The quest for the elusive HIV vaccine has generated some encouraging progress over the past year, despite growing despondence and stuttering support in this important field of HIV research. This recent progress culminated in September with the first ‘successful’ vaccine trial, conducted in Thailand, which reduced HIV infection by 30 percent ('HIV breakthrough as scientists discover new vaccine to prevent infection', The Guardian, 24 September 2009). The global reaction to the release of this finding in late-September has been mixed but generally optimistic. This response, which could be described as one of hopeful expectation, is indicative of an international community in desperate search for a light at the end of the proverbial HIV tunnel. While much of this euphoria may be premature, as has been the case in the past, this result is certainly encouraging and a genuine breakthrough, which must now be built on.
Energising and redirecting the AIDS vaccine field
The direct implications of this research for Africa, at least at this stage, are negligible, due to the fact that the Thailand vaccine is based on different strains (B and E strain) of HIV than the strain most commonly found in Africa (C strain). According to the AIDS Vaccine Advocacy Coalition, this is the third major study of its kind since 1983, and the results of the trial should be welcomed as “a historic milestone” ('HIV breakthrough as scientists discover new vaccine to prevent infection', The Guardian, 24 September 2009). While the results of the study may bear no immediate effect on the current state of the epidemic, the findings mark "a historic day in the 26-year quest to develop an AIDS vaccine." Africans, and those with an interest in Africa, should also feel optimistic about these findings, which have been described as “tantalisingly encouraging” by Dr Richard Horton, Editor of the Lancet medical journal ('HIV vaccine ‘reduces infection’', BBC, 24 September 2009). The findings are predicted to “energise and redirect the AIDS vaccine field” (‘The breakthrough on AIDS vaccine’, Business Day, 28 September 2009, which should (hopefully) lead to some more substantial progress in the not too distant future. According to Dr Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases in Thailand, the details of the US$ 105 million study will be made public at a vaccine conference in Paris in October ('HIV breakthrough as scientists discover new vaccine to prevent infection', The Guardian, 24 September 2009).
Coupled with Thailand’s recent vaccine trial findings, September 2009 also witnessed the discovery of two antibodies with the ability to potentially cripple the HI-virus ('Two new antibodies found to cripple HIV', IAVI, 3 September 2009). This research was conducted by the International AIDS Vaccine Initiative (IAVI), and has recently been published in the Science journal. These intriguing findings may also provide a significant boost to the advancement of vaccine research. Wayne Koff, Senior Vice-President of Research and Development for IAVI, has commented that, “The findings themselves are an exciting advance toward the goal of an effective AIDS vaccine because now we’ve got a new, potentially better target on HIV to focus our efforts for vaccine design…And having identified this one, we’re set up to find more, which should further accelerate global efforts in AIDS vaccine development” ('Two new antibodies found to cripple HIV', IAVI, 3 September 2009).
Progress amidst growing speculation
The quest for a vaccine has been a daunting and largely fruitless one. However these recent developments make it more realistically attainable and provide good reason for some optimism. The progress that has been made as of late has been achieved amidst a significant decline in HIV vaccine research, which has become increasingly disregarded with a number of unsuccessful trials in the past few years leaving funders and researchers despondent and frustrated.
Following reports of the unsuccessful Merck vaccine trial and several other large clinical trials, many people working in the field of HIV began to emphasise the need for a shift in research focus and funding, towards other more ‘achievable’ HIV prevention initiatives. Since then, far more attention has been directed towards microbicides and pre-exposure prophylaxis (PrEP). According to a report by the HIV Vaccine and Microbicide Resource Tracking Working Group, entitled 'Adapting to Realities: Trends in HIV Prevention Research Funding 2000 to 2008', in which the group trace the funding trends of HIV and AIDS treatment research, funds for vaccine research decreased dramatically by 10 percent in 2008. Data from the report also confirms that funding for microbicides increased by 8%, while PrEP research received 13 percent more funding.
During the Global AIDS Vaccine conference in Cape Town, South Africa in October 2008, exactly a year ago, top names in HIV research gathered to examine the importance of laboratory research compared to human clinical trials, after the spate of disappointments in the field of vaccine trials. Lynn Morris, the head of the AIDS unit at South Africa's National Institute for Communicable Diseases and co-chair of the conference, stated that, "There's a real redirection and rethinking" ('Global HIV/AIDS Vaccine Conference In South Africa To Seek New Strategies Against Disease', Medical News Today, 15 October 2008), with many supporting the idea of moving away from clinical vaccine trials. Some scientists and advocates were, however, concerned that human clinical trials of vaccine candidates may experience setbacks as funding shifted toward basic research.
Ensuring continued progress and momentum
On the contrary, however, vaccine research in the past year has made some important advances, and will hopefully provide a significant push for the support of future work in this area. In addition to the vaccine trial that was conducted in Thailand, there are approximately 30 other clinical AIDS vaccine trials in progress in several other countries. These include the South African AIDS Vaccine Initiative (SAAVI), which began human trials in the USA in December 2008 and in South Africa in July this year. This is the first vaccine to be developed in Africa, and is specifically geared towards treating people infected with the C-type of the HI-virus, which is currently the most prevalent HIV strain in Southern Africa. According to Anthony Mbewu, President of the Medical Research Council (MRC), if these trials produce pleasing results, the vaccines will be produced for the public to use, something that he believes could happen within the next six years ('Trial of Africa's first HIV vaccines underway', SciDevNet, 23 July 2009). In line with the recent funding trends, however, South Africa’s Government and other donors have been pulling funding from the project since March last year, which could substantially hinder the progress of the project.
The World Vaccine Congress, which will be held in Lyon, France, from 5-8 October, will provide the perfect opportunity to reflect on these recent advances, and just as importantly address the declining state of vaccine support and funding. It is critical that the advancements that have been made are built on, and that momentum is maintained in the quest for the elusive HIV vaccine.
- Jonathan Mundell is a Director at Consultancy Africa Intelligence (firstname.lastname@example.org). The October edition of the HIV & AIDS in Africa Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political, and economic happenings in Africa. For more information see http://www.consultancyafrica.com or http://www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, visit http://www.consultancyafrica.com/promo2 to take advantage of CAI’s free, no obligation, 3-month trial to the company’s Standard Report Series.