San Francisco Chronicle - June 28, 2006
Sabin Russell, Chronicle Medical Writer, srussell@sfchronicle.com

More than two decades after Health and Human Services Secretary Margaret Heckler proclaimed that an AIDS vaccine was but two years away from testing, prospects for finding an effective one lie mostly in the realm of wishful thinking.

The need for such a vaccine is compelling. UNAIDS, the Joint United Nations Program on HIV/AIDS, estimates that 4.1 million people last year were newly infected with HIV, the virus that causes AIDS. Worldwide, 39 million people are carrying the virus.

So when Melinda Gates, the wife of the Microsoft chairman, told reporters in New York on Monday that an AIDS vaccine remains her "fondest dream," there was reason to be optimistic that a healthy portion of Buffett's billions would find its way to research in that field.

"You don't get a lot of good news in the AIDS field, but doubling the size of the Gates foundation is right up there in the great news category," said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition in New York.

Buffett, the founder of Berkshire Hathaway Inc., has pledged to donate $31 billon to the Gates foundation, which already has assets of $29 billion and a track record of grant-making for AIDS prevention and improving the health of the world's poor.

Warren estimates that the global AIDS vaccine effort is funded at $700 million a year -- much of it for research that is paid for by the federal National Institutes of Health. "The collective wisdom is that we need $1 billion to $1.2 billion for vaccine research. We are getting closer to where we think the optimal level is," he said.

Just how much of Buffett's money the Gates Foundation might direct toward AIDS vaccine research is pure speculation. Foundation spokesman Andrew Shih said the organization "does not comment on future funding decisions."

What is known is that the Gates foundation, prior to the Buffett announcement, had been seeking proposals for grants totaling $300 million over the next five years for AIDS vaccine work. "It will be spread a lot of ways," Warren said.

Although more cash for research undoubtedly will be welcome, AIDS vaccine experts concede that what is holding up a product today is not money but the level of understanding needed to make a breakthrough.

"It's the science. There are fundamental scientific concepts that need to be addressed and solved," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

HIV remains a devilishly complex foe. Early attempts to develop a vaccine against it failed because the virus can quickly mutate into a form that sidesteps antibodies raised against it.

Twenty-five years into the AIDS epidemic, scientists still do not understand precisely which immune responses are necessary to protect an individual from infection with HIV -- the so-called correlates of immunity.

"We haven't done that yet. Not that we haven't tried," Fauci said.

The federal government is spending more than $500 million a year on AIDS vaccine research, much of it on fundamental studies to understand the molecular nature of HIV and its interaction with the human immune system. Fauci said his agency plans to spend $50 million a year on one center -- the Center for HIV-AIDS Vaccine Immunology based at Duke University -- to focus on the correlates of immunity problem.

"To my mind, that is the big gap in understanding. It is why it has been so difficult to control HIV," Fauci said.

So, although an increase in Gates foundation funding will be welcome, even its largesse is unlikely to come close to the government-funded effort to find a vaccine.

Long before Buffett's offer was revealed, the Gates foundation made known its interest in funding vaccine research. It has contributed $126.5 million to the International AIDS Vaccine Initiative, a private, nonprofit financier of vaccine research and development based in New York. "One thing about the Gates foundation is that they are prepared to be there in the long run. An AIDS vaccine is not something to be solved overnight," said Dr. Robert Hecht, the Vaccine Initiative's senior vice president for public policy.

Hecht said that, while large amounts of money are being spent on AIDS vaccine research, there are three areas where more money is needed. "Another $300 (million) to $400 million a year would help fill those gaps," Hecht said. His priorities:

-- Support for a large consortium of research institutions to find "broadly neutralizing antibodies," proteins in the blood that would attack not just one strain of HIV but the virus in any of its shape-shifting forms.

-- Funding for early trials of multiple vaccine candidates developed by academic and industrial laboratories. Early trials can pose the greatest financial risk for companies because the outcome of costly research is hardest to predict.

-- Creation of more sites in the developing world where vaccine trials can be launched. Such trials require willing and informed volunteers, political support from host nations and a medical infrastructure that can track outcomes for up to five years from vaccination.

Hecht acknowledged that the effort to find an AIDS vaccine has been filled with disappointments, but the consequences of a vaccine breakthrough still make the work imperative.

"It would be a transformative event for the AIDS epidemic," he said.

And yes, "more money would make a difference."

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