Chicago Tribune - July 18, 2001
Stevenson Swanson, Tribune staff reporter

The official was Margaret Heckler, President Ronald Reagan's secretary of health and human services. The year was 1984.

Now, no one predicts when a vaccine will be found.

Despite great strides in deciphering HIV and probing for its weak spots, the scientific stumbling blocks to finding a vaccine remain daunting, as researchers made clear at a recent United Nations meeting on AIDS.

But, with the virus running rampant in the developing world, public health experts see a vaccine as the best hope for slowing its spread. That is giving renewed urgency to the hunt for a safe, effective immunization against HIV, the virus that causes AIDS.

It's about time, according to the founder of a research and advocacy group, who maintains that public health officials need to begin preparing now for the day a vaccine is available so it can be distributed quickly in the developing world, where 95 percent of new infections occur.

"It's easy to ignore vaccines with a global crisis going on," said Dr. Seth Berkley, president of the International AIDS Vaccine Initiative, referring to the need to treat the 36 million people worldwide infected with HIV. "The fact remains that 20 years after the epidemic began, no vaccine is available. This is a disgrace."

In part, the fate of AIDS vaccine research mirrors that of most other vaccine research, which is expensive and uncertain, yielding less profit for pharmaceutical manufacturers than illness-treating drugs, which receive the bulk of research dollars. But in the early years of the AIDS epidemic, researchers also realized that they faced the most cunning virus mankind has encountered.

HIV changes form easily. It inserts itself into the genetic code of human cells, making it a part of the new cells that result when that cell splits. Unlike other viruses, it targets the white blood cells that combat infections, destroying a body's defenses.

By the late 1980s and early 1990s, the emphasis in AIDS research had switched from finding a vaccine to developing lifesaving drugs for AIDS patients.

Currently, worldwide spending on vaccine research amounts to about $400 million, or 2 percent of the $20 billion spent on AIDS prevention, treatment and research.

UN recommendations

Recognizing the importance of finding a vaccine, the UN meeting on AIDS last month concluded with recommendations for, among other things, increased funding to accelerate vaccine research.

That's already happening in the United States, where the AIDS vaccine research budget at the National Institute of Allergies and Infectious Diseases is on course to more than triple, from about $100 million five years ago to $350 million next year.

And advances in the last five years in understanding HIV, such as mapping the crystalline envelope that protects it, is giving researchers hope that a vaccine--or more than one vaccine--will eventually be found.

"HIV isn't just one virus," said Dr. Peggy Johnston, who oversees AIDS vaccine research at the institute. "It's a diverse family of viruses. We'd like to think that we can make a vaccine that protects against all varieties of the virus, but we don't know if that's possible."

For instance, one vaccine being tested on about 2,500 intravenous drug users in Thailand is really two vaccines in one, intended to fight the two most common HIV subtypes in Southeast Asia and the Pacific rim.

VaxGen, a California biotechnology firm, makes another version of the vaccine that is being tested in the U.S. in more than 5,000 volunteers, including more than 100 women in Chicago. It is the only vaccine to reach this advanced trial stage, of more than 50 that have been studied or are being developed.

Results won't be known until later this year at the earliest, with years of further testing and regulatory approval after that.

Frustrated by the slow pace of research and testing, Berkley and other AIDS experts formed the International AIDS Vaccine Initiative in 1996 with the goal of providing funding to a variety of vaccine projects, especially those aimed at the subtypes most frequently found in the developing world. By backing as many approaches as possible, the non-profit group hopes to increase the chances of success.

Vaccine must be affordable

To date, the initiative has raised $230 million, including more than $100 million from Microsoft founder Bill Gates. The group's goal is a $550 million war chest, which would allow it to back 12 vaccine projects. As a condition of its support, the initiative insists that any vaccine developed with its funding be affordable for people in developing countries.

Of the five research projects it is supporting, one started human trials earlier this year in Kenya, with the goal of creating white bloods cells specifically designed to hunt down HIV.

Simply testing vaccines in the Third World presents challenges not usually encountered in industrialized nations. Before the vaccine trial of 18 people could begin in Kenya, a laboratory had to be built so the vaccine could be stored and administered safely. To scale up from such clinical studies to widespread distribution of a vaccine could necessitate dramatic improvements in a country's medical facilities.

That is why the AIDS initiative is pushing not just research but preparedness, arguing that plans have to be made now for how a vaccine could be licensed quickly in several countries at the same time and then move immediately into mass production, something that usually requires five years or more.

"Even if we had a vaccine ready to go, we wouldn't be able to produce it at sufficient levels for all the populations that need it," said Wayne Koff, head of research and development at the AIDS vaccine initiative.

High-risk groups first

In this country, a vaccine would probably be given first to high-risk groups, such as homosexual men and intravenous drug users. If the immunization proved highly effective with few side effects, someday it could be given as routinely as measles and tetanus shots.

"My crystal ball is failing me today," said Dr. Timothy Mastro of the federal Centers for Disease Control and Prevention, who is studying the potential uses of an AIDS vaccine. "It's conceivable the first generation of vaccines that come out could be substantially less efficacious than the vaccines we're used to getting now, and the question becomes, how do you use it?"
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