InterPress News Service (IPS); Wednesday, 10 July 1996.
Analysis - By Yvette Collymore

Currently, the overwhelming majority of funds for AIDS research goes toward drugs for the industrialised North. And even when research is conducted in the South, the focus is on Northern strains of the virus.

A newly established International AIDS Vaccine Initiative (IAVI) which brings together the Rockefeller Foundation in New York and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Geneva, plans to lead the search for a vaccine by the South, for the South -- and the rest of the world.

But for now, there is little money available to fund such research. And health experts attending the Jul 7-12 11th International Conference on AIDS are themselves divided over whether to go forward with big trials of a couple vaccines now under study.

Most scientists stand somewhere in the middle of this issue, saying that advanced testing of vaccine candidates is both appropriate and necessary. Others are adamant that more scientific data is needed first.

Referring to India, where some estimates of HIV-infected adults exceed three million, one reproductive health advocate said the financial constraints appear insurmountable, but that a vaccine would be the one method that would be sanctioned culturally and socially and that women would easily use.

"We have limited access to technology, but women already take their children to centres for vaccines," said Geeta Sethi of the Population Council's office for South and East Asia.

According to the Rockefeller Foundation, the international community spends 10 billion dollars a year on AIDS prevention and research. Of this, a total of roughly two billion dollars goes to research on the epidemic. Vaccine research overall gets 160 million dollars, with less than five million dollars going to vaccine development for the South.

"Vaccines are grossly underfunded," declared Seth Berkley, the Foundation's associate director for health sciences, who acknowledged that the science of vaccine development was tough and uncertain, and that the appearance of new drug therapies on the horizon could reduce the urgency for such a product.

In one of the harshest realities facing AIDS victims in poor countries, the private sector, which leads investments in product development, see few benefits in financing a product for Southern markets. Hence, of the 10 strains of HIV terrorising the world, research targets super, high-tech vaccines for subtype B, the strain found in Europe and North America.

Three companies have done preliminary trials of vaccine candidates in Thailand, even though the research is for a vaccine to serve the North American market, noted Bruce Weniger of the U.S. Centres for Disease Control in Atlanta.

Brazil is one notable exception among developing countries.

A phase-one vaccine trial that is scheduled to end Jul 24 in Rio de Janeiro and Belo Horizonte in south-western Brazil is testing a strain of the virus common in that country. This initial test is focusing on 30 volunteers and is being done with the New York company United Biomedical Inc. (UBI).

The Rockefeller-UNAIDS vaccine initiative is offers another glimmer of hope, since one of the main purposes is to collect money for vaccine research.

According to UNAIDS executive director Peter Piot, the plan is to advocate the speedy development of a vaccine for worldwide use.

"That will require a major effort to guarantee the best scientific and ethical type of research. It's not right and ethical to do research where the benefits are not going to be enjoyed by local people," said Piot.

The initiative will help coordinate AIDS research and guard against duplication. UNAIDS has lately undertaken to support three centres in Brazil, where expertise will be developed for testing vaccine candidates.

Funding for vaccine research has traditionally fallen on governments. Companies fear that all their profits would be gobbled up in lawsuits and compensation, particularly in the United States, should problems develop. Piot recalls that some people became paralysed in the early stages of polio vaccine delivery.

But, overall, vaccines have proven to be cost-effective measures in halting many viral diseases.

For now, some 25 vaccine candidates have entered preliminary, phase-one trials on humans. More advanced tests on people have been carried out by two San Francisco companies Biocine/Chrion and Genentech/Genevax, as well as Pasteur-Merieux in Lyon, France.

But even with the new initiative, where will the money come from for research and product development? The answer is particularly important given the mandate IAVI officials set themselves of producing a vaccine in the South. The IAVI would have to build the capacity within developing countries to train local investigators to conduct vaccine trials.

Rockefeller's Berkley, who is on the IAVI's interim board, suggests the World Bank may be tapped for new lending.

He may, however, have a difficult time selling the idea to the developing world, which is up to its ears in debt.

"Who will be responsible for paying these loans?" demanded professor Nkandu Luo, microbiologist and immunologist at the Unza School of Medicine in Zambia. "This over-burdened Third World has to deal not only with financial constraints, but also with diseases."

The lack of funding for a vaccine to prevent the spread of strains of AIDS found in the developing world is presenting the medical community and development funders in what many say is a deep moral and ethical dilemma. (END/IPS/AP-HE-PR/YC/CPG/96)

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