InterPress News Service (IPS) - Monday, June 29, 1998
Dipankar De Sarkar

Scientists also admit that next to nothing has been done to develop such a vaccine. But last week, just days before the opening of the ongoing 12th World AIDS Conference here Sunday, one initiative was announced.

On Jun. 24, the Vaxgen drugs company from California in the western United States, announced that the first tests of an anti- AIDS vaccine on humans have begun in multiple sites all over the United States. Large-scale tests may start in Thailand later.

Volunteers in Philadelphia, considered to be a high-risk group, had received their first inoculations a day earlier.

That should be good news for developing countries -- home to 90 percent of people living with HIV/AIDS, but whose people are too poor to afford expensive drugs that have made AIDS a manageable disease, though not curable.

A slew of 20 anti-AIDS drugs are now said to be on the market, many of them routinely administered to patients in developed countries.

Their access is limited because they cost upward of 10,000 dollars a year per patient, they must be administered throughout the patient's life and they need a strict day-by-day regime of administration, supervision and monitoring in order to be effective.

That in turn requires the kind of health infrastructure and equipment that are lacking in most developing countries. This is even more so in the poorest regions of sub Saharan Africa, which has the highest proportion of people living with HIV/AIDS.

At least that is what the spokespersons of multinational drug companies say. Many in the Third World's so-called AIDS community, including doctors, community workers and nongovernmental organisations, suspect the worst.

They say that blaming the inadequacies of health systems in developing countries could be no more than a smoke screen to cover the drug companies' failure so far to make their expensive drugs affordable to people living with HIV/AIDS in poor nations.

"I think an AIDS vaccine is very important for developing countries," said Thailand's Werasit Sittirai, who works with the Joint United Nations Programme on AIDS (UNAIDS). But it is also important for us to have the know-how of these trials, not just p articipate in them."

Whether even such a gigantic gathering as the World AIDS Conference can persuade pharmaceutical companies to concentrate their energies on finding an AIDS vaccine is doubtful.

"Substantial investments are required for such an effort -- but this is the proper place where public money must partly support the research," said conference chairman Bernard Hirschel. "Northern companies I hope will become conscious of the need and will not think that because there are other products available, that there is no need for a vaccine."

Many participants from the developed world remain sceptical about the possibility of such a thing happening. Even if it does, they say, it will be no magic bullet.

"For us a vaccine is just a dream at the moment," said Sheila Kanyangarara, who works in the area of human rights for people living with HIV/AIDS. "We must demand the right to life before dreaming of a vaccine."

Nevertheless, as the so-called treatment gap between rich and poor nations widens with the development of every new anti-AIDS drugs, calls for drug companies to come up with a vaccine are growing more and more strident.

The New York-based International AIDS Vaccine Initiative (IAVI), a nonprofit organisation that Sunday launched a global initiative to promote the development of an AIDS vaccine, says the need for such a vaccine has become "urgent and compelling".

"Despite progress in prevention interventions and the advent of powerful drug combinations to treat HIV infection, approximately 16,000 people become infected every day," IAVI says in a recent report.

The figures mean that by the time the six-day conference is over, 96,000 more people would have been infected with the AIDS virus worldwide, most of them in developing countries.

IAVI believes that the goal of identifying an effective HIV vaccine can be achieved in the "shortest period of time" if additional resources are made available for vaccine development and clinical trials, including the design, development and testing o f vaccines for developing countries.

What little has been done so far in developing vaccine designs have taken place in the laboratories of private pharmaceutical companies.

This creates its own problems: according to campaigners, vaccines are being developed for use and evaluation only in the United States and Europe. The involvement of Southern countries in developing vaccines is minimal, in spite of their scientific exper tise and practical experience with AIDS/HIV treatment. "Unlike the development of most established vaccines, which were first found efficacious in industrialised countries, achievements of an HIV vaccine will require developing countries to become active and long-term partners throughout the development pro cess," the IAVI report says.

V. Ramalingaswamy, a respected Third World medical scientist and former director of the Indian Council of Medical Research, said the IAVI initiative deserved to be backed because it harnesses "whatever good science there is" in the developing world.

"The initiative will mobilise world-class scientists from the Third World. There are skills out there -- a global disease should be fought globally," he added.

But as yet, unanswered questions remain about vaccines -- as with so much else about HIV/AIDS. For one, developing countries will need to work out their own risk-benefit ratio analyses if and when vaccines are developed and tested in these countries.

And some AIDS researchers are already concerned that a vaccine would only partially protect patients, and that patients, believing themselves to be protected, would stop taking precautions or engage in risky behaviour such as unprotected sex or sharing n eedles while injecting narcotics.

Whatever the doubts, as Arnaud Fontanet, an HIV-positive Ugandan Catholic priest put it, "The situation in the South is desperate. Anything they tell us about -- even if it's an aspirin -- we want it." (END/IPS/DDS/RJ/98)

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