In April 1985, in the early days of screening blood supplies for the AIDS virus, the New York Blood Center sent a telex to the Red Cross of Switzerland, advising it that a small part of its shipment of Swiss blood appeared to have tested positive for H.I.V.
The New York center said it had destroyed the suspect units. The Swiss Red Cross now concedes that that telex was the first warning that the virus that causes AIDS was present in Switzerland.
Yet for 12 months after the warning, according to a Swiss Government investigation, the Swiss Red Cross continued to use and distribute untested blood and blood products in Switzerland. And after the Government made AIDS screening mandatory on May 1, 1986, investigators said, the Red Cross still failed to recall possibly contaminated blood products from clinics and hospitals.
Now, the Swiss Red Cross, one of the country's most prestigious institutions, is having to answer for these decisions. This month the Government charged Alfred Hassig, a hematologist and a former director of the Red Cross central laboratory, with inflicting grievous bodily harm for allowing the use of possibly infected blood.
According to health officials, the tainted blood products infected 68 hemophiliacs with the AIDS virus in the mid-1980's. Twenty-four of them have died. The officials said an estimated 100 to 200 others were contaminated through hospital blood transfusions between 1983 and early 1986. They said half of those patients are believed to have died.
The Government's investigation into the Swiss health system sheds new light on a critical period in the 1980's. At that time, people with hemophilia in need of regular blood-proteins were almost doomed to H.I.V.-infections. But their subsequent protection depended on how the health authorities reacted to the news of the spreading AIDS virus.
It is now apparent that the Swiss were slow to respond because at first they thought the problem was largely confined to the United States, Haiti and Africa. Other Western European countries, including France and Germany, also minimized the threat initially even though European health authorities as early as 1983 warned against importing American blood plasma. But the Swiss in particular believed that they were shielded by their tradition of clean living.
Anger and Disbelief
But today in Switzerland, the revelations have created anger and disbelief, not only because of the apparent negligence but also because the Swiss Red Cross, which is separate from the International Committee of the Red Cross, also based here, has always been regarded as an unquestioned symbol of Swiss probity.
"This was done by our beautiful Red Cross, a national monument beyond suspicion," said Jacques Barillon, a lawyer for several infected people. "Distrusting the Swiss Red Cross was like saying that Mother Teresa starved children to death."
On a recent walk in Geneva, a pale 44-year-old man, a victim of tainted blood, tried to contain his rage as he talked of his double struggle, first with hemophilia, then with the AIDS virus.
"It's scandalous because it needn't have happened," said the man, an architect who wanted to be known only by his first name, Francois. "It happened because the Red Cross was incredibly arrogant and nationalist."
Asked About Safety of Blood
He said he and others had repeatedly asked Red Cross doctors and the Swiss Hemophiliacs Association about the safety of blood supplies as early as 1983, when scientists warned of the risk to hemophiliacs and urged the virus-destroying heat treatment of blood extracts and blood-clotting substances that hemophiliacs need.
"The response always amounted to this: we are very clean; we have few heroin addicts; we have few homosexuals; we use mostly Swiss blood," he said. "Red Cross doctors used stupid Swiss reasons instead of scientific arguments. But I had to trust them, my life was in their hands."
In Switzerland, the Red Cross is responsible for collecting all blood donations, and it processes and distributes about 80 percent of the country's blood products. It gets the blood from unpaid local donors.
But in February, the Ministry of the Interior reported that AIDS infections were caused not only by Red Cross products but also by Immuno, an Austrian company that in the early 1980's bought plasma in the United States. Blood suppliers often buy or exchange components they need to make different products. The New York Blood Center, faced with local shortages, has long imported red cells needed for transfusions from Swiss and other European centers.
Scandal in France
The Swiss case follows two other major European scandals involving H.I.V.-infected blood. In 1992, France convicted three health officials for knowingly allowing the distribution of tainted blood products in 1985. Last year, German prosecutors charged a German company, UB Plasma of Coblenz, with failing to test blood adequately beginning in 1985.
In Geneva, the case against Dr. Hassig, who is now retired from the Red Cross, was begun two years ago when Miguel Fernandez, a 27-year-old hemophiliac, charged in a lawsuit that the Red Cross could have avoided infecting him with AIDS. He said that between 1983 and 1986 a German company tried but was unable to sell "safe," heated blood products in Switzerland.
Four more hemophiliacs and two others contaminated by hospital blood transfusions have since joined Mr. Fernandez's lawsuit, which seeks to establish criminal responsibility. In the clearest case, lawyers said, one hemophiliac tested H.I.V. negative as late as February 1985 but was positive by mid-1986.
The most damaging criticism, though, came in a report by the Swiss Interior Ministry accusing several institutions of serious shortcomings during the 1984-1986 period. The report, released in February, said that the Swiss health officials took too long to make H.I.V. screening mandatory by law, effective May 1, 1986. Switzerland and Spain were the last West European countries to take this step.
Report Criticizes Red Cross
The report also criticized the Swiss Red Cross for not starting its H.I.V. tests sooner. After introducing tests, it said, "the Swiss Red Cross continued to distribute non-tested blood stocks; it did not make a systematic recall of all the non-tested products already distributed, nor did it try to find the recipients of blood or blood products coming from a donor who subsequently proved seropositive."
It added, "This could have protected their sexual partners."
Marcus Haechler, a spokesman for the Swiss Red Cross in Bern, said H.I.V. screening was introduced in its central laboratory in July 1985 and in its other centers by November 1985. In the United States, where AIDS had spread earlier and wider, all blood supplies were being screened for the AIDS virus by early 1985.
Asked why the Red Cross continued using untested stocks to make blood clotting products as late as May 1, 1986, when testing became mandatory by law, Mr. Haechler said that at the time the grave risks of H.I.V.-infections were not fully understood. He said that the Red Cross feared shortages of the vital clotting substance, known as factor VIII, without which hemophiliacs could have died.
"It was a choice between two evils and people thought they chose the lesser of the two," he said. "We were wrong to think there was no problem for Switzerland. We thought: we have unpaid donors, a more rural population and few donors belonging to risk groups."
Faces 20 Years in Prison
Dr. Hassig, 73, who faces charges carrying a maximum prison term of 20 years, has not commented. He became an internationally known blood expert who campaigned against paying blood donors to reduce risks during his three decades as the director of the Swiss Red Cross central laboratory. He retired in 1986.
In an article published in 1992 in the journal Medicine and Hygiene, he wrote that in hindsight, "we must admit that we underestimated" the presence of H.I.V.-infections among Swiss donors and that "some infections of hemophiles could have been avoided."
He also blamed contaminated plasma imported from the United States. More infections could have been avoided, he said, if from 1983, the health authorities had abided by European agreements and had forbidden "preparations made from American plasma" including those sold by Immuno, the Austrian company. According to the Swiss Government, one-third of the infected hemophiliacs had used products from Immuno.
Dr. Hassig is so far the only person charged, although lawyers expect several others may follow as the Government investigates the responsibility of Immuno and of the federal public health department in charge of controlling medicines and blood.
David vs. Goliath
Francois, who said he had used only Red Cross products for his hemophilia and who has also joined the lawsuit, spoke of his hopes to muster enough strength for what "promises to be an exhausting battle of David and Goliath."
His life and health have crumbled since 1986, when he took a test on a doctor's suggestion and learned that he had the AIDS virus. First, his wife left him and then, in 1990, he was dismissed from his job as a town planner. He said the dismissal was not specifically because of AIDS, but that he was told his "absences were not compatible" with his work.
Sitting on a park bench near Lake Geneva, he reviewed his situation. "Whatever the Red Cross argues, for me the truth is simple," he said. "They are robbing me of the rest of my life. They will rob my daughter of her father, and they have already ruined the old age of my parents."
Of the nearly 300 Swiss hemophiliacs, 22 percent have the AIDS virus, compared with 55 percent in the United States, according to the World Health Organization. Today, the blood in Switzerland is considered safe. But in Europe, Switzerland now has the highest per capita number of patients with full-blown AIDS. Of 3,662 known patients, 2,400 have died. And of the country's 6.9 million inhabitants, as many as 19,000 are estimated to be infected.