Uganda AIDS Vaccine Test: Urgency Affects Ethics Rules

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Uganda AIDS Vaccine Test: Urgency Affects Ethics Rules

New York Times (10/01/98) P. A1
Specter, Michael

While HIV-infected individuals in wealthier countries have access to potent antiviral drugs, many infected people in poorer nations cannot get treatment. The main hope of controlling the disease in Africa is through the creation of an HIV vaccine. Vaccines have been traditionally developed in nations with excellent health care systems so that any vaccine failure can be addressed and treated. However, the need for an HIV vaccine is so great in nations like Uganda--which has a 20 percent HIV infection rate--that they have gone ahead and initiated trials. Subjects who cannot afford antiviral therapy are prime candidates for the trials, because the use of treatment along with inoculation with a vaccine candidate would skew results. Nevertheless, the development of vaccines in these countries raises a number of questions, including whether to give top-level treatment to any people who become infected due to the trials, even though they would not have received the treatment had they contracted the virus under normal conditions. Researchers are also debating whether the use of placebos is ethical and what should be done in the event that a vaccine is discovered that does not prevent the spread of HIV, but only reduces the fatality of the virus. Additionally, some are worried that even if a vaccine is developed, it will be too expensive for widespread distribution in the areas that need it most. Peter Piot, executive director of the United Nations AIDS Program, said: "Everyone is worried that we will use Africa, develop a vaccine there, say thanks and then take it back to Europe and America. I don't believe that will happen. But we are in a terrible position." Some health officials in Africa respond that their increased role in vaccine development warrants access to the vaccines.

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