AIDS Vaccine 2001 Conference Begins in Philadelphia; Participants to Discuss Research Progress, Challenges
AIDS vaccine researchers, public health officials and pharmaceutical company representatives are gathering in Philadelphia today for AIDS Vaccine 2001, the "first in a series of meetings designed to speed" research on AIDS vaccines, USA Today reports (Sternberg, USA Today, 9/5). Tonight at the conference, sponsored by the Foundation for AIDS Vaccine Research and Development, the NIH, CDC, UNAIDS, WHO and the French Agence Nationale Recherches sur le SIDA, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, will deliver a keynote lecture detailing recent developments in vaccine research and challenges facing researchers as they look for a substance that can prevent infection or prime the immune system to hold HIV infection in check. "Historically, vaccines have provided safe, cost-effective and efficient means of preventing illness, disability and death from infectious diseases," Fauci noted in a NIH release, adding that a "safe and effective vaccine for HIV infection is a central goal of AIDS research and a necessary tool to bring the HIV epidemic under control." Fauci will also detail the agency's spending projections for fiscal year 2002. NIAID will spend $450.7 million on vaccine research next year, with $276.5 million earmarked specifically for HIV vaccine development.
State of Vaccine Candidates
NIAID is researching about 24 vaccine candidates, 16 of which are specifically designed to fight the A and C HIV subtypes most prevalent in the developing world (NIH release, 9/4). Worldwide, there are approximately 20 candidate vaccines, all made with HIV proteins and genes instead of whole HIV, undergoing human trials. Most are being tested in Phase II studies (safety and effectiveness), but AIDSVAX, developed by Brisbane, California-based VaxGen, is currently undergoing Phase III studies (effectiveness) in 8,000 human volunteers in the United States, Europe and Thailand. AIDSVAX, which works by "provok[ing]" an immune response to keep cells from becoming infected, could be submitted for government approval later this year if the two-year results, due this fall, show an effectiveness rate of 30% or more. If the initial effectiveness is less, AIDSVAX will undergo another year of testing before being considered. Another promising candidate, ALVAC, developed by Aventis Pasteur, works by using canarypox virus cells spliced with HIV genes to initiate a response from T-cells, white blood cells that fight infection and are the main target for HIV. ALVAC is currently being tested for safety in the Americas and Thailand, and NIAID and the Department of Defense are looking to begin testing its effectiveness in the United States and Thailand.
Vaccine trial volunteers are paid up to $50 a visit for their time and for transportation, but they are not otherwise compensated. According to Barney Graham, head of the vaccine trial unit at the NIH, volunteers "come from all walks of life" and participate for different "personal" reasons, such as the desire to protect their children against the virus or in memory of a loved one who has died of AIDS-related complications. Vaccine candidates do not contain whole HIV and therefore do not pose a risk of infection to volunteers, but the stigma of AIDS may nevertheless "taint" vaccine trial participants, USA Today reports. Vaccine candidates can cause trial volunteers to test positive on some HIV tests. Although more advanced tests can "distinguish" between HIV infection and vaccine response, many potential volunteers do not participate because they are concerned about what could happen if an employer or an insurance company found out they had tested HIV-positive. NIAID gives all vaccine trial volunteers a photo ID card with a toll-free phone number in case an employer or insurance company has a question. Mary Allen, a nurse and community liaison for the agency's Vaccine Trials Network, said she has "never failed to resolve a conflict" of this type (USA Today, 9/5).
Two Books Examine the Quest for a Vaccine
In a related piece, USA Today also reviews two books about the search for an AIDS vaccine, "Shots in the Dark: The Wayward Search for an AIDS Vaccine" by Jon Cohen and "Big Shot: Passion, Politics and the Struggle for an AIDS Vaccine" by journalist Patricia Thomas. Cohen, a writer for the journal Science, "convincingly" demonstrates how "the nation's leaders lacked the savvy, courage, political will and compassion to put aside prejudice and act on behalf of public health" during the early years of the epidemic. Thomas takes a "less political" approach in examining the "interplay between" the NIH, the Department of Defense and the biotech and pharmaceutical companies working on vaccine development (Sternberg, USA Today, 9/5).