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Shot in the arm.

Big money boosted the AIDS vaccine effort, but it also underscored the work that remains to be done

Across the world 40 million people will ring in the New Year infected with HIV. Another 7,900 men and women in the United States, Canada, Puerto Rico, the Netherlands, and Thailand will kick off the year as part of the first-ever AIDS vaccine clinical trial. Most people, however, will enter 2000 unaware that the AIDS epidemic will get worse long before it gets better and that an effective vaccine remains more hope than reality.

The extent of the AIDS vaccine research that remains to be done became especially clear earlier this year when the William H. Gates Foundation, established by Microsoft founder Bill Gates and wife Melinda, donated $25 million, the largest AIDS grant in history, to the New York City--based International AIDS Vaccine Initiative. While a huge boost to the three-year-old nonprofit group, the grant underscores how funding for AIDS vaccine research has often been ignored in favor of funding for new drug treatments.

At the same time, these AIDS treatments have led many Americans, including gay men and lesbians, to think that the worst of the AIDS epidemic is over. But numbers prove otherwise. By January 1, 2000, AIDS will have killed more than 15 million people worldwide. In some African countries 25% of the entire population will be infected with HIV. And while the Gates grant is a huge step in the right direction, IAVI estimates that it will cost $350 million to $500 million over the next seven years to develop an effective vaccine. The group so far has raised $75 million, including the Gates donation.

"The initial emphasis in the early years of the epidemic was on treatment, and that was appropriate," says Victor Zonana, IAVI's vice president for public affairs. "It never should have been a vaccine-versus-treatment discussion, and it can't become that now. They are both important. Even so, there's no question that a serious, focused vaccine development effort should have been started earlier. It took 18 years to begin the first efficacy trials."

AIDS vaccine researchers have met one disappointment after the next, both in terms of scientific advances and financial backing. Part of the problem, researchers and advocates say, is that drug companies see vaccine research as high-risk, requiring a lot of money and promising little monetary return.

"Prior to these past three years, we really suffered--not from a lack of ideas but from a lack of money," says Michael Keefer, director of the AIDS vaccine evaluation unit at the University of Rochester School of Medicine. "Now there is more money going into vaccine production and more government support of industry actually malting these vaccines. And that's the big thing that has changed toward the end of this decade."

Not that vaccine development has ever occurred quickly. It took 16 years to create an effective hepatitis B vaccine, 47 years to develop the polio vaccine, and 105 years to develop a successful typhoid vaccine.

With AIDS, part of the research problem is that there is no good animal model in which to test possible vaccines. Researchers have also been stymied by how wily and resistant the virus is. And the more they learn about HIV, the more difficult the task of developing a vaccine appears.

Scientists from the University of Minnesota, for example, recently reported in the journal Science that as soon as HIV enters the body, it rapidly replicates and not only spreads to active cells but also hides in inactive ones. The discovery made vaccine researchers even more aware that the vaccines now being tested won't be fully effective in their current form.

Still, the research continues. Keefer is part of a team that hopes to have an AIDS canary pox vaccine in clinical trials soon. The vaccine will be made from a virus that infects canaries but isn't dangerous to people. Meanwhile, Italian researchers are working on a vaccine that doesn't block the virus from entering cells but keeps it from reproducing. IAVI has funded two different approaches and will fund three others with money from the Gates grant. In 1998 the American Foundation for AIDS Research also began funding vaccine efforts, which resulted in some potential new strategies. And earlier this year, VaxGen's AIDSvax became the first vaccine to be tested in a clinical trial.

While these efforts will shed light on how an AIDS vaccine should work, most researchers agree that it will be many years before an effective vaccine will be found.

Many say government agencies such as the National Institutes of Health and the Centers for Disease Control and Prevention should have done more to promote vaccine research earlier. It wasn't until September 1998, for example, that the CDC even established an HIV vaccine unit. There are few critics, however, of gay men's and lesbians' contributions to this effort.

"I would say the gay community responded heroically to the call to enroll in vaccine trials," Zonana says. "I know a lot of friends who have wrestled with these issues and who have volunteered for the trials out of a real sense of altruism, out of a belief that a vaccine is our only way out of this crisis in the long term, and who want to be part of the solution. I think that a lot of HIV-negative men, especially those in their 30s and 40s, feel a responsibility to give something back for having escaped."

Even so, the burden of keeping AIDS vaccine research center stage has been one primarily shouldered by researchers, not activists. "In the last couple of years we've seen increased awareness that vaccines are important," says Bill Snow, a vaccine advocate and founding member of the AIDS Vaccine Advocacy Coalition. "We're not there yet, but we're moving in the right direction."

Activists and philanthropists aside, the work ahead is perhaps best illustrated by the unwillingness of any researcher to predict when an effective AIDS vaccine might be found. "You cannot put a time line on science," Zonana says. "But I guess the point is that the sooner the world mounts a serious and sustained effort, the sooner we'll get a vaccine."

Rochman is a San Francisco-based freelance writer.
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Publication:The Advocate (The national gay & lesbian newsmagazine)
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 18, 2000
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