Opinions on HIV vaccine research

I’ve got three opinion pieces here, which I’m just going to link to and comment on briefly.

New York Times — Letter to the Editor (July 25)
San Francisco Chronicle (July 28)
International Herald Tribune (July 30)

>>New York Times — Letter to the Editor (July 25)
By former director of the White House Office of AIDS Policy, Joseph O’Neill

Key quote:

The sector most adept at developing vaccines, our biotechnology and research-based pharmaceutical companies, have remained largely on the sidelines.

Hope of return on investment that would have motivated an all-out effort has been eroded by years of popular activism and sanctions (based on a belief that profit derived from AIDS research is immoral) and overreliance on the academy’s ability to develop practical solutions to health problems.

O’Neill thinks the search for an HIV vaccine should take full advantage of the profit motive and get drug companies more involved.  But whether you think “profit derived from AIDS research is immoral” or not, there’s a lot of evidence out there to suggest that, taken as a whole, the pharmaceutical industry is often more motivated by profit than by the prospect of saving lives.

When it comes to pricing AIDS drugs, we’ve seen one scandalous episode after another — only relatively recently have ARVs begun to become somewhat more affordable in the developing countries where they are most needed, and (with some exceptions) the pharmaceutical industry has been kicking and screaming the whole way.  (For a recent example of a drug company’s unsavory approach to supplying HIV meds in North America, see this article on a recent antitrust suit.)  O’Neill may be right that drug companies can and should be more engaged in HIV vaccine research.  But to allow the process to be completely driven by the search for corporate profit could be disastrous.


>>San Francisco Chronicle (July 28)

Key quote:

A vaccine remains frustratingly distant. For starters, the federal initiative must continue. That means a larger budget for the National Institutes of Health, the central research agency behind the AIDS vaccine. Private biotech firms remain leery of heavy investments in a vaccine that could be quickly copied by rivals or face heavy public pressure to limit prices.  [Emphasis added.]

That’s depressing.  And I think it’s Exhibit A for O’Neill.


>>International Herald Tribune (July 30)
By Laurie Garrett

Key quote:

In a few days some 20,000 people who work in various capacities on the AIDS pandemic will gather in Mexico City for the International AIDS Conference. I will not be there: This will mark the first AIDS Conference I have deliberately missed since 1985, when a cluster of scientists convened the first such gathering in Atlanta.

Many of the leading lights in the battle against AIDS from all over the world are similarly disinclined to attend, saying they are not able to join in celebrating the creation of a vast, multibillion dollar AIDS treatment industry, employing hundreds of thousands of individuals worldwide that serve as a vested lobby on behalf of a prolonged medical approach to a virus that ought to be eliminated entirely from the pantheon of threats to Humanity.

Um, isn’t that a little . . . well, harsh?  I’m not going to argue that everyone involved in the International AIDS Conference (and/or AIDS advocacy in general) is a perfectly unselfish angel — far from it.  But I don’t think it’s fair to accuse the AIDS community en masse of somehow avoiding the discovery of a vaccine so that they can benefit from a long, drawn-out pandemic.

Garrett may be right that vaccine research gets a short shrift, I really don’t know.  She’s certainly not the first to warn about the danger of pursuing treatment to the detriment of prevention efforts.  But isn’t she forgetting about prevention strategies other than vaccine development?  She mentions PEPFAR’s heavy focus on treatment: that emphasis was actually opposed by a large coalition of AIDS organizations.  It ended up being added to the final legislation largely because a few US Senators refused to let the bill go forward unless it included the treatment provision.

There are many, many HIV/AIDS activists, policymakers, and health workers who undoubtedly care just as much about prevention as Garrett does.  But most of them aren’t able to focus much on the end goal of a vaccine: they’re too busy trying to deal with the situation as it exists on the ground.  No matter how well-funded vaccine research is, it will take time.  (Not to mention the inevitable — and likely very substantial — lag time between the development of a vaccine and its universal application.)

If some of the 20,000 people attending the International AIDS Conference are a little short-sighted, I think they can be forgiven.  I agree with Garrett that the best possible thing for the AIDS pandemic would be its definitive elimination “from the pantheon of threats to Humanity.”  I hope to see that day.  But in the meantime, like it or not, millions of people around the world have no choice but to live in the present, where an HIV vaccine is a matter of “if/when.”


~ by h.e.g. on August 2, 2008.

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