premium on scientific and cultural exchange efforts between the two countries, encouraging the private sector as well as government agencies to get involved.

In the fall of 1986, two high-level delegations of American health officials traveled to the Soviet Union, the first official visits since the late 1970s. One delegation was led by then-Surgeon General C. Everett Koop, the other by then-NIH director James Wyngaarden; they paved the way for resumption of official joint committee meetings to expand government health exchanges. The first official meeting of the glasnost era took place in Washington and at the NIH Bethesda campus in the spring of 1987.

Public Health Service international health director Harold P. Thompson remembers the session as a mixture of tension and humor. The meeting was "almost canceled" at the last minute, he recalled, because of a Soviet "AIDS disinformation campaign" that accused the U.S. of creating the AIDS virus as part of a military biological Koop, he said, was told "to read the riot act to the Soviets" and tell them there would be no expansion of health exchanges and no cooperative research in AIDS "until they knocked it off."

Koop showed up in his imposing Public Health Service uniform and surprised the 10-member Soviet delegation by sternly reading from talking points supplied by the White House, according to Thompson. "You could hear a pin drop in the room. Everyone was waiting. We thought the Soviets might walk out. Koop finished and there was dead silence. And then the Soviet deputy health minister Oleg Shchepin responded, 'So that's why you wore your uniform today,' and everyone burst out laughing." Later, said Thompson, Koop gave him two autographed photographs, one of himself in civilian clothes "for good days," the other in his government uniform "for bad days."

The meeting went well. "I was impressed at how much more relaxed the Soviet officials seemed. The deputy minister of health mentioned both perestroika (the restructuring of Soviet society) and glasnost (the official policy of openness) in his introductory remarks," said NIH's Stepanian. "It was momentous in that it was the first meeting in nine years. People felt very positive about resuming cooperation and moving forward."

Subsequently, at the next joint committee meeting, held in Moscow in November 1988, three new areas of cooperation were added, including AIDS, the biomedical problems of alcohol and drug abuse and the use of primates in medical research.