A Promise Is Not Enough
by Bruce Mirken Frontier Newsmagazine
The good news cited by the report is a number of positive developments. They include encouraging results from monkey studies of possible vaccines, increased investment in AIDS vaccine development by large pharmaceutical companies (among them Merck and GlaxoSmithKline) and a major infusion of cash into vaccine research by private philanthropists, including the Bill and Melinda Gates Foundation.
The grim other side of the coin is that "half the 15-year-old boys in South Africa alive today will perish from AIDS, and still only one vaccine is being tested to determine whether or not it works." That vaccine, VaxGen's AIDSVax, has been regarded with skepticism by many researchers. Preliminary data from Phase III efficacy studies should be available later this year and final results are due in 2003.
UC San Francisco researcher Dr. Susan Buchbinder said only one other candidate--a "prime-boost" combination where AIDSVax is paired with another vaccine thought to be more effective at stimulating the cellular arm of the immune system--is in Phase II studies. But with just one product within striking distance of evaluation for Phase III trials, it will be difficult, though not impossible, to meet the goal of getting a vaccine fully tested and approved by 2007.
To accelerate the process, AVAC argued a need for increased funding as well as tax credits for companies working on vaccines. But the report also cited a need for greater coordination and communication among the public and private institutions involved in HIV vaccine research: "Absent leadership and coordination, there is no guarantee the expanding research effort will be as efficient or speedy as it should be." Additionally, the report argued that the issue of guaranteeing poor people in the developed and developing worlds access to any successful vaccine must be addressed now. "If those issues are not addressed up front, whole communities and whole countries are not going to be willing to participate" in vaccine trials, Buchbinder said.
The other critical element, the report argues, is community involvement. The document calls for heightened efforts to involve and educate communities of color, who had "limited" representation among AIDSVax trial volunteers.
AVAC board member Steve Wakefield, who doubles as community education director for the U.S. government's HIV Vaccine Trials Network, noted that the effort to develop treatments for HIV has shown that "success happens when strong community involvement is present. There is great value in involving communities in the research and development of HIV/AIDS strategies." He said that means community organizations, particularly those involved in AIDS prevention, must get involved in advocating for and educating the public about vaccines.
AVAC members emphasized that any push to increase funding and attention to HIV vaccines must not take resources away from efforts to provide treatment to those now infected. "This absolutely must not be a zero-sum game," stressed AVAC Board Chairperson Chris Collins, reiterating the group's support for expanding programs to provide treatment for all who need it.