Inter Press Service - October 8, 2003
Miriam Kagan

During a discussion sponsored by the International AIDS Vaccine Initiative (IAVI), leading AIDS vaccine specialists described the accomplishments, challenges and goals of the worldwide initiative to develop a viable HIV/AIDS inoculation.

Globally, over 70 million people are infected with HIV/AIDS, with 15,000 new infections every day. In Africa alone, 12 million children have been orphaned by the AIDS pandemic.

"We are never going to end the AIDS epidemic without a vaccine," said Dr. Seth Berkley, IAVI president and CEO.

Berkley described 2003 as the year in which "global AIDS has broken through as an issue", pointing out that so far this year, 22 billion dollars have been committed worldwide to fighting AIDS.

Nevertheless, Berkley said, "there hasn't been enough attention focused on a vaccine".

Some progress has been made, including a first ever Phase III clinical trial -- the last stage, which if successful, can lead to mass-market distribution. Unfortunately, that particular vaccine failed to prevent infection, and Berkley pointed out that in general, progress has been slow.

Noting that it took more than 22 years to bring any version of an AIDS vaccine to clinical trials, Berkley said one of the priorities and challenges of IAVI "is to make sure to move forward as soon as possible and build a global constituency".

According to Berkley, the last five to seven years have seen a tremendous amount of progress, with numerous vaccines now in various stages of the clinical trial timeline.

Dr. Chrispin Kambili, IAVI's regional medical officer for East Africa, described a clinical trial based in Africa that will involve over 20,000 participants and numerous African nations.

According to Kambili, pilot programs have met with overwhelming success and support, in significant part due to strong efforts to involve the local communities and develop a sense of ownership and respect among participants.

Getting woman participants was one hurdle encountered by the trial in East Africa, Kambili said.

Women worldwide are particularly vulnerable to HIV/AIDS. Over 60 percent of those infected in Africa are women, women are the fastest growing population of new infections globally, and women are more susceptible to infection when exposed to the virus than men.

According to Kabila, traditional lifestyles and attitudes in some societies may require women to get permission from husbands or fathers before entering a clinical trial, but he stressed the importance of women participants since vaccines may have different effects on men and women.

Berkley added that despite some challenges, "the extraordinary thing (about the trial in Africa) is not only that people rallied, but the quality of the lab is as good as anywhere in the world".

According to Berkley and the other panellists, conducting clinical trials in the developing world is essential, because the South contains many of the most vulnerable populations and because different strains of the virus may react differently to vaccines.

The panellists also discussed challenges related to vaccine development.

Dr. Dennis Burton of the Scripps Research Institute described efforts to develop an HIV/AIDS vaccine based on a type of antibody known as neutralising monoclonal. Unlike more common antibodies that usually fight only one virus, these antibodies are effective against a large spectrum of viruses.

Burton told the conference that scientists have been working to isolate, reproduce, store, and make available to other scientists the rare neutralising antibodies for research into an antibody-based vaccine.

All the panellists discussed the importance of planning ahead and considering all components in successfully developing and distributing the vaccine.

Dr. Andreas Neubert, manager of Vaccine Production at IDT, a Germany-based biotechnology firm, said going from the development and testing stages of a vaccine to mass production and distribution could pose significant problems.

According to Neubert, "there is a bottleneck of vaccine capacity in the world, even for current vaccines".

Producing 100 million doses of vaccine would require building new facilities, especially because the components likely to be used in an HIV/AIDS vaccine would require technologies and techniques that do not exist in current facilities, said Neubert.

Berkley estimated that an investment of 300-350 million dollars would be needed to develop sufficient facilities, not including funding for distribution networks and pricing schemes to reflect the ability of the developed and developing world to pay for the vaccines.

Despite the enormous challenges of coordination and development, panellists were optimistic that a vaccine could be developed.

"The ultimate tool that will defeat the virus is the human brain", said Burton.

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+International AIDS Vaccine Initiative (http://www.iavi.org)

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