The Bay Area Reporter - Friday, January 8, 1999
Bill Snow, ACT UP/Golden Gate Writers Pool

I've been harping in this column for the last couple of years about the shortcomings of government and industry in developing an anti-HIV vaccine. You should know that there are a very few nonprofit foundations and advocacy organizations that are making a contribution to this effort. Each has it own niche and strength, as well as its own acronym. All are important; aside from that, they have almost nothing - besides the ultimate goal of an AIDS vaccine - in common.

Joint United Nations Programme on HIV/AIDS (UNAIDS)

The Joint United Nations Programme on HIV/AIDS, known as UNAIDS, is a joint venture of four UN agencies, the World Health Organization, and the World Bank. Despite these aristocratic parents, the group, led by Dr. Peter Piot and based in Geneva, is small and modestly funded, partly by the U.S. State Department's USAID program. UNAIDS sees itself as a provider of information, consultant, and facilitator for AIDS-affected countries, particularly in the developing world. Piot is an untiring spokesman for the worldwide epidemic; year after year reporting increased devastation and highlighting the continuing urgency of the problem. Among other activities, UNAIDS co-sponsors three regional AIDS meetings in the developing world during the years when there is no International AIDS Conference.

On the vaccine front, UNAIDS has an ethics committee and a science committee that are available to review and make recommendations about vaccine trials at a country's request.

They are presently completing a thorough review and recommendations about the ethical guidelines for conducting preventive HIV vaccine trials. The recommendations will go to the Council for International Organizations of Medical Sciences (CIOMS, more noodles) that sets international ethical guidelines for biomedical research. UNAIDS has also been very good about working with the U.S. organizations described below.

International AIDS Vaccine Initiative (IAVI)

This most ambitious and well-funded non-governmental AIDS vaccine program started as a project of the Rockefeller Foundation, which held three workshops in 1994-95 to determine how to accelerate the development of preventive HIV vaccines for the world. IAVI was launched the next year as a global initiative dedicated to speeding the pace of HIV vaccine research and development of a vaccine suitable throughout the world. Its president, Dr. Seth Berkley, has put together an organization that funds product development, lobbies primarily for more international programs, particularly from the G8 economic leadership countries and for a Global HIV Vaccine Purchase Fund, and publishes a great newsletter, IAVI Report (iavireport@iavi.org). With funding from the Rockefeller and Sloane foundations, Bill Gates, the United Kingdom government, the World Bank, UNAIDS, and others, IAVI is in a class by itself.

Just before World AIDS Day 1998, IAVI launched its own product development teams, based on a blueprint plan they had issued at Geneva earlier in the year. Their strategy is to link promising vaccine approaches with countries to test them since vaccines need to be designed with a particular population in mind. In a sense IAVI is acting as venture capital investor for the developing world because developing a vaccine is so expensive and risky. This $9.1 million initiative creates two AIDS vaccine development partnerships. The first is with Oxford University and Nairobi, Kenya to develop a naked DNA vaccine plus a modified vaccinia Ankara vaccine for East Africa. The second is with researchers from the U.S. AlphaVax Corporation and the University of Capetown, South Africa to develop a vaccine using a new carrier virus of the alphavirus family to be tested in South Africa. These three approaches with acronyms of their own, DNA, MVA, VEE, are among the newest and most promising technologies for potentially delivering parts of HIV safely and more potently to the immune system.

The IAVI partnerships are particularly exciting since most previously developed products were designed for use against the strain of HIV in the developed world. In exchange for its support IAVI has secured, also for the first time, intellectual property agreements to help ensure access to these vaccines at a reasonable price in developing countries if they prove to work. Dr. Andrew McMichael says the money for the Oxford program will be used to manufacture safe test lots of vaccine, employ and equip Kenyan scientists, technicians, and nurses on site, and fund Phase I trials in the U.K. and Kenya (along with support from the British Government's Research Council).

The American Foundation for AIDS Research (AmFAR)

Because it was one of the first AIDS charities, because of its emphasis on treatment research, and because it has Dr. Matilde Krim as its founder and Elizabeth Taylor as its spokeswoman, AmFAR is well know. Perhaps not so well known is that AmFAR funds research grants on a level much smaller than the National Institutes of Health (NIH), but with its own scientific review process. Last year for the first time, AmFAR solicited applications for grants in AIDS vaccines and awarded about $1 million to 11 investigators. This is a small fraction of the amount spent by NIH that year on it so-called innovation grants, but among the grantees are some more adventurous, high-risk projects that have had a difficult time obtaining government funding. One of the most exciting findings, a new way to make much more potent anti-HIV antibody, was just announced by Dr. Jack Nunberg, of the University of Montana, as a result of an AmFAR grant.

Until There's A Cure (UTAC)

The brainchild of two Bay Area mothers, Until There's a Cure Foundation has grown to over $1 million a year fundraising for AIDS. Their centerpiece is sales of AIDS bracelets, but they also raise money by sponsoring fund-raising events, advertising, and being the beneficiary of sports events. The Giants and 49ers have had Until There's a Cure days in the last few years. This group targets young people and families and often appears on talk shows and gets young stars to promote AIDS awareness.

UTAC doesn't fund research directly, but they have traditionally earmarked half of their money for other organizations that support AIDS vaccines. As such they had the foresight to be among the first supporters of IAVI and AVAC, allowing them to establish themselves as viable organizations.

AIDS Vaccine Advocacy Coalition (AVAC)

Three treatment activists - David Gold, Garance Franke-Ruta, and this writer - founded AVAC in 1995, in an effort to raise awareness and generate activism for preventive HIV vaccines. AVAC's mission is to speed the development of preventive HIV vaccines by analyzing obstacles to HIV vaccine research and advocating to overcome those obstacles. In its day-to-day advocacy and its well-received and influential major reports, such as Industry Investment in HIV Vaccine Research and 9 Years and Counting: Will We Have an HIV Vaccine by 2007?, AVAC provides an informed, independent, and honest critique of current efforts toward developing an HIV vaccine. The goal is to speed development of HIV vaccines without taking resources away from basic HIV research, drug development, or other prevention research.

Vaccine Advocates (VA)

San Franciscan William O'Connell created Vaccine Advocates when he was public health student at San Francisco State University. Originally called VACT-UP (Vaccine Activists Committed to Universal Prevention, noodle-lovers) and unrelated to any ACT UP, this small dedicated group participated in the San Francisco AIDS Walk the last two years and developed a website that has recently been taken over by AVAC. If you have a VA T-shirt or bumper sticker, hang onto it. Since this organization has been dispersed to local community advisory boards and AVAC, they'll be collector's items when we find a vaccine.

ACTion UPdate:

Give some bucks

Any of these organizations would be happy to accept tax-deductible donations. If you make a contribution, tell them Bill Snow sent you.

AIDS Vaccine Advocacy Coalition (AVAC) 1875 Connecticut Avenue NW, #700, Washington D.C. 20009

International AIDS Vaccine Initiative (IAVI) 810 Seventh Avenue, New York, NY 10019

The American Foundation for AIDS Research (AmFAR) 120 Wall Street, 13th floor, New York, NY 10005

Until There's A Cure Foundation (UTAC) 520 So. El Camino Real, Suite 718, San Mateo, CA 94402
990108
BR990102

Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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