Wall Street Journal - April 25, 2008
Seth Berkley

Actually, there are sound scientific reasons to believe we can create a vaccine against AIDS. In fact, we will probably develop it before scientists discover a way to inoculate against the kind of unrealistic expectations that have produced much of the negative noise around the endeavor of late.

That doesn't mean we don't have a difficult task. Last September, vaccinations were stopped in an efficacy trial of an experimental AIDS vaccine made by Merck & Co. when it became clear the candidate had failed. Worse, it appears the vaccine candidate may have increased susceptibility to HIV infection in some volunteers. The results were a disappointment. But in pharmaceutical product development, failure is the rule. For every 5,000 or so new chemical entities that are investigated, only one gets approved.

Media accounts have also claimed that researchers have learned nothing, or next to it, about how to devise a vaccine in the 25 years since HIV was found to be the source of AIDS. This assertion confuses the finality of breakthrough with the tedious, step-by-step process that is the reality of scientific discovery.

The past two decades have produced a steady stream of incremental advances in knowledge that provide the foundation for AIDS vaccine discovery efforts now underway across the globe. In fact, we have probably learned more about HIV and its disease course than about any other pathogen in history.

Key findings include the discovery that HIV's outer protein is the principal target against which to design vaccines capable of neutralizing the virus; that the virus is enormously variable, which leads scientists to focus on those regions of HIV that don't change; that broadly neutralizing antibodies can protect against HIV and related viruses in the laboratory and in monkeys; that cellular immunity can control the virus for several years, sometimes decades; and that live attenuated vaccines can protect monkeys from infection with simian equivalents of HIV. These leads give researchers critical clues as to what an effective human vaccine must do.

Nobel laureate David Baltimore was right when he said in a recent speech that AIDS vaccine researchers currently see "no hopeful route to success," in that they have no single, clear path to victory. But they have many promising avenues to pursue.

The efforts of these innovators would be brought to a halt if it were up to one vocal group. The AIDS Healthcare Foundation, which does the noble work of distributing life-prolonging antiretroviral drugs to AIDS sufferers globally, recently adopted the stance that since there is no AIDS vaccine yet, all U.S. government money now being spent to develop one should be devoted instead to existing means of coping with AIDS: prevention methods like condoms, testing and treatment.

That might make sense if those tools held the hope of ending rather than just ameliorating the pandemic. But this is a benefit a vaccine alone can offer.

There is evidence that antiretrovirals can reduce contagiousness, but HIV commonly spreads before people even know they are infected, and before they are sick enough to go on treatment. We must expand access to treatment to ease the suffering caused by AIDS, but we also need a vaccine to bring the pandemic to an end.

It's not as if the vaccine budget is hogging funds. Around 3% of total AIDS spending in the U.S. goes to vaccine R&D.

If scientists of an earlier time had subscribed to a defeatist, treatment-only doctrine, polio patients would still be in iron lungs. Indeed, once, not so long ago, the antiretroviral drugs used to treat AIDS were thought to be beyond the reach of science. They exist today because billions of dollars were invested in research and development. That effort was a product of urgent necessity married to a clear-eyed belief in the power of the scientific process.

Unfortunately, we are still in the early stages of the search for an AIDS vaccine. We know less than we hoped, and less than we will know. Merck's vaccine was only the second product to be fully tested in an efficacy trial. Others are in the pipeline. Laboratories will produce even more, and clinical trials will determine their efficacy.

With patience and a belief in science, we expect to succeed. And when we have - and AIDS has gone the way of polio and smallpox - people will look back with gratitude on the realists who knew that the only impossible thing was giving up.

###

Dr. Berkley is CEO and president of the International AIDS Vaccine Initiative.

080425
WJ080406

Copyright © 2008 - The Wall Street Journal. Reproduction of this article (other than one copy for personal reference) must be cleared through the WSJ Permissions Desk.

Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2008. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .