HIV/AIDS Vaccine Experts Discuss Hopes and Fears for the Future of Vaccine Development

Executive Editor

Myles is the editorial director of and

Before AIDS 2010 had even officially begun, some of the luminaries in the HIV/AIDS vaccine field gathered to talk about how bright and bubbly the future looks for vaccine development.

All right, it wasn't quite that simple.

To be sure, there was a considerable amount of cheerleading during the July 18 satellite session entitled "The Search for an HIV Vaccine: Where Are We, Where Are We Going, and How Can We Get There Faster?" (Watch a video of the session below, courtesy of the Henry J. Kaiser Family Foundation.) But there was also plenty of sober reflection. After all, we are just a few years removed from one of the greatest failures in the history of HIV vaccine development -- one that left many in the field wondering whether there even was a future for HIV vaccines. You don't go from death to rebirth that quickly unless you're in the Bible.

Nonetheless, as low as things got for HIV vaccine advocates when the STEP trial failed, many did not give up hope. Those stalwart defenders no doubt felt a sense of victory -- and relief -- when results of the RV144 "Thai" trial were announced last year. Those findings marked the first time a major HIV vaccine study had not ended in failure (thus rendering it a smashing success by comparison). And, as former UNAIDS director Peter Piot put it during the satellite session, it "put vaccine development back on the world map." Alan Bernstein, the executive director of the Global HIV Vaccine Enterprise, put it even more starkly: "The last 18 months has been the richest period of vaccine research since the epidemic began."

But this whiplash-inducing change in the vaccine climate has left the field in a precarious position: There's suddenly a lot of excitement, but apparently not a lot of unified direction. Throughout the satellite session, speaker after speaker (11 of them crammed into a two-hour block) expressed a need for better communication and coordination among the considerable number of companies, groups, organizations and scientists involved in vaccine research. (More than two dozen vaccine candidates are in various stages of development right now, many of which work in very different ways.) What types of vaccines are most worth pursuing? How effective should vaccines aim to be? (100% protection against all strains of HIV? Something more realistic, like partial protection? High protection when used with other methods, like microbicides?)

It's an important set of questions to answer. When antiretroviral research really hit its stride around a decade ago, it revolved around one core concept: creating drugs that disrupted HIV's ability to make more copies of itself. That mission helped research become more focused; made collaboration and discussion easier; and gave drug companies a cohesive idea to throw their money behind.

Vaccine research doesn't appear to have that right now. In fact, even within this satellite session, speakers sometimes seemed directly at odds with one another when talking about directions for moving forward. Mark Feinberg, M.D., urged vaccine developers to be more specific about their ideas in order to increase the chances a drug company would fund their research; however, a number of other speakers urged drug companies to do more to help them get more specific about their ideas. Robin Shattock, of St. George's Hospital Medical School in London, said too many trials were being done in primates before moving on to humans, since many primate studies with good results ended up falling apart when they were done in humans; however, Alan Bernstein said that primate studies had a massive amount of potential that wasn't being utilized.

There seemed to be general agreement that major human studies of vaccines have been far too slow in coming and far too conservative in their approach (there have been just four human clinical trials of vaccines in the past 30 years). But not a ton of agreement about what to actually do about that.

So we find ourselves at a crossroads. HIV vaccine research appears reborn, a vibrant and exciting field once again. But does the field have the ability to find a tighter focus and a more specific mission, or will it continue to be a Tower of Babel populated by a gaggle of competing interests?

This satellite session was organized by five different vaccine advocacy organizations (most sessions are organized by just one or two). While these groups may generally play well together, they also each have their own missions and their own causes to promote. They've united under the umbrella of the Global HIV Vaccine Enterprise to produce a report on the state of HIV vaccine research -- the report was released today. Perhaps it is a start of a more unified approach to vaccine development that can bring us more success over the decade to come (there appeared to be agreement among the speakers that we are at least that far away from developing an effective vaccine). Time will tell.

Here is Kaiser's video footage of the satellite session:

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