In the wake of failure to develop an effective HIV vaccine, several years of a flat budget from Congress, and calls to suspend HIV vaccine research altogether, the US National Institute of Allergy and Infectious Diseases (NIAID) convened a summit meeting on HIV Vaccine Research and Development in Bethesda, Maryland yesterday, Tuesday 25th March, where hundreds of scientists gathered to re-evaluate HIV vaccine research and find a more appropriate balance between discovery and development.

Many of the experts said that HIV vaccine research has to go back to the drawing board after the last most promising candidate, the Merck HIV vaccine, failed in trials last September. Scientists don’t know why the vaccine failed.

Dr Adel Mahmoud, professor of microbiology at Princeton University and co-chair of the meeting referred to the Merck vaccine failure as “only one step back”, and urged all present that “the status quo and finger pointing isn’t going to take us anywhere”, according to a report in WebMD.

Dr James Hoxie of the University of Pennsylvania said there was a “tremendous need for innovation” in developing a new HIV vaccine, wrote the New York Times.

Dr Beatrice H Hahn, MD, a microbiologist at the University of Alabama at Birmingham, is reported by WebMD to have told the meeting:

“We have to admit to ourselves that we don’t know how to make an HIV vaccine right now.”

“Nothing currently around is going to cause significant protection, in the opinion of many of us,” added Hahn, who backs the large number of leading scientists supporting a reduction in money for testing existing experimental vaccines in favour of going back to basics to finding new vaccines.

Director of the NIAID, Dr Anthony S Fauci, said that “everything was on the table”, wrote the New York Times, and he gave a presentation on the current state of vaccine research and the questions that needed to be addressed at this juncture.

He said there was a need to re-evaluate the 1.5 billion dollars that the NIAID spends on AIDS research so that more focus can be placed on discovering more basic knowledge about HIV and how the human body responds to experimental vaccines, wrote the Times.

In a press interview, Fauci said “there is not an immediate solution to the problem” and the budgetary constraints meant there was a greater need to “justify what we are doing”.

An important area that needs attention is to inject more young blood into the field. Many scientists are now working beyond retirement age.

Fauci said one option would be to cut back on existing projects and use the money to attract scientists with new ideas by offering substantial new grants.

There was some support for increasing effort to develop animal models of human HIV and to increase collaboration among those who work in this area.

Experts appeared divided on whether testing in humans should start before or after all the fine points of animal trials have been resolved, reported the New York Times.

According to the World Health Organization, HIV/AIDS has killed 25 million people worldwide. In 2007, over 33 million people were estimated to be living with HIV, 2.5 million became newly infected, and 2.1 million people died of AIDS.

There is a slight glimmer of optimism in that the percentage of people worldwide living with HIV has levelled off and the number of new infections has fallen. The WHO suggest this is partly due to the impact of HIV programmes (ie prevention and treatment, since there are no vaccines).

At the same time as the HIV Vaccine Summit yesterday, AIDS Healthcare Foundation (AHF), the largest non-profit HIV/AIDS healthcare and research organization in the US, conducted a press teleconference to call for the suspension of what it described as “costly HIV vaccine research funding and the re-allocation of resources into effective HIV/AIDS prevention, testing and treatment strategies proven to save lives”.

Last Sunday, writing in the Baltimore Sun, AHF Chief of Medicine (US) Dr Homayoon Khanlou, and AHF President Michael Weinstein criticized the “ballooning HIV vaccine research budget”, saying it was “time to stop the waste”. Titled “Enough is Enough”, their article concluded:

“Suspending US funding for an HIV vaccine and investing in strategies that save lives and stop new infections is the wisest and most effective use of limited public resources.”

“And with thousands of lives lost daily because people around the world lack access to proven, effective and relatively inexpensive prevention and treatment options, it is also the only moral choice,” urged Khanlou and Weinstein.

But Fauci said at the end of the summit meeting that “under no circumstances will we stop AIDS vaccine research”.

Mahmoud said it would be crazy to shut down everything done so far in order to start something else, and referred to Winston Churchill’s famous World War II saying, where he urged:

“Never give in. Never give in. Never, never, never, never.”

New York Times, WebMD, World Health Organization, NIAID press brief, Businesswire press release.

Written by: Catharine Pad