Newsday - April 18, 1992
Laurie Garrett
The U.S. Army said yesterday will help inoculate 60,000 Thai Army soldiers in the largest human AIDS vaccine experiment in the world.
An Army representative outlined the plan to the AIDS advisory panel of the National Institutes of Health, adding that it will take up to two years to develop the physical resources for the vaccination campaign. The effort is being coordinated by a consortium of federal agencies headed by the White House.
Thai recruits already are tested for the HIV, or human immunodeficiency, virus that causes AIDS, and studies show that 3 percent of all 21-year-old Thai men are HIV positive, said Dr. Donald Burke of the U.S. Army's Walter Reed Medical Center, in a presentation to the advisory panel, which discusses upcoming issues involving treatment and research on HIV.
Pointing to the Chiang Mai region of Thailand on a map, Burke added: "Men from up here are testing 10 to 21 percent positive." Presenting a slide photograph of young Thai recruits, he said, "To put it another way, about one out of every six men in this picture are going to get AIDS."
That means the HIV infection rate in the country is high enough to allow rapid testing of an AIDS vaccine, he said.
Because so many people are already infected, within two years after vaccinating a pool of people, it would be possible to tell if fewer of them have become HIV infected than would be expected through normal activities, such as sexual intercourse, said Dr. D. A. Henderson, of the White House Executive Office.
The experiment will rely on statistical results because it is medically unethical to test whether a vaccine works by injecting the AIDS virus into people after they have been inoculated.
Some members of the NIH panel asked whether using Thais might raise questions of exploitation or coercion. But Burke said the Army and White House would take steps to insure the experiment is "conducted in the best interests of the Thai people."
The Chiang Mai area people, for example, are infected with a strain of HIV that bears little genetic similarity to strains found in North America. The Army is working with four U.S. drug companies to tailor a vaccine against the Thai strain. It is also promising the Thai government that, should the vaccine prove effective, it will be made available at an affordable price to all Thai citizens.
Over the next year and a half the Army will screen all available vaccine products to decide which should be used in the Thai study. None are perfect - to date, no HIV vaccine has elicited the kinds of immune responses considered classic signs of immunity. Such measures are necessary, Henderson said, because "The real question is, `Is it going to be possible to do a vaccine efficacy trial in the U.S.?'
"And I'm afraid we believe we just can't do efficacy trials of the size needed in a timely manner in this country," he added.
Safety trials of at least nine different possible AIDS vaccines are already under way in the United States, some involving small groups of civilian volunteers who are HIV negative. The largest trial is on HIV-positive American military personnel who are receiving a vaccine made from the outer envelope of the virus.
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