In may 1997, President Bill Clinton set a deadline for the scientific community to find a vaccine for HIV within 10 years. Many of us in...
In May 1997, President Bill Clinton set a deadline for the scientific community to find a vaccine for HIV within 10 years. Many of us in that community felt like we were personally called to take on this challenge.
Regrettably, we didn’t get there; there is no fully licensed, safe vaccine to prevent HIV.
But did we completely fail? I would argue, “No, we did not.” My fear, however, is that the public will perceive failure and, even worse, will believe that there is no hope for an HIV vaccine.
In truth, our battle against AIDS will be won only through a long-term partnership among scientists, government and the public, together committed to meet this difficult challenge no matter how long it takes.
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Today, a decade removed from the president’s call for action, remarkable achievements have been made. At the same time, the complexities of finding a protective vaccine have forced us to adjust to short-term goals on the path to the final one.
We have made great strides in developing a vaccine that may suppress the disease once someone contracts HIV. This requires that the vaccine turn on T cells — white blood cells that specialize in immunity — to specifically attack HIV once it enters a cell.
Ten years ago, we lacked such vaccine approaches that could stimulate this T-cell arm of immunity. Today, we have promising vaccine candidates that can do this, and trials are under way that will tell us if they are effective against HIV infection and disease.
The issue is whether the public will accept and settle for a vaccine that turns HIV into a less deadly and more manageable chronic disease, or will demand one that totally prevents someone from getting HIV. I believe that we as a society may have no choice but to accept such interim solutions in order to achieve an ultimate victory.
There’s good news and bad news. The good news is that we are closer than ever before to finding a safe vaccine that will reduce the impact of HIV infection on persons at risk. It is quite possible that evidence for such a vaccine will be available in three to five years.
But the bad news is that we still may be far away from knowing how to make a vaccine to prevent HIV, and no one can say when we will be able to do so. There are still intermediate challenges to meet and overcome, but we are closing in on this goal.
Over the past three months, the HIV Vaccine Trials Network (HVTN), which is headquartered at Fred Hutchinson Cancer Research Center, reached two major milestones. We completed full enrollment in the first large-scale study of a T-cell-based HIV vaccine. This study, called the “STEP” trial, involves about 3,000 volunteers in the Americas, including more than 100 Seattle community participants.
Additionally, the HVTN launched a second large-scale study among 3,000 volunteers in South Africa, where the HIV pandemic continues unabated.
These are major milestones. Our hope is that these trials will answer whether this vaccine can slow HIV disease and, if we’re really fortunate, prevent HIV infection in those who have engaged in high-risk activities. Additionally, the South African study is likely to tell us how the test vaccine might work in both women and men affected by that country’s predominantly heterosexual HIV epidemic. Additional large field studies around the globe are scheduled to begin this fall, fitting more pieces into the puzzle on how to prevent AIDS.
When Clinton made his challenge, he was most likely invoking the spirit of his idol, John F. Kennedy, who called on American science and industry to put a man on the moon and bring him home, within 10 years. Kennedy asked for the moon, and got it.
Clinton asked for a different moon. As a member of the research community, I was hopeful and challenged, but at the same time apprehensive. One reason for my concern was that 10 years ago, no infrastructure was in place for conducting large, multisite clinical trials throughout the world. We had to start from scratch for this gigantic mission.
Since 2000, the Hutchinson Center has proudly led the charge in establishing a global network of trial sites. Building this foundation was a huge, complex and time-consuming project, which included finding, educating and training people in rigorous scientific methods and good clinical practice in more-remote, less-advanced areas of our world. That network is now in place, and promising clinical results are coming in.
Since that challenge, our knowledge of HIV and AIDS has grown exponentially. We have a better understanding of this formidable foe, which has established itself worldwide deep within the human species. It is a “smart” virus, which not only attacks the immune system but also multiplies and remains there for a long time, increasing its chance of spreading to others through exposure.
Most daunting, and making the search for a vaccine even more demanding, is that HIV is not just one single strain of virus; there are multiple strains that change and adapt quickly within the host.
For all these reasons, finding a “magic bullet” vaccine that can stimulate antibodies, in addition to T cells, to recognize and attack all strains of HIV remains the toughest problem to solve. One of the most significant aspects of the recent South African vaccine trial is that it lays the groundwork for a potential universal HIV vaccine that recognizes and prevents multiple strains of the virus.
Partisan participant that I am, I believe that based on what we have already done and where we are going, we will reach our goal. We simply cannot do it alone.
Kennedy’s challenge was met with the full financial support of the government and big business. Clinton’s challenge has, to date, met with a far different fate. Federal money for research has declined dramatically and precipitously in the past decade.
While we can debate the value of the war on terror, the facts are that it has pulled vast sums of money away from vital research across all disciplines. Replacing and increasing those resources will take a combined push from the private sector. A call must go out to congressional representatives to increase funding and to private citizens to donate directly to research centers that are tackling this continuing global threat to mankind.
Ten years ago, a challenge was delivered. Now, as we are finally closing in on the decisive battle with this treacherous killer that has penetrated into all corners of civilization, all of us — the scientific community, the government and individuals — must combine forces in the struggle. The ultimate challenge must come from within our ranks. We can do this. Together.
Dr. Julie McElrath is director of the HIV Vaccine Trials Network laboratory program; a member of the Clinical Research Division, Fred Hutchinson Cancer Research Center; principal investigator of the FHCRC/UW HIV Vaccine Trials Unit (206-667-2300); associate head of the Program in Infectious Diseases, Fred Hutchinson Cancer Research Center; and a professor of medicine at the University of Washington.